Dental implants need bone
A dental implant (shown orange in the image above) replaces a natural tooth root. It’ll come as no surprise that the implant is fitted into bone, and needs that bone to support it.
Ideally, we’re looking for bone to be present along the full length of the implant, and 1-2mm thickness all around.
How do we know if you have enough bone?
Using a 3D CBCT scan like shown above, we can easily measure the jawbone in all dimensions. We can place a virtual implant in position to check how much bone is present, and whether we may need to add more, so you’d usually know before starting any treatment.
Osteoporosis and bone density
If you have osteoporosis and are considering dental implants, you’re not alone.
The good news is that reduced bone density isn’t usually a barrier to dental implant treatment. We can measure bone density on a CBCT scan and implants are successful even in softer bone. It’s very rare that we would dismiss implants as an option because of osteoporosis.
(Some medications for osteoporosis can carry a rare side effect, but again, this rarely prohibits dental implant treatment)
Tooth removal and immediate implant placement
When a tooth is removed, it leaves a socket, empty of bone. In many cases, this socket is about the right size and shape to take a dental implant straight away.
This means that we can often combine tooth removal and implant placement into a single appointment (immediate placement). This is usually the case for front teeth where there’s no significant infection (abscess) present.
Types of Bone Grafting
Socket preservation
A larger empty socket, such as that left by the removal of an abscessed tooth or larger molar tooth may be too wide to support an implant straight away. In this situation, we’d usually need to replenish the bone with a socket preservation (bone grafting) procedure before fitting the implant a few months later.
Bone grafting to increase width
If it’s been a while (longer than a year) since tooth removal, especially if no socket preservation was carried out, the jawbone is likely to have shrunk away. This may be to the extent where extra bone is needed to support an implant, but often there’s still enough bone present that a graft isn’t needed.
Where the bone is narrow, we can often add extra bone to increase the width, before fitting a dental implant a few months later.
Sinus lift bone addition
Where an upper molar or premolar has been removed, the bone separating your mouth from your sinus often shrinks in height, which means that there mauy not be enough to cover the full length of the implant.
A simple sinus lift process can generate extra bone height predictably by gently lifting the soft tissue of the sinus using saline pressure. This allows us to add extra bone at the same time as implant placement, with no delays to the treatment timeline.
The addition of bone here won’t affect your breathing or the ability of your sinus to function as normal. The volume of a sinus is typically 15-20cc, and the new bone just 0.5cc.
Where does the bone come from?
Specialist bone for grafting is usually bought off-the-shelf. It may be synthetic, human-derived or animal-derived (often bovine).
Any human- or animal-derived bone has all cells, DNA and other living components removed during processing.
At No.4, we usually use human-derived or synthetic bone, because with these types, your bone cells will gradually turn this into your own living bone. Bovine bone often remains stable but inert after placement.
Bone graft timelines
More about dental implant timelines
Short timeline
Sometimes bone addition is carried out at the same time as implant placement. This may be the case for sinus lifts and simpler cases of width augmentation or socket preservation. This means the overall timeline for your full treatment is likely to remain at around 4 months
Longer timeline
For more significant cases of width augmentation or socket preservation, we may need to leave the bone graft for 4 months to mature before placing a dental implant. This means the overall timeline is likely to increase to around 8 months.
What shoud you do if you’re considering implants but are concerned about bone?
The first stage is always to have a consultation and 3D CBCT scan. This will give you the information and answers you need about whether a bone graft may be needed, what type, how long it would take etc.