Onlay Block Grafting
When there is inadequate volume of bone (either width or height), an onlay block graft can be used to secure a solid block of bone obtained from either the back of the lower jaw or the chin area to the area where the future implant will be placed. The block is secured with temporary screws and allowed to heal for six to nine months prior to placement of implants, at which time the screws will be removed. This clinical scenario is ideal in younger patients with congenitally missing teeth and retained wisdom teeth. The block graft can be obtained from the site of the wisdom teeth and repositioned to the site of the future implants. This essentially combines two surgeries into one with an extremely predictable result.
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The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants in the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and second premolar. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), usually other less aggressive options are considered first.