What if I don’t have enough bone for a dental implant?

Why it happens
If you lose a tooth, the bone in that area will gradually start to shrink, while the other areas stay intact. There are many reasons why people loose teeth. It can be caused by some of the following:

• Periodontal (gum) disease
• Dental caries (cavities) and infection
• Injury or trauma
• A defect in development

Dental implants can be very useful when:

• we would otherwise have to crown (cap) healthy teeth
• A denture or bridge would be difficult or sometimes impossible because there are no suitable teeth or gums for support.

If you have to lose a tooth, it is very important to prevent bone loss. Dental implants preserve your jaw bone and prevent the natural shrinkage that WILL occur with bone loss.  A bridge or removable partial denture does not preserve or maintain your bone.
You’ll need to have a thorough examination by your dentist, to determine how much bone volume and density you have in the area of the missing tooth.

There must be enough bone in order to support your implant. If you don’t have enough bone, the bone can be rebuilt.  If you don’t have enough gum, that can be added back too. This must be carried out before implants can be placed. The treatment is called Bone augmentation and has been used successfully for years.

What options are available to me?

There is no reason anyone cannot get implants because of bone loss today.  There are a variety of techniques to achieve this. Your dentist will select one depending on the type, location and number of implants to be used. It is important that your dentist discus’s all of the options available to you.

BONE GRAFTING

This procedure involves grafting (adding) bone or bonelike materials to the jaw.

An excellent choice for a bone graft is your own bone. This will most likely come from your chin or ramus (the back part of your lower jaw). If your dentist is unable to get enough bone from these areas, bone may have to be obtained from your hip or shin bone (tibia) instead. The hip is considered to be a better source simply because the hip bone can provide a large amount of bone. However, this will require a hospital stay and general anesthesia. Furthermore, this does not increase your risk of hip fracture.

If you don’t like the idea of having bone removed from your body to be placed in your jaw, there are other options available. Materials can be sourced from the bone of human cadavers or cows. In addition to this, newer products and materials also can be used for bone grafting.

SINUS LIFT (or elevation)

It increases the height of your upper jaw by filling part of your maxillary sinus with bone. The maxillary sinus is the area above your jaw on either side of your nose above the back teeth. This is done when the back part of the upper jaw does not have enough bone to allow implants to be placed.

RIDGE EXPANSION

This is another type of bone graft and is only carried out when the jaw is not wide enough to support implants. Some dentists will place implants directly after this procedure. Others will wait several months for the ridge to heal. This procedure, called a split ridge technique, can be done in the dental office under local anesthesia.

DISTRACTION OSTEOGENESIS

This technique will be used most often to increase the height of bone that is too short. A surgeon makes cuts in your jawbone to separate a piece of bone from the rest of the jaw. A titanium device inserted with pins or screws holds the piece of bone apart from the rest of the jawbone. Each day, you unscrew the device a small amount. Over time, this makes the space between the piece of bone and the jawbone taller. The area between the pieces gradually fills in with bone.

DISTRACTION

“Distraction” refers to the process of separating the two pieces of bone. “Osteogenesis” refers to the forming of new bone. Distraction osteogenesis is used more often to make the jawbone taller, but it can be used to increase the bone in any direction. The procedure is becoming more common today.

Implant Procedure 

Dental implant surgery is usually carried out under local anesthesia (numbing the area where the implant is to be placed) and is a relatively comfortable procedure. You may experience some minor vibration during preparation of the implant (bone) site, but it is quite tolerable. Since there are no open wounds following implant surgery and it is minimally invasive, there is little post-operative discomfort. You will be given a course of antibiotics to take home and use over the following week.

A single implant usually needs to be left for a period of two to four months to fuse to the bone before a crown can be attached. The healing time will vary from person to person, but ultimately depends upon the bone density at the site of the lost tooth; the more dense the bone, the quicker the healing. The next step is to make a crown to fit on the implant that will look, and function exactly like a normal tooth.

Success rates

Dental implants traditionally have a very high success rate. Research concludes that over 95% of procedures are successful — the highest of any tooth-replacement option. Even in areas of low bone density, success is quite common. A successful and functional implant restoration can last a lifetime.

Although it is rare, an implant can fail. There can be complications with the implant fusing to the bone properly or it can come loose from it for a variety of reasons.

Sometimes, it’s the number of implants that’s at fault: too few implants are placed to handle too much stress — a situation known as overload. Sometimes an implant-supported tooth can stick up a little higher than the other teeth, meaning it will be subject to more biting and chewing force. This is why it’s so important to choose a qualified professional to install your implants.

Risks

• The success rate for bone grafts in the jaws for the purpose of placing dental implants is very high. However, there is always a chance that the bone graft will fail, even if your own bone was used. Bone grafts are not rejected like organ transplants. Dentists don’t know why some bone grafts fail – it could be because the patient is a heavy smoker, or because of a medical condition. It is important to be aware that there is a higher risk of failure in implants placed into grafted bone rather than natural bone. However, in the event of a failed graft, this graft will simply be will be removed. Once the area has healed, your dentist may choose to place a second graft.
• As mentioned above, there are certain health conditions and habits that have a bearing whether a dental implant is successful or not. For example, if you have uncontrolled diabetes, your ability to heal in general will be affected. This will cause complications with the implant attaching to the bone tissue.
• If you are a smoker, this can compromise the success of a dental implant as it reduces blood supply for healing, (though smoking does not disqualify you from receiving implants).
• The osteoporosis drug Fosamax, if taken for more than three years, can compromise bone healing. Osteoporosis itself can affect bone density, making it difficult for implants to be strong enough to handle the normal functional stresses associated with biting and chewing, for example.
• Oral hygiene is particularly important with implants. Failure to remove food particles and plaque from the gums near the implant on a daily basis can lead to a bacterial infection, known as peri-implantitis. This infection can destroy bone and loosen the implant.
• Patient may experience pain, swelling and bruising in the area where the graft (bone) has been taken from. If bone has been taken from the hip, they may find it uncomfortable to walk for two to four weeks. Swelling in the jaw normally lasts for about one to two weeks.

Implants are normally placed by dental surgical specialists (periodontists and oral surgeons) or general dentists who have undertaken special training in implantology.

Your general dentist is the place to start!

Perfect Smile Spa based in Hornchurch Essex is a Leading Cosmetic Dentistry practice and is dedicated to PAINLESS dentistry.

Call us for a free consultation on 01708 442 114 or email care@perfectsmilespa.co.ukWhat if I don’t have enough bone for a dental implant? was last modified: June 29th, 2018 by Dr Jas Sagoo