Many of our patients have heard it before. They asked about implants years ago, a dentist looked at an X-ray, and they were told there wasn't enough bone. Some went back to their denture and stopped asking. The techniques have moved on a great deal since then, and many people who were turned away are good candidates today.
Why bone disappears
The jaw bone stays strong because tooth roots load it every time you chew. When a tooth is lost, that part of the bone stops working and slowly shrinks. Most of the loss happens in the first year or two, but it continues for as long as the area is empty. Dentures make it worse over time, because they press on the ridge without stimulating the bone underneath.
Gum disease, infections, old injuries and failed root canals can all add to the loss. In the upper jaw, the sinus also tends to expand downward into the space where back teeth used to be.
Angled implants
The simplest answer is often to change where the implants go. All-on-4 places the two back implants at an angle so they anchor in denser bone further forward, staying clear of the sinus in the upper jaw and the nerve in the lower jaw. For many long-term denture wearers, this means fixed teeth without any grafting at all.
Bone grafting
When an implant needs to go in a specific place and the bone isn't there, it can be rebuilt. A socket graft fills the space left by an extracted tooth to keep the bone from collapsing. A ridge graft adds width or height to a thinned area. A sinus lift raises the floor of the sinus and places bone beneath it so implants can go in the upper back jaw.
Grafting works well, but it adds time. Depending on the type, the bone may need several months to mature before implants can be placed. Your doctor will tell you whether grafting is likely to be needed and whether there's a way to avoid it.
Planning around the bone you have
Some cases don't fit a standard layout at all. There may be good bone at the front and almost none at the back, or a previous implant may have failed and left a defect. An All-on-X plan uses the number and angle of implants your anatomy allows, mapped on a 3D scan before surgery. Sometimes that means five implants. Sometimes it means more than six.
Specialized implants for severe loss
For the most severe cases in the upper jaw, longer implants can be anchored in the cheekbone or in dense bone deep at the back of the jaw. These are known as zygomatic and pterygoid implants. They're specialized procedures, and when they're the right answer your doctor will plan the case with a surgical specialist so your care stays coordinated.
What the scan shows
A two-dimensional X-ray can make bone look thinner than it is, and it can't show width at all. A 3D CBCT scan measures the height, width and density of bone everywhere in the jaw. Many patients who were turned away based on an older X-ray learn from a scan that they have more options than they were told.
Don't wait if you're still deciding
Because bone keeps shrinking where teeth are missing, time matters. If you've recently lost teeth or have teeth that need to come out, ask about preserving the bone at the time of extraction. And if you were told years ago that implants weren't possible, it's worth a second look.
Have questions about your own case? Book a complimentary consultation at our Brentwood office on San Vicente Boulevard or our Burbank office on West Alameda Avenue. We see patients from across Los Angeles, including Beverly Hills, Santa Monica, Glendale and Pasadena.