Dental Health Topics

Bone Replacement Graft – First Site in Quadrant - Dental Procedure Code Description

When periodontal disease progresses to the point where it results in a deformity of the alveolar bone tissue that surrounds a tooth, a bone replacement graft may be placed in the area to stimulate the regrowth of this bone tissue. Without such intervention, the tissue undergoes what is known as resorption (“breakdown”), which, at the cellular level, takes component materials and disperses them elsewhere throughout the body. In layman's terms, the bony material is essentially “taken” back “into” the body for other use.

 
This resorption of bone tissue can affect the efficacy of future restorative dentistry, such as implants and prosthetics. It can also change facial features and therefore alter one’s general aesthetics. As a result, many dentists prefer to proactively stunt this resorption by using a bone graft.
 
There are three different types of bone graft that can be used to stimulate bone regeneration under this code. They are: 

  • Autograft – Bone harvested from patient’s own body
  • Xenograft – Bone grafts or collagen from bovine or porcine origin
  • Allograft – Block bone graft from a cadaver
Generally speaking, layering one of the above materials into the area where the bone tissue has subsided completes a bone graft. This is accomplished by first exposing the area by means of a surgical incision, and then by layering the material into the recessed area. A protective collagen membrane is then placed atop this material to aid in healing and stability, and then the area is sutured shut. When a bone graft is needed in the rear of the mouth and in the upper jaw, the procedure is more complicated because the sinus cavity is often involved. When bone loss occurs below the sinus cavity, the cavity tends to “drop” as a result. Thus, surgery in the area requires specialized care so as not to disrupt the very delicate sinus cavity.
 
To place a bone graft in this area, then, the sinus membrane needs to be elevated (or lifted) out of harm’s way to allow for the addition of bone graft material. To accomplish this, an incision is made in the gum tissue to expose the bone, and a small oval-shaped hole is cut to expose the sinus cavity. Then, gently, and sometimes with a surgical balloon, the sinus membrane would be lifted out of the way to make room for the grafting material. Once again, a protective collagen membrane would be layered atop the graft, and the incision sutured shut.

There is great variety to the type of bone graft and the procedures involved, and much is dependent on your dentist, your budget, the quality of the extraction performed, your overall health, your oral health, and the type of material to be used. Since preserving the ridge is critical to future restorative work and your cosmetic satisfaction, it is wise to consult with your dentist at length to determine the best procedure for you.

Keep in mind that while this description covers the full process involved in bone grafting, this code only covers the graft itself and not the flap to gain entry to the tooth, cleaning, contouring, or the placement of any biologic materials or tissue membranes. Each of those procedures has its own specific coding.

To look up and find more cdt dental codes from the American Dental Association, please visit our complete Dental Procedure Code Library.