Severe jaw bone resorption years after a teen-aged car accident left Edna with receding gums and tooth loss. INFUSE® Bone Graft helped rebuild Edna's jaw bone density in preparation for dental implants, restoring her confidence and "great big smile."
In 1995, Edna was in a serious car accident that badly injured the right side of her face. Her jaw was shattered, she lost several teeth and many of those that remained were broken or otherwise damaged, as well. At the time, the primary focus of her treatment was to repair her jaw and restore her mouth's normal appearance and function.
"I was 18 and just about to start college, so the main goal was to give me a mouth that looked good and worked properly," she says. Her treatment included multiple root canals and veneers, which are wafer-thin porcelain shells that are bonded to the front side of the teeth. "But this was basically just a band-aid, and I was told I'd need more work done down the road. My doctor explained he didn't feel it was in my best interest to do anything more at the time because in 10 years or so there would most likely be new technology available to help me that was not around then."
Fortunately for Edna, her doctor was right.
In 2005—or as Edna puts it, "almost 10 years to the day"—after her accident, Edna noticed that her gums were receding, leaving the roots of some of her teeth exposed. "I tried all kinds of things—changing my toothpaste, using a different toothbrush - to try and get my gums to grow back," she says. "But nothing worked. So I finally went to my dentist, who found that in addition to losing my gums, I had also lost a significant amount of bone in my jaw."
Jaw bone loss may be a common occurrence in people whose teeth have been extracted or, as in Edna's case, knocked out. Natural teeth are embedded in the bones of the jaw and attached via a root structure. Activities such as biting and chewing stimulate the root structure, which in turn stimulates the bone material the root is attached to. When teeth are missing, the bone no longer receives this physical stimulation and starts to resorb, or break down.
Dental prostheses, such as Edna's veneers, also may cause the bone to break down. As a result of her accident, Edna had lost one of the back molars on the right side of her upper jaw, or maxilla. Because of their location and broad surface area, molars are very important for normal mouth function, so Edna's missing teeth were replaced by the veneers. "Over time, I 'chewed' away the area of bone above these veneers," she says. "And my doctor explained to me that when you have veneers rubbing on natural teeth, this exerts too much pressure on the bone and it begins to resorb away."
Over time, bone resorption in the jaw may result in pain, problems with the remaining teeth and gums, changes in facial appearance and difficulties when speaking and eating. Edna couldn't bear to chew on that side of her mouth because her gums were sore and irritated and her teeth were very sensitive to hot and cold. Headaches woke her up in the middle of the night. "I was in a whole lot of pain," she says.
Because her receding gums emphasized the gap where her molar used to be, Edna also became very unhappy with her appearance. "I'm a big smiler, and I used to have this big, toothy grin," she says. "But I became really self-conscious about not smiling too wide, because I didn't want anyone to see that big hole in the back of my mouth."
Realizing the dental "band-aid" she'd been living with for more than a decade was now just making her miserable and it was finally time for more permanent oral restoration, Edna met with periodontist Dr. James L. Madigan, DDS, of Knoxville, TN, who recommended dental implants. Dental implants typically consist of tiny metal posts implanted into the bony tissue beneath the gumline, with a natural-looking, artificial tooth fastened on top once the post has successfully bonded with the bone. However, because implants require a sufficient amount of bone to anchor them in place, Dr. Madigan determined the first step in Edna's treatment plan would be to increase the bone mass in the portion of Edna's upper jaw that anchors her teeth—the alveolar bone—with bone grafts, which not only fill the void the bone but also promote bone growth.
When Edna and Dr. Madigan discussed which type of bone graft to use, she was reminded of just how accurate her previous doctor's predictions had been regarding the potential for new technology in the future.
