Bone Reduction Leveling For Dental Implants to Avoid a Bone Graft

stimulation of bone reduction leveling to take off the skinny part of the jawbone.  This is the jawbone in cross section.

Bone leveling is a procedure called “alveoloplasty.” Bone leveling is extremely beneficial in cases where a bone graft can be avoided altogether. Especially in the lower jaw when the bone atrophies, (melts away) what’s left of the bone is just a skinny spine knife edge type of ridge where the teeth used to be. That skinny knife edge ridge will not allow a normal size implant to fit inside of it.

stimulation of bone reduction leveling to take off the skinny part of the jawbone.  This is the jawbone in cross section.

stimulation of bone reduction leveling to take off the skinny part of the jawbone. This is the jawbone in cross section.

What’s interesting about our jawbone especially in the lower jaw and even in the upper jaw is it is shaped like a triangle if you look at it in cross section. The top of the bone is the apex of the triangle which is skinniest and the bottom of the bone is the base of the triangle which is the widest. So if your bone is really skinny at the tip and is wider at the base, a bone leveling alveoloplasty reduction procedure can take top of the triangle off leaving a wide base of bone to place the implants.  The procedure has minimal risks.

I do this very commonly when replacing implants in the lower jaw when all teeth are missing. This serves many purposes. One purpose for leveling bone is to avoid bone grafting. A second purpose would be to provide bone around the entire head platform of the implant. Finally, bone leveling for dental implants reduces cost to the patient and decreases the time until you get your final teeth… A win-win situation!

Bone reduction alveoloplasty example (1)

Before —note uneven bone that is higher in the front of the mouth where some broken roots remain

Bone reduction alveoloplasty example (2)

Before —note uneven bone that is higher in the front of the mouth where some broken roots remain

sample real case bone reduction for dental implants (1)

Before —note uneven bone that is higher in the front of the mouth where some broken roots remain

sample real case bone reduction for dental implants (2)

After –simultaneous extraction, bone leveling and placement of four dental implants….this is healing at one month

Bone reduction alveoloplasty example (3)

After -Bone reduction alveoloplasty example

Why don’t we just do this for all implants?

Why is this only limited to full arch replacement such as a Prettau dental implant bridge or when replacing large segments of teeth?

The reason is that it makes the teeth longer from the gum line to the top of the tooth. If you are missing all of your teeth bone leveling (as opposed to bone grafting ) can be extremely beneficial because it provides thickness to the overdenture or fixed dental implant bridge such as the Prettau.

Having significant thickness of your bridge will prevent problems that you may not think about such as breaking your bridge or breaking your implant overdenture. This happens so commonly when the depth of the implant is too shallow and a full arch zirconia, hybrid all on 4 bridge or overdenture case is made and the material was so thin that it just breaks in half or the teeth chip or fracture off.

Bone leveling reduction alveoloplasty can be very important for replacing all upper teeth also especially if you are missing gum tissue. Sometimes we have to use pink tissue ceramic colored porcelain to mimic lost gums. You never want this transition between the prosthetic pink gum and your natural gum to show when you smile. Although the pink gum tissue looks very natural, it does not look natural if you see the line between the two in full smile. So sometimes a bone leveling reduction alveoloplasty is done in order to hide the transition. I have been doing this procedure for at least 15 years as of 2015.

Other Benefits

Another other benefit is the bone shavings can be used to graft another area of the mouth that may need bone! This can be combined with L PRF/PRP (made from your own blood)  and other bone grafting materials to as your own bone and make a composite bone graft that is extremely successful.

Bone leveling is also important to make sure that the heads of all the implants are all relatively on the same plane. It is extremely common for the lower jaw to be missing more bone in the back and the bone to be sticking up in the front. This bone that is sticking up in the front is usually reduced for thickness purposes and to make sure the implants are at a good level with the rest of the bone and the other implants. Typically I do this procedure when I am placing anywhere between 3-10 implants in the jaw. It also allows for the gum to be closed very well and stitch in such a way that the gums almost always touch each other. This is called primary closure and leads to fast healing from surgery.

What is the disadvantage of this procedure?

If bone leveling reduction alveoloplasty is used in the wrong location, such as a single missing tooth, you will end up with a huge, open black triangles between your teeth. It is not meant to be used in cosmetic areas of the mouth such as upper front teeth. These areas are better served with bone grafting than bone reduction leveling. It is meant to treat long span missing teeth or when you are missing all teeth. Bone reduction alveoloplasty needs to be carefully planned from a full set of photographs and a 3-D scan. The point is to take away just enough bone but not too much.

