Do you have missing teeth and avoid laughing at the jokes of your friends for fear that someone will notice the space? If the answer is YES, then you are the perfect candidate for dental implants.
Few people know, however, that dental implant is like a home and needs a solid foundation to withstand any earthquake. In other words, there are some minimal bone conditions in which insertion of dental implants is possible. We invite you to read the following article to find solutions, advice and choose the right way to get great and enviable smile.
What does minimal bone conditions for placing dental implants mean?
The bone should be tall and thick enough for a dental implant to fit into it. Like architects, dentists have set some limits, some conditions called “minimum” or “limit” for the insertion of dental implants.
The minimum size is indicated by the dimensions of the implants which the doctor decided to operate with and differs depending on the arcade and the region of the tooth to be implanted.
Therefore, the minimum thickness of the bone in the upper jaw and in the lower jaw should be at least 2 mm greater than the thickness of the implant used.
The narrowest implants existing on the market are 2.5 mm and the minimum thickness of the bone should be 4.5 mm, of course, if you are using this brand of dental implants.
However, usually a little thicker implants are used, 3 – 3.5 mm and in this case the minimum thickness of the bone should be 5 – 5.5 mm.
The minimum height of the upper jaw bone can be equal to the length of the implant. If the surgeon decides to use the shortest implants, which are approximately 5 mm, the same should be the minimum height required to insert the dental implants.
In the case of the mandible (lower jaw) the bone must be at least 2 mm higher than the length of the implant in the regions where the mandibular nerve passes (region of the premolars and molars). So, if we use the same 5mm dental implant in the lower jaw, the minimum bone height would be 7mm. It is important to note that in these areas only the height of the bone present up to the level of the nerve is calculated, not the total height of the mandibular bone. Rarely, however, there are fortunate patients who indicate a favorable position of the mandibular nerve and sufficient bone in thickness, thereby allowing the surgeon to insert longer dental implants, “avoiding” the mandibular nerve. In these rare cases, the height of the bone up to the nerve could be 5 -6 mm and the implant length could be 8 or even 10 mm.
In the frontal area of the jaw, the nerve does not pass and the bone atrophy is slower, so longer implants can usually be inserted.
As to determine the minimum bone conditions for the insertion of dental implants, it is necessary to measure both the height and the thickness of the bone, with millimeter precision, making a computed tomography becomes a necessity and helps to make the right and justified decisions.
What are the options you need to look at since you have “minimal” bone conditions for dental implants?
If you are in a situation where the bone conditions are at the limit, there are 2 possibilities:
- Insert the dental implant in existing bone conditions;
- Improve the bone conditions and then insert the dental implant.
Below we will explain the advantages and disadvantages of both possibilities. For several reasons, some doctors will propose the first option and other specialists may recommend the other. This is also the starting point for explaining the different estimates that you might receive when looking for a dental clinic to treat your teeth. The goal we have set out in this article is to make you understand first of all the situation you are in and the existing alternatives with their particularities. It is the patient who has to make the decision, taking into consideration several external factors that may or may not influence the chosen alternative (the requirements regarding the number of final teeth for each arch, the aesthetic result, the age, the state of the health, the hygiene, the time required proposed to finish the treatment and the budget).
The advantages and disadvantages of the two possibilities of inserting implants in minimal bone conditions.
In the table below we have made a comparison between the two options for implant placement when the bone conditions are minimal, indicating their particularities.
Probably the most difficult and important thing is to make the right choice of the treatment (in order to help you please read the article ‘How to choose the right estimate’), especially when the bone conditions are at the limit. We have decided to present in the following table both the advantages and the disadvantages of each option to make the idea easier. We hope it will be useful for you!
