Brady J. Semmel DMD, MD

Map Icon1422 Commonwealth Drive, Wilmington, NC 28403

Map Icon910-509-1422
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Jawbone Health

Reasons for Jawbone Loss and Deterioration

About Bone Grafting

Ridge Augmentation

Sinus Lift

Nerve Repositioning

Socket Preservation

When teeth have been lost, the supporting bone tissue can start to be reabsorbed by the body. This can lead to misalignment and changes in the shape of the face. It can also cause problems with restoration procedures and prevent an implant from being anchored properly. To help patients who have experienced bone atrophy, our practice offers bone grafting procedures.

Bone grafting in Wilmington, North Carolina, can grow tissue onto a site that has been damaged by dental injury, tooth loss or gum disease. The grafting samples are taken either from other areas of the body or from a tissue bank. Guided tissue regeneration may also be used to help the bone grafting procedure.

There are many different dental issues that a bone grafting procedure can repair. Whether you are looking to restore bone loss due to surgery, injury, tooth loss or congenital defects, our practice can help. Depending on the patient, bone tissue may be taken from the skull, knee or hip. Each procedure will be completed in a hospital by our oral surgeon. Call 910-509-1422 for more information.

Jawbone Health

Tooth loss can have negative consequences on both your oral and dental health. The gap left by the missing tooth can cause the bone to deteriorate. Without the stimulation caused by normal teeth, the alveolar bone begins to be reabsorbed by the body. This can lead to a host of problems, including:

  • TMJ or jaw pain
  • Expansion of the sinus and cavities
  • Interference with eating, biting or speech
  • Collapsing and distortion of facial structures, especially around the lips and mouth
  • Shifting of the teeth, such as loosening, misalignment or even additional tooth loss

Reasons for Jawbone Loss and Deterioration

Some of the most common causes of deterioration include:

Tooth Extraction or Removal

If a tooth is lost or removed over time, the supporting bone can start to become reabsorbed by the body. When the natural teeth are embedded into the jawbone, they provide stimulation and prevent the tissue from deteriorating. This is because the body no longer recognizes that part of the jawbone as necessary. Often, this process begins within the first 18 months and continues to worsen as time goes on.

Gum Disease

Periodontal disease affects the soft tissue and gums, but it can spread and affect the teeth and jawbone. This is a common source of damage to supporting dental structures (such as alveolar bone, gingiva, cementum or periodontal ligament). The two forms of periodontal disease our practice often sees are gingivitis and periodontitis.

Gingivitis is caused mainly by dental plaque and can be linked to genetically inherited traits. Plaque itself is made up of bacteria strains and food debris, building on the surface of the tooth along the gum line. This buildup can cause the gums to become red, inflamed or swollen. Left without treatment, the gum tissue can start to pull away from the teeth, and plaque can harden into calculus. Eventually, gingivitis will lead to periodontitis, which can eat away at the gums, teeth and eventually the bone tissue.

Other Restorative Appliances

Dentures and bridges lay on top of the gums. While they can look and function like teeth, they provide no stimulation to the underlying bone, unlike natural teeth. When the dentures and bridges are not anchored in place, they can cause deterioration and become uncomfortable and ill-fitting. When this happens, the appliances may need to be replaced.

When bridges are placed, often the neighboring teeth can provide stimulation, but deterioration can still develop underneath the space left by the missing tooth or teeth.

Bone grafting can help restore the function and production of tissue within the jawbone, avoiding need for further restoration.


When trauma or accident affects the teeth, jawbone or other areas of the face, it can lead to bone loss. If there are fractures in the bone, if a tooth has been forcefully knocked out or if it has been broken off, bone grafting may be necessary to prevent the death of the tooth or to prevent bone deterioration.

Dental Misalignment

Misaligned teeth can cause a variety of issues, especially if it interferes with a proper bite. Misalignment can cause over-eruption, TMJ and jaw pain, or unnecessary wear-and-tear. Over time, this can lead to bone deterioration.

