Dental implants without bone? How can that be done? If you don’t have any bone left at all, and you’ve been told there’s just not enough bone to get implants, what are your choices? In my office, I treat the most extreme of extreme patients. So when the bone is missing, you have two options.
One is to use the good bone that’s left. It may surprise you to find out that there is good bone available. And the second option is to rebuild the bone through bone grafting also known as bone rebuilding. In this video, you’ll discover the details for both options for how you can get dental implants without having any bone.
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Dental implants without bone, how can that be done?
Video transcript lightly edited for easier readability.
What if you don’t have any bone at all, you’ve been told there’s just not enough bone for this procedure? In my office, I treat the most extreme of extreme patients. So when the bone is missing, you basically have two different options. One is to utilize the good bone that’s left and that may not always be in the area that you think. And the second option is to rebuild the bone back through bone grafting, bone rebuilding. So let’s go with the first option of the concept of using the good bone that you have.
Some people have really tiny bone, they’ve lost all their upper and lower teeth and their face has sunken in and everything is just gone. Now the only way to really build back the bone with all missing teeth would be to take bone from your hip at the hospital and stick it in your mouth, and so doing hip grafting. A better option and I’ve written on this before, is called bone leveling and using the good bone that you have. It may be in remote locations. So let’s talk about the upper jaw.
If you have no bone, implants with no bone in the upper jaw, the solution, oftentimes is what’s called a zygomatic implant and I’ll post some links to that here as well. Zygomatic implants come this way. They are long, about maybe 45 millimeters long. They go into the good bone of the cheekbone. That’s very hard and you can put implants through the mouth and connect those up very easily. And again, I won’t belabor that point. I’ll put some links up for zygomatic implants.
Other options are what’s called pterygoid implants. Those go in different spots as well. Now instead of rebuilding the bone, they go back where the wisdom teeth used to be and where it looks like there’s no bone. 99% of dentists will not even know what that implant is or how it is placed or where it goes or they’ve never even heard of it. The same thing with zygomatic implants. It’s not a very common thing because it’s more difficult.
The other option in the upper jaw, so we’re talking about pterygoid implants, zygomatic implants and also implants that go into the base of the nose or they go trans sinus, they go through the sinus and into basically the side portion of the nose called the piriform rim. Those are all things in my practice I do on a daily basis to treat the patients that have no bone and not only do they have to have this surgery done, but they get teeth on the same day or by the very next day. It’s not wait and wait and wait for the bone to get rebuilt and then come back and have 50 appointments and two years later to finally get teeth. No, you get teeth the very next day and it’s an awesome procedure.
On the lower jaw, again, there’s usually some remaining bone in this area kind of in-between where the nerves end on each side. Even if it’s as thin as my pinky, I can generally still put implants in and make a fixed bridge. Sometimes I have to do alternatives like I need to move the nerve called the mental foramen. Moving the nerve is called repositioning of the nerve so that it’s in the way sometimes, those called the wires of the jaw, run through each side about right here. Sometimes I have to move them out of the way to put implants into the right spot. So these are obviously more extreme dealing with patients that have no bone at all but still want implants to stay in place. Not a snap-on overdenture that would have to come in and out.
So nerve repositioning on the bottom jaw or moving that little hole we call the mental foramen, move it out of the way so that implants can be put into the right spot. Sometimes managing the lower jaw with another option called a subperiosteal implant. It’s an implant that goes over the bone. It doesn’t go in the bone. It’s an older technique, but we’ve seen some resurgence with it using different technologies for 3D printing and milling and titanium. Other things called blade implants that I use for the no bone patient that has nothing at all. Those options oftentimes are much better and much more cost-effective, requiring a lot less surgery than rebuilding a massive amount of bone, especially for full mouth replacement.
In smaller segments, rebuilding bone if you’re missing a section of teeth here or a section of teeth over here or one tooth, then certainly building bone by taking bone from the jaw over here, transplanting it up over here. Sometimes it’s ground up and placed there. Sometimes it is powdered or synthetic bone or usually bone from a tissue donor is planted underneath that membrane. It’s tucked under the gum and bone is placed, a membrane is placed to hold it all in and it’s allowed to heal for several months. So even in spaces that have no bone at all, you’ve been told you’re missing a front tooth, either the lower teeth or the back one, that bone can be rebuilt, the nerves can be moved. Sometimes it just takes more extreme measures, building a cage with titanium to hold in a bone graft, to sometimes move a segment of bone, not even detach it, meaning leave it attached to the gum and move it. We call that a vascularized pedicle bone flap.
I don’t mean to be too technical, what I’m trying to do is give you a hope that you can certainly have implants if you’ve been told there’s no bone. You just need to do your due diligence and see a provider and that’s all they do and that’s what they’ve done for a long time. This is something that’s very common in my practice. I treat the patient that has really extreme needs. Of course, I treat normal missing teeth and teeth that are about to be lost, but having no bone requires definitely a certain expert level of treatment to be done.
So I’ll post some links so you can click around and begin to learn a little bit about it but have hope. You can have dental implants for sure. It may just cost a little bit more. It may take a little bit more time, sometimes a lot less time than you thought, but it is certainly doable. Thanks for watching.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry