Last week, we talked about health concerns and implant dentistry. This week I want to talk about whether or not you have enough bone for implants

It is important to understand that once a tooth is removed, the bone that supported that tooth in the jaw starts to melt away. In fact, up to 50% of the supporting bone can be lost within the first year after the tooth has been removed. What does this mean?

Well, the bone can diminish in two different dimensions: horizontally and vertically. Remember, dental implants simulate a tooth root, even though they may look like a screw. So to place the implant, the surgeon needs to have enough width of bone so that after the implant is placed, there is at least another 1-2 mm of bone surrounding the implant to hold it in place. If the bone is too narrow, part of the implant will not be embedded in bone, and this leads to a very unstable implant in addition to being very unsightly.

Let’s say that the implant is replacing a front tooth: if the missing tooth has been gone for a while, it is relatively simple to rebuild the bone so that there is enough bone for an implant. But that’s not all that is necessary.  It is often crucial for the surgeon to rebuild the lost gum tissue as well so that the front tooth that is an implant looks like a tooth and not like an implant just stuck in bone

 
Also, what if the bone has shrunk in the vertical dimension? The standard length of an implant is 10.5-12 mm in length. If there isn’t enough bone vertically, the implant will have to be shorter, and this leads to an unstable implant. Also, there are often anatomical structures that can get in the way of the implant that would prevent the surgeon from placing the implant into the jaw. These structures include the sinuses, nerves and blood vessels.

So what if there is insufficient bone? What can be done?

There is a multitude of techniques to deal with insufficient bone in height or in width, so rarely is the situation hopeless. Some of these techniques are bone grafting, where the surgeon adds bone to the site to encourage new bone to grow so that there is sufficient bone for the implant. Others involve changing the position of the implant. 

Next week, I will explain some of the options of the different materials we can use to help grow the bone by grafting.

Stay tuned and be well!