Bacterial Infection

Osteomyelitis occurs throughout the bone tissue of the jaw. Left untreated, this can lead to inflammation and inject portions of bone that will need to be removed. A bone grafting procedure can replace removed or infected bone tissue.

Facial Tumors

While most facial tumors are benign, they may grow and need to be removed. Removing these growths usually requires removing parts of the jawbone. For additional restoration, Semmel Oral and Facial Surgery provides restoration for benign and malignant tumor removal.

Developmental Conditions

Due to developmental issues, sometimes dental tissue, facial bones, the skull or jawbone fail to develop fully. Dr. Brady J. Semmel provides procedures to help patients have full function in these areas.

Enlarged Sinuses

Often when the molars are missing from the upper jaw, bone reabsorption occurs, enlarging the sinuses. When this space grows, it is called hyper-pneumatized sinus. With a “sinus life,” our office can close this space and restore lost tissue.

About Bone Grafting

What is this procedure?

Bone grafting in Wilmington, North Carolina, allows our oral surgeon to restore any parts of the jawbone that have eroded away or have been reabsorbed by the body. This procedure both repairs lost tissue and can help promote the growth of new tissue.

Types of Bone Grafts:

Autogenous Bone Grafts

Also called “autografts,” this procedure uses tissue harvested from your own body. The material is usually taken from the bones of the lower tibia in the leg, the skull, the hip or the chin. Because the cells in this bone are living, it encourages growth after the procedure and reduces the chance of rejection.

With autogenous bone grafts, it is necessary to have two procedures: the first to acquire the material and the second to place it on the jawbone site.

Allogenic Bone

Also known as an “allograft,” this procedure uses bone tissue donated by a cadaver. The bone, once harvested, is freeze-dried to preserve the tissue. Because the tissue is no longer alive, it is usually used as a scaffold over which new bone tissue can grow.

Xenogenic Bone

The tissue in this procedure is harvested from the cadaver of a non-human species. In order to avoid rejection or tissue contamination, labs process the tissue at high temperatures. Overall, the tissue sample provides a framework for growth, like an allograft. Unlike autografts, the xenogenic bone procedure does not require a second surgical appointment. However, because the tissue is non-living, the results may take more time and are overall less predictable than other treatments.

Bone Graft Substitutes:

*Using synthetic materials, our practice provides safe, effective alternatives to natural bone.


Demineralized Bone Matrix (DBM), Demineralized Freeze-Dried Bone Allograft (DFDBA)

This procedure uses material from allogenic bone and are made into chips, putty, powder or gel. Once the collagen, growth factors and proteins have been processed, it can then be injected into the site.

Graft Composites

By combining growth factors and various materials from other bone grafting procedures, we can provide a customized alternative to traditional grafting procedures. For example, combining collagen cells with ceramic material creates a synthetic composite that functions similarly to bone tissue. Demineralized bone matrix can also be combined with bone marrow to help encourage tissue growth. In some instances, the materials from autografts, collagen cells and ceramic may all be combined.

Bone Morphogenetic Proteins

Also known as BMPs, these are used to help encourage and balance the growth and repair of bone tissue.

When using bone graft substitutes, there is no need for additional surgeries to harvest bone. Our oral surgeon can help you decide whether a bone graft or bone graft alternative works best for you.

Ridge Augmentation

What is this procedure?

Ridge augmentation rebuilds the shape of the gums and jaw following an extraction. The alveolar ridge is the bone tissue that surrounds the teeth. When a tooth is lost, this tissue can become damaged and cause the bone to deteriorate. Bone graft material can be used to fill in the empty tooth socket and prepare the site for restoration.

While this procedure is not always a medical necessity, it may be needed to complete a dental implant or to restore the appearance and structure of the face.

What goes into this procedure?

Ridge augmentation uses bone grafting to fill in the space left by a removed tooth. Often, a professional will recommend completing a ridge augmentation immediately after an extraction. After the space has been filled, soft tissue will be placed over the site. The tissue will be secured into place with sutures, and a space maintainer may also be put into place. After the area has healed and recovered, our office can then start preparing the extraction site for a dental implant.

