I have severe bone loss in my upper jaw, and the dentist wants to extract my teeth and give me dentures. I want dental implants, but with the amount of bone loss that may not be possible. Do I have options? Has anyone tried Emdogain or other bone regeneration techniques, or would bone grafting give me the bone I need? I really don't want dentures.
Dental Implants with Bone Loss on Jaw?
Doctor Answers 20
Bone Grafts For Dental Implants
There is no reason anyone can not get implants because of bone loss today. There are several techniques for bone grafting including Platelet Rich Plasma (uses growth factors for your own blood), rhBMP (bone morphogenic protein), harvesting a patients own natural bone and using other cadaveric bone and bone substitutes. There are also implant placement techniques, such as the All-On-Four which avoids the need for bone grafting if one so chooses. With CT Scans and computer guided implant placement this is a possibility It all depends on what type of prosthesis you want in the end. An overdenture vs individual implants and teeth vs. a bridge on dental implants. I can honestly say that in my hands there is no reason for someone not to be able to have dental implants placed ( unless they have severe medical health issues which would prevent it) Seek a consultation with a Board Certified Oral & Maxillofacial surgeon, they are the most qualified individuals and have more training in these complicated cases than any other specialist.
Dental Implants with Bone Loss
The question becomes how much bone needs to be added by bone-grafting procedures for secure placement of dental implants. Depending on the amount of bone missing, you might need a simple bone-grafting procedure where “fake” bone could be used, or you might need to have some bone taken from your jaw and placed into the area of missing bone. Those procedures have complications and require highly skilled dentists.
Patients with Severe Bone Loss Can Have a Successful Outcome with Dental Implants for Permanent Teeth
With the latest technologies that we have as surgeons, Dental Implants can have a successful outcome for almost any patient who wants permanent teeth. With computer imaging and a CT scan we map out the bone quality and quantity to see where we can place dental implants using what is called “A Graftless Solution” and “Guided Technology” Nobel Biocare is a leader in this new technology allowing many patients to have extractions, and fixed permanent teeth the same day. These techniques are called Teeth in an Hour and Teeth in a Day and are specialized procedures that need to be performed by well-trained surgeons.
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Dental implants with severe bone loss
Nearky any patient can have sufficient bone grafted onto their upper jaw to allow for dental implants placed. If the back part of the jaw is deficient in height then the sinus and be lifted. If the width of jaw needs to be widened, then a procedure called ridge augmentation can be done. In severe cases, grafting procedures may need to be done more than once.
One factor that can significantly affect the healing of grafting procedures is smoking. Smokers are far more susceptible to complications and potential failure than non-smokers
Dental Implants and Bone Loss
Even when bone loss is severe, it is possible to augment bone and place dental implants in most cases. Usually major bone augmentation is done with patient's own bone, allograft bone material or a combination of boss. Emdogain in particular is an enamel matrix protein that will not be significant for this procedure. In order to evaluate the outcome, your Periodontist must look at the amount of horizontal and vertical bone loss, the anatomy of the defect, and then treat/erradicate any periodontal disease prior to implant placement.
If you don't have enough bone to replace all teeth with implants, you have several options available to you. You may choose to go with a hybrid prosthesis (5-6 implants supporting a fixed denture without the flange) or an overdenture (2-6 implants supporting a removable denture). These options may provide enough stability and comfort for you and may minimize the amount of procedures you need to have for implant placement. Please discuss your concerns with your Board Certified Periodontist so he/she can present the best options for you.
Treatment planning of dental implants is directly related to the available amount of jaw bone.
Adequate amount of bone is directly related to success of dental implants. If you have advanced/moderate bone loss: hopeless teeth should be extracted, allow for healing of the exisiting bone for 2-3 months.
Some grafting could be done at the extraction visits depending on the amount of bone in the extraction sockets. Fabrication of a surgical template is indicated after the 2-3 months of healing post extractions. A surgical template is a mold of your exisitng dentition or denture, which is removable and has radiographic markers visible on a CT scan, (you will wear it during the CT scan procedure) A periodontistor oral surgeon will determine the amount and location of bone loss.
Often times with a full arch (upper or lower) bone loss will vary , and one may be able to place implants where there is sufficient bone, and avoid the areas with extensive loss (you do not need an implant for each tooth). Bone grafting at this point is classified as ridge augmentation. Emdogain is NOT a material of choice. The most common and predictable option today is a putty-like material called REGENAFORM.
You may be told of "BLOCK" grafts as well, however, they are much less predictable, as they shrink over time, and are much more painful. A block graft is a piece of your own bone taken from somewhere else in your mouth (chin or mandible). This is a very complex aspect of dentistry, be sure to feel comfortable with the specialist that you choose andhave a clear understanding of the end result and trhe steps necessary to achieve it.
Severe upper bone loss
Many materials and techniques are available to regenerate bone, but there are limits. Not knowing your specific type of bone loss and whether there are areas with suitable bone greatly limits my response. I've had good results using Emdogain combined with bone chips, but again it too has limitations. I'm careful about what type of bone defect I repair. I would refer you to a specialist who has extensive experience in regenerating bone.
There are always options!
There are always options. The question is how much is needed to be done in order to rebuild the bone prior to dental implants. Emdogain and other bone grafting procedures could be considered to reconstruct the bone prior to the placement of dental implants. In the upper jaw, when we have limited bone, we would consider bone grafting, bone ridge augmentation, or even sinus lifts in order to gain more bone. If all of the upper teeth need to be replaced, the "All on Four" procedure may be a good option for you. This would eliminate the need for you to wear a denture. Great question!
Bone Grafts and Dental Implants
Dental Implants with Bone Loss on Jaw?
The other option is to anchor implants where there is bone that did not resorb ( cigomatic implants, pterigoid implants) and do an inmediate loading.
It is a question of deciding what is your best option and develop the appropriate treatment plan...
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.