Tooth loss isn’t just a functional concern—it can significantly affect your facial appearance. Without the stimulation from tooth roots, the supporting bone begins to shrink, leading to sunken cheeks, collapsed lips, and a softened jawline. These changes often make patients look older than they are.
At our Berkeley, CA practice, Dr. Keith Chertok offers advanced solutions like bone grafting, ridge augmentation, and sinus lifts to rebuild lost bone and restore your natural facial contours. These procedures help support dental implants, improve aesthetics, and reverse the visible effects of bone loss—bringing back both function and confidence.
Bone loss in the jaw occurs when one or more teeth have been lost due to gum disease, tooth decay, trauma to the mouth, or injury to the jaw area. If you do not have a tooth in place to stimulate the jawbone, the bone can begin to deteriorate.
The jawbone starts to deteriorate when there is no tooth to stimulate the jawbone, and too much bone loss means there is not enough bone available to support dental implants. Dr. Chertok may recommend a bone grafting procedure to restore lost bone and prepare the site for dental implants.
The procedure is typically performed under local anesthesia and may involve removing some of the bone and bone marrow for the transplant. Bone marrow and bone grafting material are placed around the grafting site to speed up the healing process, and the site is secured with sutures. Patients may need to take antibiotics and pain medication post-procedure.
Patients who have lost teeth in the upper premolar or molar areas of the jaw often require a sinus lift, or sinus augmentation, in order to have dental implants placed. This can be due to circumstances in which the bone in the area where teeth are missing naturally beings to shrink or resorb over time, the roots of the teeth were originally positioned either very close to or within the sinus cavity or the vertical height of the bone is not sufficient enough to support an implant. As a result of bone loss, the sinuses can expand to occupy the empty space where the bone used to be. With insufficient bone to securely place a dental implant, a sinus lift is necessary to move the sinus away from the roots of the teeth or to create additional bone in the area.
As a result of bone loss, the sinuses can expand to occupy the empty space where the bone used to be. With insufficient bone to securely place a dental implant, a sinus lift is necessary to move the sinus away from the roots of the teeth or to create additional bone in the area.
There are two forms of sinus lift procedures. The form that you receive depends upon your individual needs and the amount of bone that is present. Your doctor will discuss your options prior to the procedure.
Before the procedure begins, a local anesthetic is administered to numb the site. In one form of the sinus lift procedure, the doctor will create a small opening in the bone to access the sinus cavity. Using a small instrument, the doctor will gently lift the sinus into a more favorable position. This procedure helps to encourage natural bone growth to fill the space created, but a bone grafting material is often placed beneath the newly raised sinus cavity along the existing bone. This grafting material will then mesh with your existing bone, thus creating more bone.
A second form of the sinus lift, or augmentation, procedure involves gaining access to the sinus cavity through an opening created in the bone. Bone is grafted to the floor of the sinus to increase bone height. The sinus is not actually lifted in this case but rather filled in a bit to increase the bone to a sufficient thickness that can support an implant.
You will usually require between four and nine months to heal completely from the sinus lift procedure before dental implants can be placed. This increase in bone will compensate for bone that has been lost or was not present, to begin with, and will allow for one or more implants to be placed. Without this procedure, some patients will not qualify for dental implants in the upper premolar or molar regions of the mouth.
When one or more teeth are extracted from the mouth, soft tissue, and bone can begin to regress or collapse. Without the tooth root to stimulate it, the surrounding jaw bone will often begin to deteriorate shortly following the loss of a tooth. If there is significant bone loss, it may be impossible to place dental implants, and may become more expensive, invasive, and time-consuming to replace the lost bone. Loss of bone can lead to depressions or unevenness within the ridge, as its form is supported by the contour of the underlying bone. Ridge (or socket) preservation is a type of bone grafting procedure that rebuilds and stabilizes bone where an extraction has left an empty socket. It is recommended to have a ridge preservation procedure performed at the time of an extraction, as it helps to promote the esthetics of the ridge and avoid bony defects.
After a tooth is removed the bone in the jaw will often begin to deteriorate and recede. The height and width of the socket, which was supported by the tooth, will begin to shrink after the tooth is removed. Many patients develop an indentation in the gums as a result of tooth loss. Augmentation restores the shape of the socket.
Ridge augmentation is a common procedure performed to help recreate the natural contour of the gums. Often, after a tooth is removed, the bone in the jaw will begin to deteriorate and recede. The height and width of the socket, which was supported by the tooth, will begin to shrink after the tooth is removed. Many patients will eventually develop an indentation in the gums where the tooth used to be as a result of tooth and bone loss.
Restoring the natural contour of the gums is not usually medically necessary. It is often recommended when a large depression or cleft exists in the gum tissues, which can trap food and bacteria. Ridge augmentation is frequently performed for aesthetic reasons, as the ridge is a very important structure in the mouth.
Another purpose of ridge augmentation is to increase the amount of gum tissue in areas of deficit for tooth replacement so that the teeth appear to rise from the gum tissues. This procedure may be necessary in order to place a dental implant. If the bone tissue has deteriorated too much, placing a dental implant may not be possible without an additional procedure.
There are two types of ridge augmentation procedures: soft tissue and hard tissue. Occasionally, both types of ridge augmentation are performed at once.
Soft tissue augmentation is usually done to improve the esthetics of the site. Prior to the procedure, the area will be numbed. An incision is made to expose the site and a soft tissue graft is then obtained either from the palate (roof of the mouth) or another source. The graft is then placed into the area in need and secured with sutures.
Hard tissue augmentation is performed to recreate adequate bone contouring prior to dental implants or other tooth replacement procedures. Prior to the procedure, the area will be numbed. An incision is made and the gum is lifted away to expose the bony defect. A bone graft obtained either from another site within the mouth or a donor source is placed in the area receiving the graft. The site is then closed with sutures. Healing time varies by patient and the size of the area repaired, but generally lasts between four and six months.