| Criterion | Implants placed in existing bone conditions | Implants placed in improved bone conditions |
| Professional qualification of the attending physician | Placing the implant in such conditions is an ordinary surgical procedure, so it is possible to go to any implantologist surgeon. | The improved bone conditions consist in making the bone increase both in thickness and in height. Therefore, it is important in this case that the attending physician has extensive experience in bone regeneration and reconstruction techniques. |
| Treatment duration | The treatment in this case will last 4 to 6 months and will have 2 main phases (in the first phase the implants will be inserted, and in the second phase the crowns will be fixed over the implants). | The treatment could take from 4 to 12 months. If you choose to improve the conditions of the bone, it may be possible to place the implants in the same time with the bone graft (therefore 2 visits), or it may be necessary to make one more visit (first stage – we do the augmentation, second stage-after 5-6 months – the implant placement, third stage after 4-6 months – the fixation of the crowns over the implants. |
| Invasiveness | The incision of the gum will be minimal and, depending on the number of implants that are inserted, the sutures may be necessary or unnecessary. (For more detailed information, read the article “Obtain dental implants with the help of the surgical guide”) | The bone graft involves a quite invasive bone manipulation, which involves making a cut in the gum of the entire quadrant of the oral cavity in which the implants will be inserted. Depending on the type of bone augmentation, it may be necessary to make an autologous block bone graft, taken from another area where bone conditions are favorable (usually from the area of the wisdom teeth and chin) and fix the bone block in the problem area. Therefore, additional trauma may occur in order to improve existing bone conditions. |
| Temporary prosthesis during the integration of dental implants | Provisional prostheses are not recommended in any of these cases (find out why, by visiting the link “Insertion of implants: how to avoid complications”). However, if circumstances do not allow you to remain without teeth during the osseointegration period, you can use a temporary prosthesis. | After performing a bone augmentation surgery, the prosthesis is absolutely forbidden. If you are in this situation and still circumstances do not allow you to remain without teeth during the osseointegration period, do not worry, ask your doctor what other alternatives exist in your case. |
| The effectiveness of chewing | Usually, the bone begins to atrophy, starting from the lateral areas of the jaw and reaching the frontal region. If the bone conditions of the whole quadrant of a jaw are at the limit, then in the region of tooth 7 (the last tooth, except the wisdom tooth) the bone may be very low or thin. In this conditions the last implant can be inserted at the level of the 6th missing tooth or even at the level of the fifth missing tooth. As a result the patient will have a tooth or two less than normal, which will lead to a decreased effectiveness of chewing. | As bone conditions will be improved, it is more likely that the right amount of implants will be inserted in favorable position in order to obtain a full arch of teeth. The maximum number of teeth guarantees a much higher chewing efficiency. |
| The cost | This criterion is relative, and although this first possibility seems to be cheaper than the alternative of doing bone reconstruction, it may not be so at the end. Trying to fit into existing bone conditions, placing 2 or more implants in an asymmetric way, with different inclinations, it may be necessary to use special platforms, a system of screws (abutments) designed to change the angle of the implant direction , which would allow us to get the right position of the definitive crowns. This platform has an additional cost that varies from one implant brand to another. | The cost is certainly higher than in the first option, but having good quality of the bone we have the possibility of inserting parallel implants which means that we are no longer obliged to use the special platforms to change the angle and to get the right position of the definitive crowns, though these platforms are always recommended. In bone reconstruction interventions, as a consequence of the increase in bone volume, the initial volume of the gum may not be enough to cover the entire reconstructed area. For this reason, it may be necessary to perform a gingival transplant to cover all the obtained bone volume. It could mean additional costs. |
| The aesthetic results | If the bone in the edentulous area recedes and is below the bone level around the remaining teeth, then this natural bone loss must be recovered by the shape of the future teeth. For example, if the tooth in mature bone conditions was 5 mm, and now the bone receded by 3 mm. the dentist will have to create an 8 mm tooth to bring it to the level of the remaining teeth and recover the lost bone. A very long tooth does not look nice. | If the maxillary bone has receded and you decide to recover this loss by performing a reconstructive bone surgery (artificial bone graft or autologous block bone graft), then we will obtain a normal bone level (as it was before atrophy). Bone reconstruction will help us to reproduce a beautiful and natural shape of the future tooth. |
| Durability | In this case, the surgeon guarantees the implant placement in existing (minimal) bone conditions, but can not ensure a correct position or inclination that affects the duration of the prosthetic work. (For more details, read the following article: The consequences of inserting implants “where there is bone”). | As already mentioned at the beginning of the article, the more stable the foundation is, the longer the house will last. We can follow the same principle in implantology. Under improved bone conditions, the surgeon will insert the implant in the most favorable position to provide an ideal support for prosthetic work and to increase its lifespan. |
Concluding reflections on the insertion of dental implants in minimal bone conditions
If you have difficulty making a right decision about dental care, our advice is to consult a doctor who specializes in both situations. If you refer to a surgeon who only does dental implants, he may not be very honest and plan the position of the implants under existing bone conditions without informing you of the second option and the particularities of both possibilities. On the other hand, if you refer to a dentist who already has a positive experience in bone reconstructive surgery, you will certainly be informed of both options and make the decision together with the doctor, taking into account the external factors that could influence your decision: state of health, age, esthetic needs, hygiene and the number of teeth you want to get at the end of dental care.
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