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Long Island Bone and Periodontal Gum Tissue Grafting

Many routine dental surgeries can involve or require special procedures to replace or restore gum tissues that have been lost to disease, trauma, birth defects or other common causes of gum recession.

Bone grafting procedures are used for similar reasons but play a larger role in the reconstructive procedures our patients want for restoring or replacing anywhere from a single tooth to a complete arch of new teeth.

Jawbone Augmentation Principles

The most common use of bone grafts is to replace bone that has been lost due to gum disease or periodontitis. The extended use of dentures can cause significant wear on bone height and mass.

Untreated tooth extractions will also cause bone loss which can affect the bone quality of adjacent tooth structures. The loss of bone can sometimes occur during the extraction, where tooth roots are difficult to remove. A more seemingly benign loss of bone occurs as an untreated extraction site slowly resorbs.

Bone Regeneration Goals - Treatment Specific

Bone grafting is used by Dr. Koeppel to replace, build up (augmentation) or fortify any given area of a jawbone (sometimes the entire arch) for the purpose of providing support and healthy bone mass that becomes the foundation for:
Allograft Bone Block
Allograft Bone Block (reconstructive)
  • one or several individual tooth replacements
  • implant anchors for a fixed bridge
  • specialized All-On-Four treatment
  • Nobel Biocare Teeth In An Hour protocol
  • use of hybrid denture prosthetics

Bone Sources

The types of bone material used for grafting falls into 3 groups:
  1. Autogenous - bone taken from one area of the patient and placed into an area requiring such grafting (chin block, ramus)
    2. Allograft Bone Block
    Pulverized Bone Matrix
  2. Allograft - either synthetic bone or bone from a bone bank (injectable bone graft products for sinus lift, socket grafts, cadaver bone for jawbone augmentation)
  3. Xenograft - bovine / cow bone for augmenting height, width

Gum Tissue Grafts and Regeneration Goals

Soft tissue grafting is used to replace, repair or augment tissues necessary for maintaining and protecting bone health and root structures of one or more teeth. A common use of gum grafts is to treat gum recession. Periodontal grafting is routinely used for:
  • replacing lost, receded gums
  • replace tissues removed during treatment of apthous ulcers
    • Puros Pericardium Membrane Long Island
    Pericardium Tissue Membrane
  • augment tissue for completing socket grafts
  • replace infected or traumatized tissues
  • augment gum tissues in autogenous and allograft bone grafts (chin block, ramus, donor bone) commonly used in jawbone rehabilitation

Periodontal Tissue Sources

The types of material used for grafting falls into 3 groups:
  1. Autogenous - harvested tissue (e.g., roof of mouth)
    2. Harvested Perio Tissue
    Harvested Tissue from Palate
  2. Collagen membranes - some types optimized for ridge augmentation
  3. Allograft tissue matrix - high regenerative properites - ideal for wound stabilization, increasing volume of gingiva and connective tissue, covering block grafts
To assure the highest level of predictability and long term endurance of graft procedures, Dr. Koeppel prefers using autogenous bone, where the patient provides the needed material. Autogenous grafts are the healthiest and fastest healing grafts (no foreign tissues).

In many instances, Dr. Koeppel will additionally use a pulverized bone product (can be synthetic or specially prepared [crushed] patient bone) to fill or pack a surgery site. Platelete Rich Plasma (PRP) may also be used to accelerate healing (also derived from patient) along with specialized membranes (Ossix) to further optimize tissue regeneration.

Severe Resorption - Mandibular - Maxillary

The advancements in 3-D Imaging (catscans) enables Dr. Koeppel to provide grafting opportunities for patients that would have been impossible just a few years ago. Areas considered quite critical can now be treated with unsurpassed accuracy which, for many patients, can eliminate the possibility of being permanently toothless.

Many patients who were being told there was no hope for successful bone grafts due perhaps to long term denture use, excessive tooth extractions or gum disease are discovering there may be opportunities for Dr. Koeppel to use cumulative grafting procedures that can effectively rebuild bone that has been missing for years.

3 Dimensional Cone Beam imaging provides the diagnostic and treatment possibilities that can emerge when Dr. Koeppel creatively combines the use of autogenous bone grafts, bone matrix products, PRP and barrier membranes to create needed tissues.

Patient age is not a primary factor for bone regeneration. Rather, overall general health conditions and the existence of poor oral health (active disease) are the primary considerations for determining if bone graft surgeries can be used for any given patient.

Nobel Biocare Treatment Hybrids

Bone Quantity Chicago
Density Range: D1 (most) to D4 (less)
Bone density and porosity varies significantly for every patient. Certain areas and quadrants of our upper and lower jaws have different values of bone quality and wear (or resorb) differently.

Dr. Koeppel's use of cone beam diagnostic equipment enables him to locate and prepare the best surgery sites for bone regeneration. In complex cases, specific implant sites (not the entire jaw) can be prepared to accommodate one of several choices for replacing an entire arch of teeth.

Customized implant supported dentures, All-On-Four, Teeth-In-An-Hour and Procera Implant Bridges (PIB) fabricated from milled titanium can be used for some patients.

Best Candidate Questions

What determines whether one graft procedure is better than another or if candidacy is even a possibility is entirely dependent upon current oral health conditions, treatment histories and patient compliance issues (yes, patients can cause their own failures).

Call our office at (631) 689-9777 to arrange a consult with Dr. Koeppel to learn more about bone growth technologies and how they can create new tooth replacement choices. You can also use our Consult Request form to arrange an appointment.

Patients seeking specific answers or information related to the material on this page can also choose to contact Dr. Koeppel directly with our Ask The Dentist form. Dr. Koeppel will reply to you directly with the information you are seeking.




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New York Reconstructive Dentist
Ira Koeppel, D.D.S.
126 Gnarled Hollow Road
East Setauket Long Island New York NY 11733
(631) 689-9777
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