Did you know that with modern techniques available today, significant bone loss can often be addressed, allowing for dental implant placement and thus the creation of completely fixed or very well-fixed dental restorations?
There can be various reasons for tooth extraction. Most commonly, a tooth cannot be retained due to some form of inflammation or its consequences, but accidents or overloading can also lead to this.
Regardless of the cause, there is a common consequence:
the bone surrounding the tooth is damaged or partially absorbed (or may have partially been absorbed even before tooth extraction).
If we don’t take action against it, this process also occurs during the removal of a tooth in a healthy periodontium (even with the most careful extraction). Even with the most cautious tooth extraction, strict bone loss cannot be prevented because certain parts of the bone “anatomically” belong to the tooth, so with its removal, this bone part also “disappears”. However, it is possible to think about replacing this bone and compensating for it with special techniques. Therefore, it is crucial that if a tooth is no longer viable, its removal should be preceded by proper planning!
(In our practice, depending on the future intention – whether we intend to implant a tooth implant or insert a bridge or removable prosthesis in the tooth’s place – we can plan appropriate bone preservation/construction and choose the most suitable technique from several commonly used techniques.)
If existing bone loss needs to be replaced, there are numerous techniques available nowadays, depending mainly on the location, size of the bone defect, and the intended purpose of the built-up area.
https://www.youtube.com/watch?v=956l-T9CMX0
Here are some “everyday cases” as examples:
- After tooth extraction, the “outer” (facial or lip-side) part of the bone is usually more strongly absorbed. If there is sufficient bone available for stable anchorage of the dental implant despite this, the missing part can be replaced at the same time as the implantation. Bone augmentation is performed using autogenous bone grafts and/or completely sterile and organic material-free bone granules derived from animal bone, which are covered with a “blanket” or membrane (usually also of animal origin, sterile, and organic material-free). This membrane is often secured in place with small titanium screws (practically the same material as most dental implants). This intervention is most commonly required at the sites of upper front teeth or for all lower missing teeth.
- In the locations where upper molars have been removed, there is often insufficient bone due to the sinus cavity, making it challenging to anchor dental implants. This can be due to anatomical features or, in cases of long-standing tooth loss, the expansion of the sinus cavity into this area. The necessary technique, extent, and timing of bone reconstruction depend on the amount of remaining original sinus bone and its distance from the sinus cavity. If there’s no need to replace sinus bone, typically, only the minimal amount of bone necessary to support the dental implant is created toward the sinus cavity. In most cases, a bone window is created on the outer surface of the sinus cavity. Through this window, the sinus membrane can be lifted, and the bone graft material mentioned earlier can be placed there. Depending on the existing amount of bone, the implantation either occurs simultaneously with the bone grafting or after a healing period. If the sinus bone also needs to be replaced, it’s a more extensive procedure. See the description below.
- Extensive bone loss typically occurs in cases of long-standing tooth loss, possibly exacerbated by the prolonged wearing of removable dentures, leading to further bone deterioration. In such cases, it may be necessary to reconstruct the maxillary sinus floor, a procedure that requires more bone material than the methods described above. Depending on the location and size of the bone deficit, in such cases, the primary source of bone material used for reconstruction is often the patient’s own hard bone obtained from the posterior regions of the lower jaw, supplemented with the autologous or animal-derived bone granules described above. In some cases, it is possible to use completely synthetic “hard” membranes with less of the patient’s own bone or to precisely determine the shape of the missing bone through computer-aided planning. This involves carving the missing bone shape from sterile, organic matter-free human donor bone. In such cases, this is fixed during the surgery, and after the healing period, dental implants can be placed.
In cases of significant bone loss, sometimes it’s possible to create implant-supported dental restorations without extensive bone grafting. The two most common indications are:
- Significant bone loss occurring in the area of the molars, particularly in cases where the front teeth are still present. In many cases, it’s possible to place extra-short implants here, thereby reducing the risks associated with bone augmentation.
- If front teeth are missing, it’s possible to anchor a full set of tooth replacements (known as a “circle bridge”) using multiple implants, specifically designed with intermediate elements, often placed diagonally in the rear sections.
In our clinic, we utilize all the mentioned techniques, and we always choose the most appropriate one based on the patient’s specific indications.
In our clinic, we use dental implants from CAMLOG (including the Comfour system) and STRAUMANN (all types of implants, including SLActive or bioceramic), as well as bone replacement materials from the Swiss company Geistlich and the German company Botiss.
Of course, both implantation and bone replacement have limiting factors and risk factors, which have not been listed here. So, not everyone is a candidate for any technique, and there are factors that might make such surgeries completely unfeasible. These factors are typically determined through clinical evaluation.
