I want to get a dental implant but I don't have enough bone, what are my options?

On many occasions, after losing a tooth, we decide not to replace it, or at least wait to do so. This is something we see quite commonly in the clinic. There are many reasons for this, but there are usually three:

  • We believe it will not be necessary to replace the tooth.
  • Fear of intervention
  • Because it is not the best time economically speaking to do it.

In reality, we were wrong on all three occasions: in the end the tooth played a fundamental role in our chewing or as a support and anchor for the rest of our teeth; we found out about the different options we had for the intervention; and that the more time passed, the more complicated the intervention would be and, therefore, the more expensive it would be. It is then that we decide to replace our lost tooth with a dental implant, the best option currently available. However, when the study is carried out at the dental clinic, we are informed that the 3D X-ray shows that the amount of bone we had available in the area has diminished. and is no longer sufficient to hold an implant.

The fact is that from the moment we lose the organ of the tooth, we begin to lose bone mass, because this in turn loses its function, which is to support the tooth. In fact, this loss reaches 50% in the first two years of tooth loss, which is why we always recommend replacing a tooth as soon as possible after a tooth extraction. "So what are my options then?"you ask. Well, not only do you have options, but it is actually quite common to resort to them. We are referring to bone grafting or sinus lift.

A sinus lift is an oral surgery procedure that aims to increase the available bone mass in a specific area in order to safely place an implant. In plain but visual terms, it would be like 'filling in' the support where the implant abutment is to be fixed, which will significantly increase its success rate.

This is possible because the sinus is an aerial structure, i.e. hollow, which is located at the level of both the upper (or maxillary) and lower (or mandibular) molars and premolars and therefore 'fillable' as we say. It is also 'pourable', and in fact that was the first stage of the procedure, as it was originally used to clean the maxillary sinus when sinusitis was present. However, its use has now been extended to the field of implant dentistry. There are two main techniques used for sinus lift.

Cadwell-Luc technique, used when there is little bone.

By applying local anaesthesia we numb the area to be operated on, although this can be complemented with conscious or intravenous sedation techniques if the patient is very apprehensive and so decides, and we open a lateral incision that we extend to create an access window to the inside of the breast. This gives us a better view of the area we are going to work on. The tricky part, of course, is the following: on the floor of the sinus is the Scheneider's membrane, which has to be lifted but not damaged or torn so that the substance can be added to replace the missing bone. This requires considerable expertise due to its complexity, which is why it is so important that this technique is only performed by experienced implantologists with previous experience in their field.

2. Autramatic technique, used when we have more bone available

This technique allows us to place the implant at the same time. Basically it allows us to access the sinus through the same hole through which we will then place the implant. It would be similar to opening the hole in the sinus, 'filling' it with bone for support and then placing the abutment.

What does the 'bone' that is grafted in look like?

In both techniques, the floor of the sinus cavity is filled using an artificial bone composed mainly of calcium hydroxyapatite, a completely biocompatible and biodegradable substance that does not generate problems of incompatibility with the organism. It is mixed with the patient's real bone and integrates perfectly.

Although the intervention is simple for the expert and is performed relatively frequently, it is better not to give rise to it and to replace our missing teeth as soon as possible, so that we do not have to resort to it.