The Importance of Bone in Implant Therapy
Jawbone Density Problems
Bone loss and deterioration both in the Maxilla (upper jaw) and Mandible (lower jaw) is a serious issue that, unfortunately, many patients don’t understand well…. until they are diagnosed with it.
Characteristics of jawbone structure and material are critical for the retention of teeth, maintaining good oral health, maintaining a choice of treatment options for treating or replacing teeth and lastly, obtaining dentures that fit well, feel good and preserve basic dental function.
Maxilla – Mandible Bone Integrity – Understanding Bone Stimulation
Natural teeth are attached to our jawbones via a root structure. Depending on the location and size of any given tooth, these root structures will vary in size, depth and complexity. The behaviors of biting and chewing (forces of mastication) produce physical stimulation of each and every root structure which in turn stimulates the immediate bone material that the root is attached to.
As long as we have our natural teeth and the absence of any disease process, our mandibular (lower jaw) and maxillary (upper jaw) bone structures can be expected to remain healthy and intact.
Common Causes of Jawbone Deterioration
Numerous events, dental conditions, oral disease and a patient’s choice of dental treatment can compromise important jawbone characteristics. Some of the more common causes are listed here:
- Extractions: As soon as an adult tooth is removed, and not replaced, bone stimulation ceases for that particular site.
- Trauma: Events that cause a tooth to be knocked out or broken off to the extent that no biting surface exists (such as broken off at the gum line), bone stimulation ceases.
- Gross Malalignment: Alignment issues due to growth factors, trauma and untreated extractions can cause situations where certain tooth structures do not have an opposing tooth structure. The unopposed tooth may super erupt and also undergo underlying bone deterioration.
- Bridgework: Custom bridges are a popular treatment for replacing missing teeth. The bone structure underlying the span of missing teeth will undergo deterioration (only the anchoring teeth continue to provide important bone stimulation.
- Dentures: Low cost, unanchored dentures are designed to ride or rest on top of gum tissue. Contrary to what many people want to believe, there is no direct stimulation of jaw bone material. Rather, there may be accompanying loss of gum tissue while the all important underlying bone structure slowly resorbs.
- Abnormalities in the Bite Occlusal Relationship: Dentists routinely maintain a close focus on bite and occlusion. Assessment of the biting surfaces assures normal bite characteristics, overall dental function and patient comfort. Long standing occlusal issues arising from lack of treatment, normal wear and tear and certain TMJ-TMD problems can cause abnormal physical forces that disrupt the balance of the occlusal relationship. When significant, bone deterioration can occur with certain tooth structures.
- Advanced Gum Disease: Periodontitis, if left untreated, causes wholesale devastation of all tissues at the site of infection. Bone tissue, gingival tissue and connective tissue all undergo destructive changes that may or may not be fully restorable
- Bruxism: Teeth clenching and excessive grinding, commonly cause occlusion problems but can also cause abfractions, manifested by gum recession and loss of periodontal connective tissue. Untreated, affected teeth can become loose, wobbly and destroy bone tissue.
Preventing or Limiting Jawbone Deterioration – Resorption
Using the outline provided above describing different cause and effect relationships with bone loss, treatment possibilities are listed below:
- Extractions: Depending on the site and need, replacement of the root-jawbone stimulation is best restored via an implant.
- Trauma: A combination of single or multiple implants is efficient.
- Gross Malalignment: Alignment should be restored using whatever treatments are appropriate (orthodontics, tooth extractions, implants, onlays, etc).
- Bridgework: Follow dentist’s best recommendation for type, size and location.
- Dentures: Edentulous patients should consider implant anchored dentures whenever possible, using the largest practical number of implants possible (2 is good, 4 is better, more than 4 is even better.
- Abnormalities in the Bite Occlusal Relationship: Sometimes difficult to treat without intensive study and use of articulators. Treatments might include new fillings, onlays, new crowns, bite appliances, night guards (treatment for bruxism and teeth clenching).
- Advanced Gum Disease: Seek immediate treatment. Stopped and controlled early enough, a patient may have treatment choices that can restore a substantial percentage of function. Tissue grafting and specialized implants are possible in some cases.
- Bruxism – Abfractions: Night guards and occlusal adjustments can be effective. Periodontal surgery and bone grafting procedures can be used in some cases to restore healthy attachment of affected tooth structures.
Healthy Jawbone Structures – The Natural Order of Things
Mother Nature developed a system of opposing physical forces that promotes optimal dental function and long term oral health.
Disruptions that occur, as outlined above, have the potential of altering the physical forces that science has proven to be essential.
Jawbone integrity is best maintained by keeping a mindful eye on the physical forces that should be operating on each and every tooth in a patient’s mouth.