East Brewster Dental LLC

The Perfect Blend of Technology & an Amazing Staff

Our dental office is unique in that we are able to perform additional surgical services which in many dental practices are referred out to
another dentist / specialist. Dr. Bellorini has been continuing his oral surgery training with his mentor Dr. Arun Garg, who is a world renowned clinical instructor. During this 2 year training there are 2 skill levels of tests and documented cases needed to attain a Master’s Certification and only 1% of the doctors attain this award. With 100,000 dentists currently in the United States and only 3 % are members of the International Dental Implant Association. Dr. Bellorini is proud to be a member of both groups, and has trained his staff extensively in the added materials and techniques to provide you with these expanded services below.

Sinus Lift:


5143007Your upper back teeth are located in a position such that their roots are very intimate in proximity to your sinuses. These roots act as like tent poles to prop-up the lower sinus lining (called a sinus membrane). When the back teeth are removed there is a gradual slumping of the sinus membrane down into the area where your teeth once occupied.

A sinus lift is surgery that adds bone to your upper jaw in the area of your molars and premolars – it’s sometimes called a sinus augmentation. The bone is added between your jaw and the maxillary sinuses, which are on either side of your nose. To make room for the bone, the sinus membrane has to be moved upward, or “lifted.”


What It’s Used For

A sinus lift is done when there is not enough bone height in the upper jaw, or the sinuses are too close to the jaw, for dental implants to be placed. There are several reasons for this:

  • Many people who have lost teeth in their upper jaw – particularly the back teeth, or molars – do not have enough bone for implants to be placed. Because of the anatomy of the skull, the back of the upper jaw has less bone than the lower jaw.
  • Bone may have been lost because of periodontal (gum) disease.
  • Tooth loss may have led to a loss of bone as well. Once teeth are gone, bone begins to be resorbed (absorbed back into the body). If teeth have been missing for a long time, there often is not enough bone left to place implants.
  • Tooth loss may have led to a loss of bone as well. Once teeth are gone, bone begins to be resorbed (absorbed back into the body). If teeth have been missing for a long time, there often is not enough bone left to place implants.
  • The maxillary sinus may be too close to the upper jaw for implants to be placed. The shape and the size of this sinus varies from person to person. The sinus also can get larger as you age.

Technique

Prior to undergoing sinus augmentation, diagnostics are run to determine the health of the patient’s sinuses. Panoramic radiographs are taken to map out the patients upper jaw and sinuses. In special instances, a computed tomography or CT scan is taken to measure the sinus’s height and width, and to rule out any sinus disease or pathology. Generally, the material which is used to add bone volume to the sinus floor is:

  • Autogenous bone (a bone graft, taken from elsewhere on the individual’s body, e.g. another area of the mouth or body)
  • Freeze-dried human cadaver bone (from a tissue bone bank)
  • or both.[3]
  • Platlet-rich Fibrin (PRP) -concentrated growth factors (CGFs) and autologous fibrin-rich blocks and is obtained from a small sample of the patient’s own blood

sinus

There are multiple ways to perform sinus augmentation. The procedure is performed from inside the patient’s mouth where the surgeon makes an incision into the gum. Once the incision is made, the surgeon then pulls back the gum tissue, exposing the lateral boney wall of the sinus. The surgeon then cuts a “window” to the sinus, which is covered by a thin membrane. The membrane is carefully lifted away, and bone graft material is placed into the newly created space. The bone material can be allogenic (from a tissue bank) or autogenous (taken from the patient). Synthetic materials may also be used. Clinically, it has been proven that as long as the implants “tent-up” the membrane, bone will fill the space regardless of whether graft material has been placed. The newly formed space can now be filled simply with concentrated growth factors (CGFs) and autologous fibrin-rich blocks called PRP.
yYcy6dvAs an alternative, sinus augmentation can be performed by a less invasive osteotome technique, in which the sinus membranes are lifted by gentle tapping of the sinus floor with the use of osteotomes. The amount of augmentation achieved with the osteotome technique is usually less than what can be achieved with the lateral window and is usually only for an area that has one tooth missing. The goal of this procedure is to stimulate bone growth and form a thicker sinus floor, in order to support dental implants.

Ridge Splitting:

1Jjr7QLIt has been widely accepted by dental clinicians that the utilizing of the patient’s own bone dramatically increases the success of dental implants. A patient’s bone is more porous in the upper ridge than the lower, thus can be expanded using a ridge splitting procedure. Among bone ridge widening techniques, the ridge-split procedure demonstrates many benefits, including no need for a second (donor) surgical site, rare risk of inferior alveolar nerve injury, able to place the implants at the same surgery and less pain and swelling. Lateral bone expansion through the ridge-split works best in a localized bony defect intended for 1 or 2 implants and where the ridge is vertically intact.

 

 

Ridge Spreading:

ridgespreadingLocalized ridge expansion of a deficient upper ridge segment is a useful technique when the goal of surgery is to provide an increase in ridge width to allow an adequate bone thickness capable of receiving implants. Ridge expansion is a modified ridge-splitting technique in which there is less bone expansion required than the traditional ridge-spit procedure. These modifications include full-thickness flap reflection, simultaneous incorporation of guided bone regeneration. The modifications help to decrease complications associated with the original ridge-splitting technique while increasing the predictability of ridge expansion in the horizontal direction.

 

 

Block Bone Graft:

When teeth are removed, after the first 12 months, there has been 50% bone loss in the remaining ridge .This occurs primarily in the width of the boney ridge and mostly on the outside (cheek side). When a significant amount of bone needs to be replaced to build-up the ridge before dental implants are placed usually a customized block of bone is used. Bone blocks can be made from either your own bone (usually requires a second surgical donor site) or synthetic materials .

