September 2008 - QualityPlant newsletter
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For a free consultation in London contact QualityPlant's office:
via e-mail: info@qualityplant.co.uk or
via phone: 00-36-12763179
UK landline: +44 (0)2072722 585
Bone augmentation
 For dental implants to be successful, the jawbone must have enough bone to support them. You may not have enough bone because of tooth loss from periodontal (gum) disease, injury or trauma, a developmental defect or tooth extraction. If a tooth is extracted and no bone augmentation is accomplished you can expect at least 30-60% bone loss within 6 months around the extraction socket. You can also expect at least 1mm loss of vertical bone height. If your jaw is too short (up and down), too narrow (side to side), or both, you will need a procedure to add bone to your jaw before implants can be placed.
Bone augmentation is a term that is used to describe a variety of procedures that are used to "build" bone so that dental implants can be placed. These procedures typically involve grafting (adding) bone or bonelike materials to the jaw, and waiting for the grafted material to fuse with the existing bone over several months. Fortunately we can solve any problem due to bone loss and we do not know the phrase "you can not have an implant because of your bone status" any more!
 Most of the time we put an implant in at the same time as bone augmentation. The healing time is 6-9 months. There are fortunately only very few cases when the jaw is so destroyed that the augmentation and implantation cannot be done at the same time. After 6 months' healing time we insert implants which heal about 3 more months.
Typical Bone-Augmentation Procedures
1. The most frequent case is that we need to build bony walls around the inserted implant or expand the jaw in the implanted area because of earlier bone loss due to long time of edentolousness or too heavy extraction procedure. This time the bone comes from the implant site and the surrounding areas.
2. In addition to bone grafting, many other types of procedures can be used to build bone so that implants can be placed.
One type of bone-augmentation procedure, called a sinus lift (or elevation), increases the height of your upper jaw by filling part of your maxillary sinus (the area above your jaw on either side of your nose) with bone. This is done when there is not enough bone to allow implants to be placed in the back part of the upper jaw. If we need to do sinus lifting it is 95% sure that we are able to insert implants immediately and the healing time is about 6-9 months.
3. There are fortunately very few cases when we need to do major bone augmentation mostly in the upper frontal areas sometimes added to the earlier described sinus grafting technique. In this case we gain bone from the region of the ramus or the chin and we fix it to the recipient zone. In this situation however we do not place the implant immediately only after 6 months' healing time.
Where Does the Bone Come From?
Most bone-augmentation procedures involve the use of bone grafts. The best material for a bone graft is your own bone, which most likely will come from the implant site, or the area, where we work actually or your ramus (the back part of your lower jaw) or chin.
If you don't like the idea of having bone removed from your body to be placed in your jaw, there are other options available to you. There are synthetic materials that can be used for bone grafting. While most dentists prefer using a person's own bone because of growth factors found in your own bone, possibly in combination with other materials, the choice is yours.
There are generally four types of materials used for bone augmentation:
AUTOGRAFTS are those where bone is taken from the donor site in your own body and placed in the recipient site.
ALLOGRAFTS are taken from human donors. Many countries have donor programmes where you can specify in the event of your death, that parts may be harvested from your body to save or improve the life of others. Heart transplants are an obvious example. Bone obtained in this manner undergoes rigorous tests and sterilisation. Your body converts this bone into your natural bone thereby rebuilding the defect.
XENOGRAFTS (BioOss, Cerabone) are harvested from animals. The animal bone, most commonly bovine (cow), is specially processed to make it biocompatible and sterile. It acts like a filler which your body initially uses like a scaffold to build new bone on and then in time converts the xenograft material to your own bone. This is a very easy system to use as the "replacement bone" comes out of a bottle.
ALLOPLASTIC grafts are inert, man made synthetic materials that mimic natural bone. They are usually a form of calcium phosphate and can be either resorbable or non-resorbable. They are again very easy to use as they come in a bottle, and work in very much the same way as Xenografts.
Success of Bone Grafting
The success rate for bone grafts in the jaws for the purpose of placing dental implants is very high. However, there is always a chance that the bone graft will fail, even if your own bone was used. Bone grafts are not rejected like organ transplants. When they fail, it is usually because of an infection or because the grafted bone wasn't stabilized and has come loose from your jaw. Dentists don't know why some bone grafts fail, but they do know that certain people - such as those who smoke and those with certain medical conditions - have a higher risk of graft failure than others. A failed graft will be removed. Once the area has healed, dentist can place a second graft.