This procedure may require sedation, though typically a ridge augmentation will use simple local anesthesia.

Sinus Lift

What is this procedure?

After the upper teeth are removed, sometimes the bone that surrounds the maxillary sinuses can be very thin. Additionally, this bone can start to disintegrate following the tooth extraction. If the bone is too thin, it cannot support restoration treatments like dental implants. To help ensure the success of the implant, we may recommend a sinus lift procedure.

Also known as a sinus augmentation, a sinus lift can also restore bone tissue lost to dental injury or gum disease. It provides additional bone tissue in the sinus floor above the upper teeth.

Who is a candidate for this procedure?

You may be a candidate for a sinus lift if you have experienced any of the following:

  • Have lost boney tissue in the back of the upper dental arch
  • Have birth or developmental issues that have prevented teeth from forming
  • Have more than one lost tooth in the back upper dental arch
  • Are looking to replace lost upper teeth with dental implants

How is this procedure accomplished?

Our oral surgeon will make a small incision at the site. This will allow our oral surgeon to cut into the jawbone, move the membrane lining up and fill the space with grafting tissue or synthetic material. The site is then sutured and allowed to heal.

Depending on the state of the bone tissue, sometimes the implant can be anchored immediately after the sinus lift. However, if there is not enough bone, the site will need to heal. After a few months, the dental implants can be anchored into the new tissue.

Sinus grafts allow our patients to enjoy the stability of dental implants rather than loose dentures or other ill-fitting appliances.

Sinus lifts are performed within our office. Our oral surgeon can complete the procedure with the help of local anesthesia and, if necessary, sedation methods.

Post-Op Sinus Precautions

After your procedure, we recommend the following to help ensure healing:

  1. Avoid any hot drinks in the two days following your procedure.
  2. Avoid smoking after your procedure for one to two weeks.
  3. Do not suck through straws for one week following your sinus lift.
  4. Try to make sure you take care to gently blow your nose and do not close your mouth while sneezing.
  5. Gently rinse your mouth and avoid spitting with any force.

Please let us know if you have any questions following your sinus lift procedure and call 910-509-1422.

Nerve Repositioning

The nerve repositioning procedure allows our oral surgeon to make room for a dental implant. The inferior alveolar nerve runs through the lower back of the jaw, underneath the molars. While we try to avoid this procedure as much as possible, sometimes it is necessary in order to complete an implant.

During the procedure, a portion of the cheek will be removed in order to access the nerve bundle. Once the nerves and vessels are isolated, they are shifted out of the way while the implants are placed. They will then be placed over the restoration and covered with bone grafting material.

Depending on the individual, the implant placement and nerve repositioning may be performed simultaneously or at different times. The bone grafting material may also come from a variety of sources: the patient themselves, donated tissue or from a synthetic source. Bone morphogenetic proteins may also be used to promote healing and bone growth.

Nerve repositioning procedures are completed at a surgical suite outside of the Semmel Oral and Facial Surgery office. The surgery requires the patient to undergo general anesthesia or IV sedation, with a day of bed rest and a week of limited activity following their appointment.

Socket Preservation

If a tooth has been damaged by infection, injury or disease, tooth extraction may be necessary. Following an extraction, the bone can be reabsorbed by the body and cause the gums and soft tissue to shrink. In order to prevent bone loss and collapsing the shape of the face, our oral surgeon may recommend a socket preservation procedure.

If the bone of the jaw shrinks or becomes deformed, it can prevent the patient from receiving a dental restoration — from dental implants to dentures and bridges. Socket preservation helps prevent bone loss and helps ensure a successful restoration.

Our office uses several different procedures to help preserve an extraction site. Commonly, our oral surgeon will use bone tissue or synthetic material to fill in the empty socket. The surgical site will then be covered. After the site has healed, it can then be used to support a dental implant or other restoration. Check with our oral surgeon to see if you are a candidate for socket preservation.


Map Icon1422 Commonwealth Drive, Wilmington, NC 28403