During the first surgical procedure a gum flap is made to expose the bone, the site receiving the bone graft is prepared and then the donor block of bone is contoured to precisely fit the prepared site. The bone is tacked into place with titanium screws and covered with a collagen membrane and finally the gum flap is closed with sutures. The bone is allowed to heal for either 4-6 months before the site is ready to receive the dental implants.

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Socket Preservation:

Tooth extraction is one of the most common dental procedures. Healing of the resulting extraction socket normally occurs uneventfully. However, even with completely normal healing, there is often some resorption or melting away of the surrounding bone, resulting in less height and width that were present prior to tooth extraction. In addition, as bone resorbs the overlying gum tissue also tends to lose both volume and its normal anatomic form. These changes can occur anywhere but the most severe loss of bone and gum tissue tends to occur following removal of incisor teeth located in the front of the mouth.
1nsnm3HLoss of bone and gum tissue following tooth extraction often results in both functional and cosmetic defects. Such tissue loss often results in an unsightly collapsed appearance, especially in the front of the mouth where proper maintenance of tissue health is critical to normal esthetics. In addition, loss of bone and gum tissue often compromise the dentist’s ability to adequately replace the missing tooth or teeth with either conventional removable or fixed bridgework or with a dental implant supported restoration .Sometimes the loss of bone is so severe that additional surgical procedures are required prior to replacing the missing tooth with either a conventional or implant supported restoration.

Today, because of advances in dental surgical procedures and bioengineering, bone and gum tissue loss following tooth removal can either be greatly reduced or completely eliminated. Following removal of the tooth a specially bioengineered graft material that helps support bone formation is placed within the extraction socket. This bone graft material, with structure similar to human bone, not only supports new bone growth but also has been shown to preserve bone and overlying soft tissue following tooth removal. The bone graft material is then covered with a natural fiber material, collagen, to protect both the graft and newly forming bone as well as to help support and help guide new soft tissue growth. Together, the freeze-dried bone/collagen system helps prevent bone and gum loss following tooth removal.

Platelet-rich plasma (Abbreviated: PRP)

PRP is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains several different growth factors and other cytokines that stimulate healing of bone and soft tissue.

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Platelet Rich Plasma (PRP) is exactly what its name suggests. The substance is a by-product of blood (plasma) that is rich in platelets.

Until now, its use has been confined to the hospital setting. This was due mainly to the cost of separating the platelets from the blood (thousands) and the large amount of blood needed (one unit) to produce a suitable quantity of platelets. New technology permits the doctor to harvest and produce a sufficient quantity of platelets from only 55cc of blood drawn from the patient while they are having outpatient surgery.

Why all the excitement about PRP?
ibq6EgSPRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate. During the healing process, the body rushes many cells and cell-types to the wound in order to initiate the healing process. One of those cell types is platelets. Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. These GF (platelet derived growth factors PGDF, transforming growth factor beta TGF, and insulin-like growth factor ILGF) function to assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more growth factors released sequestered into the wound, the more stem cells stimulated to produce new host tissue. Thus, one can easily see that PRP permits the body to heal faster and more efficiently.

A subfamily of TGF, is bone morphogenic protein (BMP). BMP has been shown to induce the formation of new bone in research studies in animals and humans. This is of great significance to the surgeon who places dental implants. By adding PRP, and thus BMP, to the implant site with bone substitute particles, the implant surgeon can now grow bone more predictably and faster than ever before.

PRP has many clinical applications:

  • Bone grafting for dental implants. This includes onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures, and closure of cleft lip and palate defects. Repair of bone defects creating by removal of teeth or small cysts.
  • Repair of fistulas between the sinus cavity and mouth.

PRP also has many advantages:

  • Safety: PRP is a by-product of the patient’s own blood; therefore, disease transmission is not an issue.
  • Convenience: PRP can be generated in the doctor’s office while the patient is undergoing an outpatient surgical procedure, such as placement of dental implants.
  • Faster Healing: The super saturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and thus faster tissue regeneration.
  • Cost effectiveness: Since PRP harvesting is done with only 55cc of blood in the doctor’s office, the patient need not incur the expense of the harvesting procedure in hospital or at the blood bank.
  • Ease of use: PRP is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.

Frequently asked questions about PRP:

Is PRP safe? Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the IV. This blood is then placed in the PRP centrifuge machine and spun down. In less than 15 minutes, the PRP is formed and ready to use.

Should PRP be used in all bone grafting cases?
Not always. In some cases, there is no need for PRP. However, in the majority of cases, application of PRP to the graft will increase the final amount of bone present in addition to making the wound heal faster and more efficiently.

Can PRP be used alone to stimulate bone formation?
No. PRP must be mixed with either the patient’s bone, a bone substitute material such as demineralized freeze dried bone, or a synthetic bone product.

Are than any contradictions to PRP?
Very few. Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in office procedure. Check with your primary care physician to determine if PRP is right for you.

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Blood is drawn from your arm and placed in a special processing unit, which separates platelets, white blood cells and serum from red blood cells. The platelets and white blood cells are then concentrated and collected into a sterile syringe. Some of the blood is used to create an “activator” of the PRP. The skin and soft tissue is anesthetized with local anesthetic, followed by injection of both the PRP and activator into the tissue targeted for treatment. Depending on the size of the injured tissue, one or several needles are inserted to optimize placement of the PRP.

Research and clinical data show that PRP injections are extremely safe, with minimal risk for any adverse reaction or complication. Because PRP is produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare.

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