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Strong healthy teeth and gums are extremely important to your overall health, appearance, and self-confidence. Periodontal disease, which is a bacterial infection of the teeth and jawbone, is today’s number one reason for tooth loss in adults. When you lose a tooth - through periodontal disease, decay, or trauma - it should be replaced as soon as possible. Ideally the tooth should be replaced permanently. A dental implant-supported porcelain crown is often the best solution. A permanent tooth replacement (crown) that matches your natural teeth is attached to a root replacement (dental implant) which is gently placed into the jawbone.

Whenever a permanent tooth is lost, the surrounding and supporting bone is also lost. Periodontal disease destroys the jawbone around a tooth, which, in turn, causes tooth loss. If a tooth is removed because of decay, the bone is often lost in the extraction process. However, no matter how a tooth is lost, its supporting bone structure begins to shrink (atrophy). Bone atrophy is a serious problem that sometimes cannot be adequately corrected with bridgework or dentures. Severe jawbone atrophy can lead to cosmetic changes in the structure of a patient’s face and cause the appearance of premature aging. Only a permanent tooth replacement, such as a dental implant and crown, can prevent bone loss.

Today, almost anyone who has lost a tooth or teeth is a candidate for permanent tooth replacement. Age is not a limiting factor. As long as you are in good health, and have no extenuating medical conditions, you may be able to receive permanent tooth replacements.

In the past, the quantity and quality of a patient’s jawbone could make permanent tooth replacement difficult, unadvisable, or impossible. If too much bone had been lost through disease, trauma, or atrophy, implants could not be predictably inserted. Fortunately, there are now a wide variety of regenerative procedures that are available to correct problems of bone deficiency.

The preferred procedure for regenerating bone quantity and quality is a bone graft using the patient’s own bone. This procedure is called an autologous graft or autograft. Synthetic materials and bone bank materials can also be used, but the success rate is not yet as high as with an autograft. With future advances in biotechnology, the need for autografts will diminish. Until these genetically engineered or purified substances are available to doctors, techniques using the patient’s own bone are best.

If the need for grafting is not extensive, then bone from the mouth area is used. Bone is often borrowed from where the wisdom teeth were or from below the lower front teeth. The area from which the bone is borrowed is not weakened and does not create visible changes. Removing and grafting bone in the mouth is not considered to be major surgery. It is routinely performed in the periodontist’s office and requires only local anesthesia. The procedure is not particularly painful, and most patients need only one day of rest before they can return to their normal activities.

If extensive grafting is required, then other parts of the body are used as donor sites. Very often, bone marrow (the tissue filling the cavities of bones) is borrowed from either the hip or the top of the tibia (the larger of the two bones of the leg between the knee and the ankle). The tibia is an excellent source of bone for grafting. Feel just below your knee. Notice how thin the skin is in this area. Access to the tibia in this area is easy; it heals quickly, and leaves only a tiny scar. If bone marrow is borrowed from this area, then the procedure is generally performed in an outpatient surgery center with the assistance of an anesthesiologist and orthopedic or plastic surgeon. As with the jaw, borrowing bone marrow from the tibia does not weaken it.

In the past, patients have been told they were not candidates for permanent tooth replacement because their sinuses were too large, too low, or in the way. Sinuses are air spaces above the upper back teeth. They vary in size from person to person. Sinuses tend to get larger as we grow older. They also enlarge when upper back teeth have been lost. However, with today’s bone grafting techniques, sinuses can be gently manipulated to allow for permanent tooth replacement. The only exception to altering the sinuses is when a person has an active sinus condition or is a heavy smoker.

Today virtually everyone can receive permanent tooth replacements. If bone quantity or quality is poor, it can be improved with grafting procedures. If the sinuses are in the way, they can be gently move out of the way without creating sinus problems. In rare cases, the mandibular nerve in the back of the lower jaw may be very close to where an implant is needed. Even in these cases, techniques and technologies are available to safely provide patients with permanent tooth replacement.

In summary, the statements, You don’t have enough bone to place an implant, and You can’t permanently replace that tooth should never be made or accepted today.

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