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17 thoughts on “Bone Reduction Leveling For Dental Implants to Avoid a Bone Graft

  1. slw

    Hi Dr. I live in Reno Nv and have been seeing my dentist to try and get implants. Latest information is I don’t have enough space for them. I was told ortho could help give me the space needed but was later told it wouldn’t work after seeing the orthodontist. I’ve been asking and wondering if I could just have my bone reduced to give me space and move on to implants but it seems my primary dentist doesn’t respond well to that idea. Seems like my only option. I really would like to have you evaluate my situation. Maybe I can get there someday. How long is the healing process when bone is reduced? Thanks

    1. RamseyAminDDS Post author

      bone reduction alveoloplasty is generally a bad idea for single front teeth dental implants. This concept is usually used for multiple dental implants that are placed adjacent to one another.

  2. chiupo Liu

    Dear Dr Ramsey A.Amin
    I am sixty years old. one of my lower incisors was lost over four decades . And was told by a G P saying that the space of my bone Gums (less than 2mm)is not big enough for me to implanted even if making bone grafting. Was it ture? And what of the effect is to bone?
    Best regards!
    Paul Liu

    1. RamseyAminDDS Post author

      if there are teeth on either side and the spaces too tight you run the risk of killing the teeth on either side. Ideally would like to keep a minimum of 1 mm away from teeth on either side of a single tooth implant.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  3. Sheila Webber

    Hi Dr . Amin, Thank you so much for your informative articles. I live in Alabama and I would use you if I could go CA. but I am barley getting by and I will have to use a oral surgeon in Birmingham . He has quoted me a price of $ 4,400. 00 for bone leveling . Is that a far price. Thank You Sheila

    1. RamseyAminDDS Post author

      hmmm…..are the extractions and sedation included in the cost? is just the total cost of your treatment or just of the bone leveling alveoloplasty?

      1. jacquiline fraga

        Dr. ? do you have a team in Huntsville Alabama, im about to go full on , on fixing my mouth, im gonna use my credit card,,, but I have been saving up for implants since I was 35, im 49 now, im seing a mini implant Dentist in Huntsville and he recommended, bone grafting, then some mini implants, and some real implants, and I don’t understand a thing he said, or was saying . anyhow, he gave me an estimate which is some 10 thousand dollors and month and months of work… good lord Dr. is it worth going through all that? should I just have partials for my back mouth till I die? im terrified of dentist , that why I waited so long to go at it, Philippines, 2 root canals and 4 extractions at age 12, WITHOUT NOVACANE… it was free.. and my single mom thought it was for the best… im still traumatized, but I feel its for the best…for myself.. but watching your video made me think about all sorts of things.. im shaking right now as I type… what should I do?

        1. RamseyAminDDS Post author

          Find a great dentist that can just put you under IV sedation and have your dental work done that way. It is extremely common in my practice and you will sleep through the whole process. It isn’t very often that a patient has to transition through miniature dental implants then do real dental implants.
          I hope you have explored all of your options to the fullest extent. There are a number of ways to build your mouth to last for decades and there are other treatment plans that tend to fail about 10 years after treatment.

  4. Rajendra Patel

    Dr Amin
    After tooth extraction I am having semi liquid food and now soft food with help of jaws. Since last six months. Now some pain has started to my jaws muscle radiating that to head and neck and ear also acidity and naseua type feel but all bearable and for denture I have been referred to oral surgeon as while extraction dentist didn’t do any filing of the bones which has come out please opine in the matter

    1. RamseyAminDDS Post author

      If you had bone exposure this can cause a significant amount of deep pain. Typically this resolved in 1 month after surgery. This does not happen often.

  5. T Edwards

    Dear Dr. Amin,
    I second the post made by Janel Williams and also want to thank you for the information you so meticulously explain in your videos and articles. It has allowed me to educate myself and ask appropriate questions to find the best possible team available in my area. I knew not only what to ask, but what to tell my team to help them understand my situation and goals.
    Thank you so much for your time and extending everyone in this difficult situation your years of knowledge. I will also tell all my friends and colleagues from California where to go when they need treatment by an expert and gifted educator.

  6. Janel Williams

    I have been reviewing your website for information. I can not afford to see you but I want to tell you how wonderful your site is and how much I appreciate reading the information that I needed to know. I will recommend you to my friends and family in LA when they need the services you offer. Again, thank you for making this information available to everyone. Your expertise is amazing. No one else I talked to seemed to be able to give me the information on options for dentures and implants that you have on your site. I have been feeling very confused and uncertain. It makes me feel less frightened and more hopeful about my advanced gum disease. Thank you.