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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5990
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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I've been missing four teeth (all my molars) on the lower left

Customer Question

I've been missing four teeth (all my molars) on the lower left side of my mouth for five years. During the last five years, the bone has shrunk. My face is no longer symmetrical because of the bone loss. I'm looking into dental implants and hope to begin the process in August. I know I'll need bone grafts, probably large ones. My questions to you:
1) Will bone grafting and eventual implants restore my jaw line on the left side of my face so that it matches the right side? If not, what procedure will restore my jaw line and improve my facial esthetics? Would this be a ridge augmentation?
2) What kind of bone (cadaver, bovine, etc.) is used for large grafts?
Submitted: 1 year ago.
Category: Dental
Expert:  Michelle-mod replied 1 year ago.
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Expert:  Mark Bornfeld, DDS replied 1 year ago.
Hello-- I'm Mark Bornfeld, DDS. Welcome, and thank you for putting your trust in me!
"I've been missing four teeth (all my molars) on the lower left side of my mouth for five years...My face is no longer symmetrical because of the bone loss."
With due respect, although I will not dispute that you've lost bone and your face lacks symmetry, you have almost certainly drawn an incorrect connection between your presumed cause and effect. (Please note that I am assuming that the only teeth you've lost are the four lower left molars, which implies that the height of your bite is being maintained by a the remaining teeth. If your bite has collapsed due to the loss of other teeth, what follows does not apply.)
In other words, it is something OTHER than the loss of your mandibular (lower) teeth and bone that is the reason for asymmetry. The only part of the lower jaw that influences facial contour is the so-called "basal" bone--the part of the jaw that is below the alveolar process (the bone around the teeth), so the loss of lower molars and that alveolar process would not be expected to visibly alter facial contour. The scaffold of the facial tissues is formed by the front teeth, the cheek bones (zygoma and zygomatic process of the temporal bone), the basilar parts of the mandible, and to a smaller degree, the upper posterior teeth. Because the lower posterior teeth and their associated alveolar bone lie medial to the upper molars, they contribute nothing to facial support.
"1) Will bone grafting and eventual implants restore my jaw line on the left side of my face so that it matches the right side? If not, what procedure will restore my jaw line and improve my facial esthetics? Would this be a ridge augmentation?"
For the reasons I stated, grafting and implantation of the mandibular molar area will NOT restore facial contour. The precise approach to correction of asymmetry would require an assessment of the location and cause. For example, if there has been loss of subcutaneous fat in some areas, an injection of a dermal filler by a dermatologist or a plastic surgeon might be appropriate. In some patients, there is asymmetry due to enlargement of one of the masseter muscles (the large muscles at the angle of the lower jaw), and some plastic surgeons or oral surgeons are injecting small amounts of botulinum toxin (BOTOX) periodically to shrink the enlarged muscle. In other words, the treatment must fit the condition, and a proper evaluation would be required to determine the most appropriate methodology.
"2) What kind of bone (cadaver, bovine, etc.) is used for large grafts?"
The largest grafts are made from "autologous bone"-- i.e., bone harvested from the same patient (i.e., donor and recipient are the same person). Obviously, this has one big drawback (two surgical sites rather than just one), but it addresses the tendency of other types of large grafts to fail. Smaller grafts are usually decided by the surgeon and his training and familiarity with the various products, and there is no clear advantage of one over the other (allografts, zenografts), although synthetics tend not to be as successful.
Hope this helps...