Short answer: Many people with insufficient jawbone can still get implants. First, the height, width and density of the bone are measured with a dental CT scan. If the bone deficiency is mild, short or narrow implants may be used; if it is moderate, a bone graft or, in the back of the upper jaw, a sinus lift may be performed. For very advanced bone loss in the upper jaw, zygomatic implants are among the options. Which method is suitable is determined after an examination and imaging.
Many people who want an implant years after losing a tooth hear the sentence "you don't have enough bone" at their examination. In most cases this does not mean an implant is impossible; it only means the planning will be somewhat more extensive. Insufficient bone is a common situation in implant treatment today, and many methods have been developed to address it. In this article we explain the causes of bone loss, how bone is measured and which solutions can be applied.
Why does bone become insufficient?
The jawbone most often becomes insufficient because, after a tooth is lost, the bone in that area is no longer stimulated and gradually resorbs. During chewing, teeth transmit forces to the bone and keep it alive. After an extraction, this stimulation stops and the bone loses both width and height, especially in the first months.
Other main causes of jawbone resorption:
- Advanced gum disease (periodontitis): The bone surrounding the teeth starts to resorb while the teeth are still in the mouth.
- Long-term use of removable dentures: The pressure a denture puts on the bone can accelerate bone resorption over the years.
- Traumatic extractions and accidents: A difficult extraction or facial trauma can cause part of the bone in the area to be lost.
- Infections and cysts: Chronic tooth infections and jaw cysts can create defects in the bone.
- Enlargement of the sinus cavity: When the upper back teeth are lost, the sinus cavity expands downward and reduces the bone height needed for an implant.
For this reason, if an implant is planned after an extraction, preventive methods such as filling the socket with a bone graft at the time of extraction can make the later process easier.
How are bone measurement and CT scanning done?
Before an implant, bone adequacy is evaluated most accurately with a dental (cone beam) computed tomography scan. Although a panoramic X-ray gives a general idea, because it is two-dimensional it does not fully show the width of the bone or its relationship to nearby anatomical structures.
The main features evaluated on the CT scan:
- Height and width of the bone
- Bone density
- The position of the sinus floor in the upper jaw and of the mandibular nerve in the lower jaw
- The condition of neighboring tooth roots
This data is used in digital planning software to plan the implant's size, angle and position. When necessary, a surgical guide is prepared so that the implant can be placed in the planned position in a more controlled way. Dental CT is a low-dose, quick imaging method.
What is a bone graft and how is it applied?
A bone graft is bone or bone-like material applied to increase bone volume in an area that is insufficient for an implant. Over time, the graft is replaced by the body's own bone, creating a solid foundation for the implant to anchor in.
Types of grafts
- Autogenous graft: Bone taken from the patient's own body, usually from inside the mouth.
- Allograft: Human-derived bone tissue processed in bone banks.
- Xenograft: Bone mineral, usually of bovine origin, that has undergone special processing.
- Synthetic (alloplastic) graft: Bone-like materials produced in a laboratory.
Methods of application
For mild to moderate loss, the graft can be applied in the same session as the implant and covered with a protective barrier (membrane); this method is called guided bone regeneration. For more advanced loss, bone augmentation is done first, and the implant is placed after the bone has matured, usually a few months later. Which path is followed depends on the amount and shape of the loss.
What is a sinus lift?
A sinus lift is a procedure in the back of the upper jaw in which the membrane forming the floor of the sinus cavity is gently lifted and bone graft is placed beneath it to achieve the bone height needed for an implant. It is a frequently used method after the loss of upper molars.
- Closed sinus lift: If the existing bone height is above a certain amount, the sinus floor is raised slightly through the implant site, and the implant is often placed in the same session.
- Open sinus lift: If the bone height is very low, a small window is opened from the side and graft is placed. Depending on the amount of bone, the implant is placed in the same session or after the bone has matured.
The procedure is done under local anesthesia. Mild swelling may occur for a few days afterward; not blowing your nose and following your dentist's recommendations are important for healing. If there is an active sinus infection, it needs to be treated before the procedure.
When are short, narrow and zygomatic implants preferred?
In some cases where a bone graft or sinus lift is not wanted or not suitable, special implant designs adapted to the existing bone may be preferred.
Short implants
When bone height is limited, implants shorter than standard implants can be used. There are studies showing that, in suitable cases, short implants can deliver reliable results without the need for bone augmentation procedures.
Narrow implants
When the bone is narrow, or when space between neighboring teeth in the front area is limited, narrower-diameter implants may be an option. However, narrow implants are not suitable for every area or every load; the decision is made taking chewing forces into account.
Zygomatic implants
For patients with very advanced bone loss in the upper jaw, long implants anchored in the cheekbone can be used. This is an advanced surgical method performed by experienced oral and maxillofacial surgery teams with detailed planning.
Treatments popularly referred to as "boneless implants" are not actually implants that don't need bone; they are approaches like these that make use of the existing bone differently or reduce the need for bone augmentation. Every implant functions by anchoring in bone.
Is it possible to prevent bone loss?
Although it is not always possible to stop bone loss completely, in most cases slowing it down is within your control. If an extraction is unavoidable and an implant is being considered for the future, filling the socket with a graft in the same session as the extraction (socket preservation) can help preserve bone volume. Not postponing the implant for long after an extraction, getting gum disease treated early and having ill-fitting removable dentures replaced also help preserve bone. Quitting smoking is recommended because it negatively affects bone healing and the integration of the implant with the bone. Uncontrolled diabetes can also slow healing, so getting blood sugar under control before treatment is important.
How are the treatment duration and fee determined?
In patients with insufficient bone, treatment duration can vary from a few months to a year depending on the method used. Whether additional procedures are needed, the materials to be used and the number of implants also affect the fee. This information is provided in writing after the CT scan and examination. For other frequently asked topics about implants, see our frequently asked questions page.
When should you have your bone loss evaluated in Ankara?
If you were previously told an implant wasn't possible because of insufficient bone, if you have been using a removable denture for a long time or if an extraction is planned soon, an evaluation with an up-to-date CT scan will clarify the options suitable for you. At our polyclinic next to Panora Mall in Oran, Çankaya, we examine your bone structure with three-dimensional images and explain the suitable method and stages to you in detail. To book an appointment, take a look at our contact page.
Frequently asked questions
Can everyone with bone loss get an implant?
In many patients, implants may be possible with a bone graft, a sinus lift or special implant designs. However, nothing definitive can be said without evaluating general health, the degree of bone loss and the anatomy; the decision is made after a CT scan and examination.
How long do you wait for an implant after a bone graft?
The graft can be applied in the same session as the implant, or, in cases of advanced loss, there is usually a wait of a few months for the bone to mature. The timing is determined by the dentist based on the method used and how healing progresses.
Is a sinus lift a painful procedure?
Because the procedure is done under local anesthesia, you do not feel pain during it. There may be mild swelling and tenderness for a few days afterward; this is usually kept under control with the care and medication your dentist recommends.
Do boneless implants really exist?
No, every implant functions by anchoring in bone. Treatments referred to as boneless implants are methods such as short, angled or zygomatic implants that make use of the existing bone differently or reduce the need for bone augmentation.