Based on a thorough examination of her condition and her overall general health, Dr. Madigan recommended INFUSE® Bone Graft, which contains a manufactured bone graft material that may now be used as an alternative to autograft (bone from the patient's own body) or allograft (bone from a donor) in certain oral/maxillofacial procedures. The active ingredient in INFUSE® Bone Graft is recombinant human bone morphogenetic protein 2 (rhBMP-2), a man-made version of a natural protein normally found in small quantities in the body. Among the benefits of INFUSE® Bone Graft is that it offers the same bone-regenerating properties as autograft while eliminating the additional surgical procedure that's required to harvest bone from the patient's own body. Learn more about bone morphogenetic proteins (BMPs).
"Knowing this was a product that would use my own cells to grow bone really gave me peace of mind," says Edna, who, as a sales representative in Medtronic's Biologics Technologies department, was impressed with the use of INFUSE® Bone Graft in spinal and long bone applications as well as the clinical trials for oral/maxillofacial use. "I think the technology is amazing. It stimulates your body's own bone-producing mechanism, and it eliminates the risk that comes with that second procedure, which is something you just don't think about until it happens to you."
To place the INFUSE® Bone Graft, Dr.Madigan performed a ridge augmentation, which involved placing the product directly into the bone of the alveolar ridge - the bony ridge of the gumline that anchors the teeth in the upper jaw - to increase bone mass and help restore the natural contours of the gums and jaw.
Edna's surgery was performed in Dr. Madigan's office, with Edna under both a local anesthetic and oral sedation. She says the aftermath was surprisingly pain-free, except for a little spot in the roof of her mouth where a small skin graft was taken to cover an incision. "My surgery was done on a Friday; the following Monday I was in Memphis for a training class," Edna says. "There was hardly any swelling, and my soft tissues seemed to heal really fast."
Within six months – the typical waiting period for graft healing and new bone growth - Edna was ready for the installation of her dental implant post. During her post implant procedure, Dr. Madigan discovered Edna also was lacking sufficient bone in the floor of her sinus cavity, so he performed a sinus augmentation, which involved placing the product above the alveolar ridge of Edna's maxilla to promote bone growth and thicken the sinus floor.
Two months later, Edna was ready for her new, artificial molar. "They made a lot of impressions of my mouth to get the tooth just right," she says. "It was so easy–when the tooth was ready they just screwed it on the post and I was done!"
Although the process took more than eight months to complete, Edna is thrilled with her results. "This has given me back my confidence," she says. "If I had not had these procedures done, I would have left myself open to a lot of distortion in my appearance. The shape of my mouth was already starting to change, and it was affecting the way I smiled and related to those around me. Now I don't have that problem anymore.
"I'm smiling my big smile again, and I'm so much happier. I've got all my teeth!"
INFUSE® Bone Graft is not appropriate for all patients. Be sure to read the complete indications and important safety information.
Important Safety Information
There are no adequate and well-controlled studies in human pregnant women. In an experimental rabbit study, rhBMP-2 has been shown to elicit antibodies that are capable of crossing the placenta. In clinical studies, seven pregnancies, in six women, were reported. Four pregnancies were reported in the rhBMP-2/ACS group and three pregnancies in the autogenous bone graft group. All of these pregnancies resulted in the birth of healthy babies except one in which the patient elected to terminate pregnancy for reasons unrelated to her participation in the clinical study.
Women of child bearing potential should be warned by their surgeon of potential risk to a fetus and informed of other possible dental treatments. The safety and effectiveness of this device has not been established in nursing mothers. Women of child-bearing potential should be advised to not become pregnant for one year following treatment with this device.
One of the most frequent adverse events reported during clinical studies for both the INFUSE® Bone Graft treatment group and the autogenous bone graft group was facial edema. Although not statistically significant, facial edema is greater in the INFUSE® Bone Graft group and is most likely due to the recruitment of fluid and cells into the
For more information, please click here for links to the INFUSE® Bone Graft (rh-BMP-2/ACS) Patient Education Brochure and related Important Safety Information.
It is important that you discuss the potential risks, complications, and benefits of INFUSE® Bone Graft with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.
After reading this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, or nerve damage are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.