All-on-4 Dental Implants & Loss of Bone

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Dental implants can benefit many people suffering from lost or missing teeth. All-on-4 implants in particular have proven to be an extremely effective, versatile, and accessible implant technology, allowing people to have their implants and dentures fitted far more quickly than traditional implant technologies. Moreover the approach used by all-on-4 implants make them more accessible to people who would otherwise not have access to dental implants, perhaps, for example, due to a loss of jaw bone. In this article we look at how and why all-on-4 implants can be an option for people who have lost some amount of jawbone, and are therefore not suitable to many traditional dental implants.

Loss of jawbone

A number of different factors can affect the amount of jawbone a person has. Contrary to popular belief, bone can be quite a dynamic structure, and in response to various stimuli you can find that your bone density (the amount of bone) at a particular part of your body can increase or decrease.

A certain amount of jawbone is lost when teeth are extracted. Tooth extractions are performed when a tooth is compromised in some way, for example through infection, and needs to be removed for the safety and health of the mouth and person as a whole. Some extractions are performed for cosmetic reasons, for example for the insertion of braces.

A tooth is normally attached to the jaw bone through the tooth, a complex structure that is unique to teeth of particular types and locations. When we use our teeth to bite and chew, we stimulate the jawbone and this acts as a signalling mechanism which preserves the overall integrity and health of the bone. If an adult tooth is removed and not replaced, then this signal is removed, triggering a process called resorption. Bone is resorbed when it is not deemed necessary by the body, in this case, because of the absence of normal, healthy signals carried to the jawbone through teeth and their roots. The extent of this resorption varies hugely, and while for some people it might be negligible, other people might suffer a more serious and progressive loss of bone.

Extraction is only one of many reasons why a person may suffer a loss of bone in their jaw. Gum disease, also known as periodontal disease, is a relatively common cause for the loss of jawbone. These diseases are usually caused by bacteria which cause gums to swell, more severe infections extend through the gum and into the bone beneath. Eventually such an infection may trigger the loss of jawbone.

Some dental solutions to tooth problems can, in the long run, cause a loss of bone density in the jaw. Bridges and dentures are commonly used to rectify lost and missing teeth, however in many cases there are instances where these measures can contribute to the deterioration of jawbone density. In these cases the dentures and bridges used are not designed to replicate the signals sent by our teeth, through their roots, to the bone beneath. As such, the factors contributing to a gradual loss of bone continue to cause this effect. This particular type of denture is usually known as an ‘unanchored’ denture,

Many teeth are lost through trauma and damage to either the tooth itself or one of the structures underneath and/or around it. Again such an event can result in the loss of the stimulation that the jawbone needs in order to maintain its density and health. Common injuries that can result in this includes avulsed or knocked out teeth, fractures in the jawbone which can sometimes lead to tooth loss, and sometimes previous injuries to the teeth can affect the jawbone much later.

Misaligned teeth can create an environment in which teeth are subject to unusual forces that can sometimes relieve signalling to the bone beneath the gum line.

In some situations tumours of the mouth, whether benign (harmless) or malignant (harmful) can have long lasting effects on the mouth as a whole, including a deterioration of the jawbone. Benign tumours can become very large and affect the bone, leading to a loss of bone density.

Malignant tumours are more aggressive and usually spread from the original tumour site to the jawbone. Once in the jawbone, the tumour usually necessitates the removal of some jawbone, often leading to a long term loss in bone density as a significant portion of the jaw can be removed.

There are a range of other conditions including developmental issues, osteomyelitis, and osteoradionecrosis, all of which can lead to a loss of density in the jaw bone. Ultimately this change in the density and quality of the bone has negative long term consequences, restricting a person’s ability to bite and chew as they normally would. One of these consequences can be that a person is not eligible for certain dental implants which require a certain amount of bone for the implants to be safely and effectively applied. Fortunately all-on-4 implants can offer a convenient solution which can hugely benefit people who have lost jaw bone.

All-on-4 implants and the jawbone

More traditional implants usually require at least 6-10 sites on the jawbone into which the implants will be inserted and left to heal. This means that a certain amount of bone is needed to safely accommodate the implants, graft to them, and allow for the required amount of strength in the jaw as a whole to maintain dentures and their bridges. For people with diminished jawbones, this requirement may exceed the bone available.

All-on-4 implants only require 4 sites into which the implants themselves are placed. This is because of the shape and position of each of these implants, which maximise the bone available to provide a lasting and stable denture structure.

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