Bone Loss and its Treatment
What causes bone loss?
Bone loss is a common consequence of loss of teeth and chronic periodontitis. In the case of periodontitis, the bacteria gradually eats away at the underlying jawbone and at the periodontal ligaments that connect the tooth to the bone.
The most common cause of bone loss is tooth loss left unreplaced, especially multiple teeth. Jawbone is preserved through the pressure and stimulus of chewing. When that is removed through tooth loss, the bone “resorbs” (reabsorbs) into the body. In the first year after tooth extraction 25% of bone is lost, and this bone loss continues on.
Bone Loss Video
This bone loss occurs in the bone surrounding and supporting the tooth, known as alveolar bone. Alveolar bone forms the ridges in which the teeth are embedded. These ridges atrophy both vertically and horizontally.
Replacing teeth with full or partial dentures doesn’t solve the problem as the dentures exert a very small amount of chewing pressure on the bone compared to natural teeth, as low as 10% or less.
Removal of the molars in the upper jaw can cause additional resorption of the bone due to expansion of the sinus cavity. With no teeth in place, the air pressure in the sinus cavity can cause resorption of the bone lining the sinuses.
Other causes of bone loss
- Bone loss can also be caused by misaligned teeth, creating a situation where normal chewing doesn’t occur, causing loss of the needed stimulus to the bone.
- Bone can be lost through infection that damages the bone.
- A large tumor in the face may require removal of the tumor and some of the jaw.
Bone loss and dentures
Dentures can accelerate bone loss by wearing away at the ridges of bone they are placed on. Every time you bite down or clench your teeth you are placing pressure on the ridge, resulting in its resorption. This is a primary cause of continual problems on getting dentures to fit, of sore spots and difficult or painful chewing.
People who wear dentures can experience another severe consequence of bone loss: collapse of the lower third of their face.
The loss of the ridge bone brings your chin closer to the nose, causing your jaw to jut out and your nose appears to stick out further because your upper lip has puckered in. Deep wrinkles appear around the mouth and the cheeks develop “jowls”— sagging skin. This facial collapse can appear to age you by many years!
Preventing bone loss
Bone loss can be prevented by giving the jawbone a replacement tooth with a root that can exert the same or similar pressure as natural teeth. This is done immediately after extraction by replacing single teeth with dental implants, or by using a fixed implant-supported bridge or denture.
A single-tooth implant or a dental bridge with three to four teeth supported by two implants provide a chewing power of 99% of natural bite force. A denture secured with dental implants, such as our Same Day Teeth procedure, provides about 70% to 80% of normal biting force and helps considerably in preventing bone loss.
What about loss of bone density?
When bones loses density it becomes more porous. Density loss is much less common than loss of bone volume, but is something we need to watch out for. Bone can lose density because of a variety of factors, including diet, hormonal imbalance, disease, lifestyle, and even tooth loss.
We can detect low density bone ahead of time using our 3D cone beam CT scanner to capture 3D images. The whiter the color of the bone in the X-ray, the denser it is. We can then avoid these areas of low density, or take precautions by using special implants with a surface that draws the bone to it, which creates denser bone around the implant.
Bone Grafting Video
In cases where bone has already been lost, bone grafting might be needed to provide enough bone for dental implant placement. We need enough height of the ridge for any teeth replacement with implants, and when replacing the back teeth (molars), we also need enough width.
We also use bone grafting to repair damaged and lost bone around teeth that have suffered from severe gum disease.
A bone graft not only replaces lost bone, it also stimulates the jawbone to regrow and eventually replaces the bone graft with the patient’s own, healthy bone. We use a variety of different types of bone graft material, depending on the patient, including new cutting-edge materials that require less healing time.
Drs. Henriod and Miller can often place the bone graft at the same time as the implant unless the bone loss is severe, in which case it might need to be done as a separate procedure. They use minimally invasive methods, including a gentle laser.
When your upper back teeth have been removed, the ridge bone resorbs and the sinus cavity expands, so that eventually the bone separating the sinus cavity and the oral cavity is very thin.
Dental implants can’t be placed in such thin bone and in these cases Drs. Henriod and Miller will do a sinus lift. The sinus is raised by gently pushing up the membrane lining the sinus away from your jaw and packing in bone graft material into the space where the sinus cavity was. Once the bone graft material has fully integrated with the jawbone, we can place your implants.
When bone loss doesn’t need bone grafting or sinus lifts
The good news is that we can help many patients get implants without any kind of bone grafting through the use of our 3D cone beam CT scanner. This breakthrough technology allows us to see the teeth, jaw and related structures in full 360º view. We can measure the exact width and height of your ridges and assess how much, if any, bone grafting is actually needed. In many cases we can find enough bone to use for implants.
The 3D scanner also permits us to perform procedures such as full-mouth teeth replacement, which can be done using just four implants per arch placed where we can take advantage of the bone available.
To make an appointment, call 626.796.5386 or click here to request an appointment online.