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Dental Implants are wonderfully versatile and predictable, but they do require a basic minimum amount of bone to be present at the site of missing teeth. What to do if you don't have enough bone for dental implants? We have the answer.

If you are reading this article, there is a good chance that you have one or more missing teeth and need permanent teeth replacement. It is also a safe bet that you have looked into getting dental implants but are worried or have been told that you do not have enough bone. So, what to do if you don’t have enough bone for dental implants?

Let us start from the beginning.

What Does 'Not Enough Bone' For Dental Implants Actually Mean?

Dental implants are designed to be placed inside the confines of your jawbone and integrate with them over a period of time, mimicking the natural roots in function [1]. To determine the best chance of success of the implants, measurements are made of the available bone before the procedure [2].

These measurements can be made with the help of a normal small X-ray that is taken on the dental chair, with the help of an OPG (a large x-ray of the entire jaw) or a CT scan of the area [3]. If these measurements reveal that the thickness of the jaw is less than the width of the implant needed or that the height of the bone is less than the length of the planned implant then that is an additional hiccup in the treatment planning process.

Doctors will often explain this to patients as them "not having enough bone for dental implants".

Why Is There Not Enough Bone For Dental Implant Placement?

This is actually a very good question, since people wonder why the bone was sufficient to hold up their teeth but not enough for the dental implant. The answer is two-fold. The first issue is that the bone could been destroyed because of periodontitis (gum disease), a condition that is surprisingly common across the world [4].

The other reason is down to neglect. The jawbone around the teeth will start to disintegrate if an implant is not placed there in a timely manner [5]. Quite often, people wait for a couple of years before they think of dental implants for their missing teeth, by which time the bone has already become destroyed.

What To Do If You Don’t Have Enough Bone For Dental Implants?

Several options can be explored in patients who do not have the ideal amount of bone for dental implants.

The first is the use of bone grafts. The bone can be harvested from the patient from another site in the body. This provides the best quality bone, but substantially increases the cost, requires another surgical procedure, and prolongs healing [6].

This is why this option is used sparingly and only when absolutely necessary.

The other, more common option is to use artificial bone grafts which are easily available commercially. These can be harvested from animals or be made from artificial particles which help induce bone formation [7].

All of these artificial bone grafts are treated for the removal of any organic matter so that there is no chance of any transmission of diseases.

The artificial bone grafts come in different sizes and different shapes for use in specific areas. They may be used on their own or with the use of an artificial membrane.

Membranes are most often made from collagen and play an important role in protecting the space in which the bone has to grow from other kinds of cellular particles. They have been found to increase the success of grafting procedures greatly and are being used more frequently than ever [8].

There are also some surgical options which are explored to increase the thickness of the available bone. A process called "splitting the ridge", where the jawbone is split and expanded with the aid of specific tools and the space around the implant is later filled with bone graft [9].

Some surgeons may choose to undertake an "All on 4" procedure where the implants are placed at an angle so as to increase their length inside the bone without actually doing any additional grafting or surgical procedure [10].

This has become a very popular option for completely edentulous patients.  

For the upper back teeth, where the sinus is situated anatomically, a sinus lift procedure may need to be carried out so that an implant of adequate length can be inserted into the jaw and provide adequate support. This is one of the most commonly performed additional procedures and has a very high rate of success [11].

Conclusion

The advancements in instrumentation, imaging techniques, and surgical methods have allowed those patients who were previously considered poor candidates for implant placement to permanent teeth replacement with ease and predictable success. The question, what to do if you don’t have enough bone for dental implants, has many good answers which you should discuss with your dentist. The final solution to non-implant permanent tooth replacement is dental crowns and bridges

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