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Feb
10

I can’t have dental implants… I don’t have enough bone

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I hear this a lot from patients. Usually they were told this some time ago, and at the time it was probably true. Dental implants require bone to be placed, without the bone the implant would just float about and come out, being not much use to anyone.

So the bone… What happens to it? Where does it go? Once a tooth is removed, the bone will start to resorb (disappear). That’s the body’s reaction to losing a tooth; the bone is only there to keep the tooth in place, and without the tooth, there is no reason for any bone.

How long does it take for the bone to disappear? Well that’s really tricky to say, as some patients seem to maintain bone very well, despite the period from when the tooth was removed. Others seem to lose bone VERY fast, usually within a few months. The upper jaw is usually worse affected, due to the upper sinuses putting pressure on the ridge of bone. Think of it as real-estate, the sinuses (the air chambers in your head) which are above your teeth, want to acquire more space, and once the teeth are gone, the sinus will expand to occupy more room, in order to do this, you lose bone. If this does happen, we take back some space by carrying out a ‘sinus lift’ (I will explain this within a future post).

As dentists, we can replace human bone with substitutes. These can be from yourself, your own bone; we’d cut a chunk out of your hip or your lower jaw, and bolt it onto the area that’s lacking. This is a bit dramatic (yes that face you just made… that’s what my patients usually do when I offer this service). It is useful in areas where A LOT of bone is missing. It’s considered big surgery and requires some careful thought.

Thankfully, this isn’t very common; most patients require simpler bone graft procedures. This can be using an artificial source of bone, which comes from a lab (totally artificial) or an animal. When the animal bone reaches the dentist, it’s not a lump of cow or pig. It’s almost a fine crystal. Think of rock salt, and you will be close. This is the inorganic part of the bone, which has been treated to remove all organic material. It is mixed with blood or saline and added to the deficient site. Once added, it is covered with a membrane to stop the gum growing into it, acting as a barrier. Over time this is said to form ‘bone’. I put bone in inverted commas, as it depends what your definition of bone is. In my opinion, this stuff doesn’t always form hard solid bone, as we would associate with the word, but a softer halfway house. Research has shown this to be an effective alternative to using blocks of your own bone.

The technology in this field is developing at an accelerated rate, and hopefully one day soon, we will be able to take some cells from you, grow your own new bone in the lab and then re-introduce it into the deficient site. The possibilities are endless, but the best part is that all these developments will ultimately benefit the patient.

Dr Nilesh R. Parmar BDS (Lond) MSc (ProsthDent) MSc (ImpDent) Cert.Ortho was voted Best Young Dentist in the East of England in 2009 and runner up in 2010. He was shortlisted at the Private Dentistry Awards in the category of Outstanding Individual 2011 and received Highly Commended for Best Dentist South at the 2013 Dental Awards.

Nilesh Parmar

Nilesh has a master’s degree in Prosthetic Dentistry from the Eastman Dental Institute and a master’s degree in Clinical Implantology from King’s CollegeLondon. He is one of the few dentists in the UK to have a degree from all three London Dental Schools and has recently obtained his Certificate in Orthodontics from Warwick University. His main area of interest is in dental implants and CEREC CAD/CAM technology.

Currently studying for his MBA at Imperial College, London, Nilesh runs a successful seven-surgery practice close to London and is a visiting implant dentist to two central London practices. Nilesh has a never-ending passion for his work and is famed for his attention to detail and his belief that every patient he sees should become a patient for life. He offers training and mentoring to dentists starting out in implant dentistry, more information can be found on his website www.drnileshparmar.com.

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