Understanding bone loss when placing implants
It is well known among the dental profession that tooth loss can also lead to bone loss, with the jawbone atrophying over time, as well as becoming more brittle.
Aside from the functional problems faced by partially dentate patients, what may be more worrying to many people—given human nature—is that this can cause the shape of the face to change, leading to a prematurely aged look.
That may bring patients to the door of your practice, but where do you go from there in terms of bone quality and quantity when looking to place implants? The good news to impart to such patients is that the benefits of implants include maintaining bone. (1)
The unique Laser-Lok® surface, for example, has been shown to elicit a biologic response that includes the inhibition of epithelial down-growth and the attachment of connective tissue. (2,3) This physical attachment produces a biologic seal around the implant that protects and maintains crestal bone health. The Laser-Lok phenomenon has been shown to be more effective than other implant designs in reducing bone loss. (4-7)
Where there is insufficient bone (or, indeed, gingiva) to place an implant, a graft may be appropriate. This requires a high degree of skill on the part of the clinician and ideally would begin after undertaking appropriate training. Indeed, bone grafting can often be more complicated than placing the implant itself.
In essence, grafting procedures place a framework of material in the areas of missing bone into which ‘healthy’ cells can enter and start the rebuilding process. Over time these cells remodel the graft material into the patient’s own functioning bone.
Bone grafting material can come from a number of sources. Autograft bone, for example, is material that is taken from another point in the patient’s body and transplanted to the desired site. It is commonly taken from the chin or ramus, or, if this is not possible, the tibia or hip (which entails a hospital stay). It is a good graft material because it contains the patient’s own cells, and carries no risk of disease transmission. The main drawbacks are that it requires a second surgical procedure and enough harvestable bone, which may not be easily available.
Allograft bone, meanwhile, is material taken from an organ donor and processed to ensure its safety and improve the handling characteristics. The advantages of allograft bone are that it is readily available and does not require a second surgical site.
MinerOss®, for instance, is a mixture of allograft mineralised cortical and cancellous bone particles for grafting for implant placement, amongst other applications. The cortical component provides structural integrity and space-maintaining capability, while the cancellous component’s porous architecture promotes osteoconduction and rapid revascularisation. (8,9,10)
It is important to take into consideration the differing trends across the implant world and what drives the choice of grafting material. Is it a projection of cultural values? Are implant patients as informed on their choices as they should be? Are they aware of the clinical evidence and successes behind each material available to them?
Bone grafting procedures may well lengthen the treatment time, with new bone taking anything from 3 to 12 months before it is ready to bear implants, depending on the volume of bone. However, when successfully employed, patients will almost certainly experience better outcomes than if such care and attention was not paid.
Quality care for all
In this day and age, there is no reason why a patient with bone loss cannot receive dental implant treatment, given the various placement techniques available, as well as proven grafting materials. These latest technologies, in the hands of a fully-qualified dental healthcare professional, offer patients long-term successful outcomes, in terms of both function and form.
Anthony Summerwill and Robert Oretti will bare the bones of grafting materials and expose the clinical evidence. The debate will explore two schools of thought and ultimately assist the clinician in presenting the options to the patient.
Be a part of the debate—book at place at the annual BioHorizons symposium now.