Dental Implants: Do I need to work on my bone structure first?

Dental implants have been around for years, and with perfect reason: They are the most successful way to replace teeth. Their success rates are well over 95%, and their lifespan extends beyond 15 years on average.

Dental implants are probably the right choice if you are missing a tooth or a group of teeth. But how are they placed? Is the surgery painful? Can everybody get implants straight away? Let’s cover some basic things first.

How are dental implants placed?

Dental implants are usually placed on two stages:

• The surgical stage:
A screw-like structure is placed inside the bone and left to heal for some time (usually between 3 and 6 months).

• The prosthetic stage:
Where the overlying crown will be placed after the bone healing period.

Are dental implant procedures usually so straightforward?

If you seek replacement as soon as your tooth is lost, then chances are the procedure will be smooth and easy. Just a simple half-hour procedure to place the screw in the bone, followed by a few stitches, with very minimal post-operative pain or swelling.

Waiting, however, has a lot of detrimental effects, mainly:

• Sequential loss of bone structure:
When a body organ isn’t used, it starts to weaken and fade away. The jaw bones’ main job is to hold the teeth in place, so when the tooth is lost, that function is also lost. Over time, the bone starts to degrade both in height and width.

• Recession of the gums:
The bones and teeth hold the gums firmly in position, so the gums usually follow when one or both are lost.

• Enlargement of the sinus space:
The maxillary sinus (a space of air that helps with breathing) is located just above the roots of the upper back teeth. With age and tooth loss, that space enlarges and creeps into the surrounding bone. The result is a very large sinus and very little bone in the area.

What happens in these cases?

That’s where bone and soft tissue improvement surgeries come in. The bone has to be in perfect condition before placing a dental implant since the implant’s success mainly depends on the bone’s healing process. The area must be conditioned to receive the implant to ensure its success.

If the bone condition is not optimal, we risk placing too much stress on the implant during healing, which could eventually lead to its failure. The failure may not be immediate, and your implant could stay in your mouth for a while, but the projected 15 years or more of service is cut short.

These improvement surgeries include:

• Bone grafting:
This means adding to the existing bone, improving its quantity (both in height and width) and quality. The bone can be autogenous (meaning it comes from your own body) or synthetic.

• Sinus lifting:
Sinus lifting is a supplemental bone improvement surgery. It is the same as bone augmentation but with an added touch: The sinus lining is “lifted” upwards and held in place by the bone graft. In the end, we get more bone height for implant placement.

• Soft tissue grafting:
The bone is not the only factor for the success of dental implants. The gums overlying the bone must also be healthy, strong, and adequate. If the gums have receded significantly while you were without teeth, they need to be improved by grafting like the bone.

That all sounds scary and complicated; is it worth it?

It isn’t. Both procedures are more straightforward than you think. In fact, in most cases, they are done simultaneously with the implant placement, so you will only undergo one – very minor – surgery. However, in cases of severe bone loss or sinus enlargement, the surgeon will opt for a 2 stage surgery, one where the graft is placed and one for the implants about 4 to 6 months later. It will only add a few months to the treatment plan but will undoubtedly improve the longevity and success of your implant.

Choosing a bone improvement surgery is far better than another form of tooth replacement. Not to take anything away from dentures or bridges, but none come close to dental implants’ comfort, success, and lifespan.