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Not Enough Bone For a Dental Implant? It’s Okay

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If you’ve been unfortunate enough to have lost a tooth or two, generally you’re a potential candidate for dental implant surgery. Implants increase aesthetics and therefore confidence, and allow the enjoyment of foods you may have had to avoid for some time. Implant supported crowns, dentures and bridges can increase bite force more than 10 times.

98% of dental implants have a ten-year success rate; to put this into perspective, crowns, bridges and root canals a ten-year success rate of 85%. There are many medical procedures that have a ten-year success rate of only 75%.

There are, however, particular diseases and conditions that highly influence whether dental implants are the appropriate solution which is why a proper medical assessment is important.

Conditions such as cancer, radiation treatment to the jaw, alcoholism, smoking, uncontrolled gum disease, diabetes, specific medications and other ailments affect the ability for the body to heal and affect the fusion of the implant to the bone.

Don’t panic: they’re not necessarily absolute contra-indicators, but it’s very likely that steps will to be taken to ensure a successful surgery with proper healing. Your dental surgeon should be thoroughly aware of your medical history and any medications; if it feels a bit personal and irrelevant, it’s all avoid any unnecessary complications.

An exam, radiograph, or CT scan are usually done to evaluate the implant site for bone strength and density, and most patients have enough for implants. The longer a tooth has been missing, the greater the atrophy or bone loss.
Sometimes a bone graft is needed.

Neither patient or dentist ever want unforeseen complications in the dental chair, and the thought of having dental implants is daunting enough – let alone adding a bone graft – but the process is absolutely worth it. A strong enough jawbone to hold your dental implants is fundamental to long-term implant success.

A graft is how new bone is added. Used to be that the only bone available was from a patient’s hip or rib; now synthetic bone graft materials are available.

As much as it sounds impossible, most bone augmentation procedures are atraumatic, simple, and successful.

There are four types of bone grafts for dental implants and if you need to have one, you need to know the difference between them.

Autogenous is the most preferred and most efficient of the procedures because the grafting material is already yours: it’s taken from you and is the “gold standard” in dental bone grafting techniques. Samples are usually harvested from your chin or other area of your jaw; for patients needing larger bone volumes it’s usually taken from the iliac crest – the largest of the three bones of the pelvis. It’s the most common source for biomaterial in orthopaedic surgery.

An issue with autogenous bone grafts is the discomfort and healing of two surgical sites and that may be a consideration for some patients.

The difference between a bone graft and a ridge augmentation is the process. A dental bone graft stimulates and encourages bone healing after a tooth has been pulled: ridge augmentation is the fully formed, newly grown bone after the graft.

Allograft bone grafts are harvested from deceased donors, verified to be free of any diseases or infection before the bone was harvested. This donor bone is treated to ensure patient compatibility, with the main concern the risk of an autoimmune reaction, or graft rejection.

Xenograft bone grafts are taken from a cow or pig and processed so that much of what is left is mineral components. Xenografts add incredible support to the site of the dental implants, and over time, the body replaces the xenograft with completely new bone.

Alloplast bone grafts have the grafting material made from a type of glass made from the naturally occurring mineral in bone, called hydroxyapatite. This material is both non-inflammatory and non-carcinogenic, which makes it particularly safe and effective with excellent resulting hardness and osteoconduction.

So these are the options to discuss with your dentist or implantologist.

Sensitivity to metals is not unusual (most commonly to nickel); sensitivity to titanium is rare, but it does exist. Some titanium implants are pure titanium, while most are an alloy to make them stronger. So if there are any concerns, you can have a Melisa test or a Clifford’s test to determine if there are issues with titanium.

Most naturopaths and dentists can arrange this test for you.

Should it prove that you have this sensitivity, zirconia implants are the non-metallic, ceramic type alternative. Although not as well known, they have been in clinical use for decades and are also excellent choice for tooth replacement.

Gum disease can be a factor in the placement of implants. Depending on its severity, and how well it is being treated and controlled, is key to infection and implant failure rate and will typically be addressed prior to the implant process.