How to Avoid Bone Augmentation?
In some cases however, bone augmentation can be avoided by using the so called Nobelguide system. NobelGuide is a revolutionary treatment planning  and surgical implementation system, enabling you to transfer extra-oral planning into the mouth with unrivalled accuracy and ease. NobelGuide is a total system concept. This will provide the clinicians, both surgical and restorative specialists, to work through an immediate loading treatment together, from downloading and converting the CT data to fabrication of the surgical guide made in Sweden to fabrication of the permanent restoration with CAD/CAM planning to delivery of restoration to your patient for immediate function. The well-fitting components and accuracy afforded the surgeon through the CT data permits an effortless and very precise surgery that minimizes the time and trauma for the patient. The new technology permits avoiding half of the prior bone augmentations, minimally invasive surgery using a flapless approach without any postoperative complaint, for example pain, bleeding or swelling and may be used with any clinical situation, from the completely or partially edentulous arch to the single missing tooth. The fixed denture can be more beautiful without healing time at all.
We would be pleased to take care of your problem and plan your individual pain-free implantation and bone augmentation procedure step by step.
Harvest Time
It's a time of joy and stress: joy because the grapes have grown to maturity and stress because they must be picked just at their peak to make the best wines. Harvest time is a beautiful season to visit Hungary; the vines are heavy with bunches of juicy grapes and multi-colored leaves, there's excitement in the air, and festive events to empty the old casks and celebrate the harvest far and wide.
 The exact time of the harvest depends on the type of grape, its ultimate use, and the weather. Some grape varieties mature early in the season, some later. Special late harvest products such as Icewine (or Eiswein) require fruit that has stayed on the vine through the first frost. The harvest can begin as early as August and last into November, depending on the region. However, it usually takes place in September, and lasts from days to weeks, depending on the size of the crop. If the weather starts to cool or threaten rain, picking has to start with little notice. So if you are planning your visit to Hungary and want to see the grape harvest, it's best to remain flexible!
The harvest parades are spectacular events with decades of traditions. Grape pickers wear traditional dress and ride through town on horse-drawn carts. The procession through the streets is joined by the whole population of the town in various fun and fancy dress, representing old and young. Crafts, wine tasting, and fireworks displays add to the excitement.
Our dental implant centres are situated in lovely provincial towns in Hungary: in Szekszárd and Sopron. Both are famous for its excellent wine growing regions.
Szekszárd
 Who will not know the Trout-quintet of Schubert? But do you know that the composer was inspired to write this piece by the red wine of Szekszárd? Franz Liszt tasted the wine visiting Szekszárd several times; he presented even Pope Pius IX with it in 1865 who wrote the following appreciative words about it: "this wine of Szekszárd preserves my health and unbroken spirit." Zoltán Kodály wrote his musical comedy, János Háry from the sources of the tradition from here. There can be no doubt about the inspiring force of the wine of Szekszárd. Vine varieties, wines: Kadarka - old, famous variety. By today it has become a rarity but its resettlement has already started. Kékfrankos - rich fragrance, harmonious, full-bodied, high tannin contents. Cabernet Sauvignon, Cabernet Franc - fine, characteristic fragrance and bouquet, fiery, velvety. White wine is made of the varieties Chardonnay and Italian Riesling; they are full and rich in aroma. The Bikavér (Bull`s Blood) of Szekszárd is of ancient origin, it is made of 2-3 red wines. Alongside Eger only Szekszárd was entitled to use the name Bull`s Blood.
Sopron
 The wine region Sopron is one of the most ancient wine growing regions of the country. Grape seed finds prove that already the Celts dealt here with vine growing. Vine growing has been performed in this region since then. In the Sopron area, in contrast to the other North-Transdanubian wine regions, red wine production is dominating. Almost everyone had a vineyard and a cellar, and nearly every farmer here had the wine licence. A fresh pine-bough hanging from a b ar indicated that new wine and a bundle of straw that aged wine was sold. A red or white ribbon showed that the farmer was selling red or white wine. This nice custom is reviving in the streets of Sopron. Vine varieties, wines: the red wines made here have their own character while white wines have high acid level. By now the Soproni Kékfrankos is retrieving its good old reputation. Vinegrape varieties in the region are: Kékfrankos, Zweigelt, Merlot, Cabernet Franc, Portugieser (Kékoportó) and the early Piros Veltelini, Chardonnay, Tramini and Zöld Veltelini that you can see as oddities.
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