Dental implants: What happens when the bone is missing ?

Replacing missing teeth with new roots made of titanium is a therapy that is finding growing approval among patients and dentists. But what if the necessary bone for grafting the implant is missing? At one time the phrase “there is not enough bone” was enough to make us feel inevitably condemned to wearing dentures. Today the means for restoring missing bone are many. At the most delicate and extraordinary interventions are needed, which are able to be carried out only by expert and careful hands. With just a warning: only a capable and trustworthy dentist will be able to assist us in choosing the most suitable therapy as well as the most appropriate surgeon.

For minor deficiencies, it is possible to increase the jaw bone thickness, by the grafting of the patient's bone fragments which are then anchored to the implant and to any remaining bone (particulate bone grafting). A small intervention that can either precede the implant insertion or be carried out simultaneously.  After a few months, the grafted bone and that already present fuse together and become strong, healthy and able to withstand the mastication forces.

Not only. It is possible to install bone free implants, but also fill in non-aesthetic dips or regain the presence of an aesthetic and pleasant smile. In the most difficult cases and with even less residual bone, it is possible to screw in a small bone screw from material always taken from the patient's mouth. The screw with fuse with the pre-existant bone (on-lay bone grafting).

In both cases, there is often the use of an extraordinary artifice researched and applied around the world. In the blood, as is well known, there is the presence of various substances (proteins) that stimulate wound healing. In our case, there is a faster and more efficient recovery by drawing these substances from the patient's blood before the intervention, concentrating them and subsequently applying them on the wounds and grafts (platelet-rich plasma).

Many surgeons prefer using the erbium laser which stimulates wound healing and sterilizes the operated area in which blood flow increases. In cases even more difficult there is the application of a technique invented by a Russian doctor noted as: mandibular symphyseal distraction osteogenesis. It consists in separating a fragment of mandibular bone from the surrounding bone by means of a small saw: a small screw then ensures that it is gradually distanced. There will be a resulting formation of a bone callus during healing within the small bone cavity formed between the jaw bone and the fragment. However, this is stretched and flattened by the fragment's gradual movement. Hence, there is the formation of new and abundant bone tissue on which the new titanium roots can be placed.

In alternative other equally efficient interventions are available, which however require a short hospital recovery. As a matter of fact, a large bone screw can be drawn from the leg and screwed into the mouth as to obtain all necessary tissue. Naturally, every surgical intervention, from the smallest to the most important, requires a careful and attentive patient exam. The surgical indications, the counter-indications, and the possible complications must be carefully assessed, explained and understood.

last update: 21 January 2008