Implants prevent further jawbone deterioration because their placement stimulates atrophied bone. When teeth are missing and roots that were once bonded to your gums and jawbone are no longer present, over time, your jawbone can begin to break down, giving your facial structure a sunken appearance.

Dental implants restore and prevent this, making them indeed life changing. Anyone with full or partial dentures will be aware of their shortcomings; implants overcome these, and are by far the best method of replacing teeth in the long term, given that growing new teeth using stem cells is at least a decade away.

Comparatively, bridges don’t carry as many functional issues, but in the long term even they can fail due to decay, fracture, or gum disease. Studies show that implants have less than 2% failure rate after ten years; the same period shows have a 15-20% failure rate for traditional crowns and bridges.

Short-term failure with implants can occur before the entire treatment is completed. It can happen during the first few months of healing following surgery, and even up to a year later. There are few things in life that last a lifetime and dental implants are no different. Despite the fact that less than 2% of implants fail, it’s not much consolation if you’re in that 2% – that makes it’s a 100% failure from your perspective…

Dental implants must remain immobile for a long enough period for osseo-integration to occur – taking a full 4-5 months to fully heal, based on a “sigma” of bone: the process of mineralisation that is a biological constant, regardless of age or ethnicity.

Any movement of the implant during the first 8-12 weeks will un-stabilise the post, and bone will not grow against its sides. Instead, there will soft tissue ingrowth with the result of a loose and likely painful implant site.

This is critical for all dentists, but more so where “immediate teeth” are part of the treatment – having an artificial tooth placed directly onto the implant without the 6-week interim. In these cases steps must be taken to ensure that forces on that implant are minimal. This can mean making the tooth shorter so that the food doesn’t press on the tooth; it can include a soft or liquid diet for 2-3 months; and splinting the tooth to other natural teeth or implants is also possible.

Immediate teeth are the solution to missing front teeth, and you need to aware that they can increase the risk of implant failure.

For any dental implant the post-op instructions are simple, straightforward, and imperative to strictly adherence. For the first few days heavy physical activity must be kept to a minimum, the surgical site must be kept clean, certain foods and beverages are to be avoided, and the recommended medication taken.

There may be other specifications given depending on the surgery, and any particular circumstances pertinent to you.

It’s important to not just heed your dentist’s instructions for the first few days when the procedure is foremost in your mind; some patients do wonderfully well in the immediate short term, feel pretty good and then assume that they’re very fast healers. Normal activities will swiftly reappear – some they were specifically told not to do – and in short order increased discomfort, swelling and other complications begin.

All of this of course leads to a much more difficult, and prolonged recovery.

So don’t ever underestimate the seriousness of your post-operative care instructions. Notwithstanding the fact of implants being a relatively painless procedure, it’s still a physical trauma to your body and utmost care must be taken. You don’t want to blow all that dough by being impatient and deciding that your super power is rapid recovery.

Despite possible pessimism in terms of dental implants not being devoid of complications, they are still the most successful and least problematic method for permanently replacing teeth. The biggest challenge really, is that it is the most expensive option so if you do have complications, the potential loss on investment can be huge.

Make sure to ask your clinician what sort of life expectancy is reasonable. Find out the details of their policy on treatment failure not attributed to improper post-operative care, because should this anomaly occur you’ll be glad you did. Certainly it’s useful to feel very positive when facing any kind of medical intervention; and by the same token it’s completely naïve to discount the possibility of a less than optimal outcome. Forearmed is forewarned, and if your dentist brushes off this concern with subjective statements of their skill, it may be an indication that another practitioner may be more suitable.

Many patients have implants for 15 years and longer with no issues – and it’s not unheard of for properly maintained implants to last for 25-40 years.

So decide now that you’ll be one of those cases. Dental implants are a major emotional, financial, and physical investment in your oral health. Honour the choice you made, respect the expertise of your dentist, and keep them properly maintained with regular brushing, flossing and checkups.

Like anything important in life, after the hard decisions and initial work’s done, you’re in it for the long haul.

Note: All content and media on the Northern Dental Design website and social media channels are created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice.

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