The art of replacing missing teeth


How and why is bone lost when teeth are lost?

The bone that surrounds and supports teeth needs stimulation to maintain its form and density. This necessary stimulation  comes from the teeth themselves. When a tooth is lost, the lack of stimulation causes loss of alveolar bone. There is a 25-50% decrease in width of bone during the first year after tooth loss and an overall decrease in height over the next few years.

The more teeth are lost, the more function is lost. This leads to some particularly serious aesthetic and functional problems, particularly in people who have lost all of their teeth. And it doesn't stop there. After alveolar bone is lost, the bone beneath it, also begins to resorb (melt away).

How can bone be preserved or re-grown to support dental implants?

Grafting bone into the extraction sockets at the time of tooth removal can help preserve bone volume needed for implant placement. Surgical techniques are also available to regenerate (re-grow) bone that has been lost, to provide the necessary bone volume for anchoring implants. In fact, a primary reason to consider dental implants to replace missing teeth is the maintenance of jawbone.

Bone needs stimulation to stay healthy. Because dental implants fuse to the bone, they stabilize it and prevent further bone loss. Resorption is a normal and inevitable process in which bone is lost when it is no longer supporting or connected to teeth. Only dental implants can stop this process and preserve the bone.


If you're faced with missing teeth, your whole world changes. With missing teeth, it often means that your ability to smile, chew, eat your favourite foods and even talk effortlessly may be compromises   

If one or more of your teeth are missing, there are a number of ways to replace them. An alternative to bridges, partials or complete dentures may be dental implants.

What is an implant?

Implants are made of titanium and are used to replace the roots of missing teeth. It is the ideal solution for a missing tooth or edentulous patients. They offer better aesthetic and functional results, and prevent greater losses of bone structure.

Who can have an implant?

If you are healthy, you have good gums and enough bone to hold an implant, you are a good candidate. If the quantity of bone has decreased or has not developed normally, a bone graft will be necessary to rebuild your bone before making an implant.

Some conditions and diseases can affect whether dental implants are right for you. For example, uncontrolled diabetes, cancer, radiation to the jaws, smoking, alcoholism, or uncontrolled periodontal (gum) disease may affect whether dental implants will fuse to your bone. It is important to let your dental surgeon know all about your medical status (past and present) together with all medications you are taking, whether prescribed, alternative (herbal) or over-the-counter.

You must also advise the dentist when you are smoking. It is highly recommended to quit smoking two weeks before and at least 1 month after surgery.

How dental implants are done

Your specialist will carefully examine your mouth and take x-rays of your head, jaw and teeth to find out if dental implants are right for you. A scan may likely be recommended and will allow to virtually plan the surgery and to minimize the length of your surgery.

During the first stage of surgery, your specialist will put a dentale implant into your jawbone beneath the gum tissus under local anesthesia. The gum tissue is then stitched back into place. As the tissue heals, the implant will bond with the bone and attach to the gum. It can take several months to heal. Depending on the clinical situation, the surgeon may opt to cover the implant with the gum or leave it uncovered.

If the implant was covered, once the tissus is healed, your specialist uncover the implant and attach an abutment to the implant. An abutment is a post that connects the replacement tooth to the implant. In some cases, the first and second stage of implant surgery may be done in one single stage. 

An artificial replacement tooth is made and your specialist attaches it to the abutment. It may take several appointments to properly fit the replacement tooth to the abutment.

When replacing several teeth or all of your teeth, a fixed bridge is anchored to your dental implants. A bridge is a dental restoration that replaces one or more missing teeth by spanning an area that has no teeth. The bridge is held firmly in place by dental implants on each side of the missing tooth or teeth.

Advantages of dental implants:

Permanently replace missing teeth without damaging adjacent teeth

Rediscover the look and feel of natural teeth

Speak and eat with added self-assurance and comfort                                                                                                                

Optimise chewing and digestion

Stimulate bone health and reduce resorption

Prevent bone loss following tooth extraction                                                   

Re-establish fixed teeth, in the case of moveable dentures.                     


What else should I know?

1. Several visits to your dentist or dental specialist may be needed until the process is done.

2. Checkups will be scheduled during the following year so your dentist can be sure your implants are working properly.

3. You will need to take very good care of your implants and teeth to avoid future complications.

4. Implants can cost more than other kinds of replacement teeth and might not be covered by your dental plan. 

5. Post-operative complications  may include bleeding, swelling, infections and brushing.

6. Although rare, possible complications may  include numbness,  injury to nearby muscles or the sinus cavity and in some cases, the implant may not be successful because it didn't bond to the bone.

Preserving the bone when extracting a tooth

After tooth extraction, the tooth supporting bone will commonly decrease in volume and change morphologically. These changes can make placement of a conventional bridge or an implant-supported crown difficult. If the bone resorption is significant enough, then the placement of an implant may become extremely challenging. 

Placing a grafting material  (bone grafts, collagen....) in the site after removing the tooth minimizes  resorption of the bone and maintains the bone volume after an extraction.    This allows the ideal placement of an implant which satisfies esthetic and functional criteria. Recent advances in bone grafting materials and techniques allow the dentist to place implants in sites that were considered compromised in the past.  

Augmenting the Bone Width

A ridge augmentation is a common dental procedure performed when the tooth extraction has created a significant defect preventing the placement of a  dental implant. This procedure helps recreate the natural contour of the gums and jaw that may have been lost due to bone loss as a result of a tooth extraction, or for another reason. The severity of the bone loss may pose a problem as it may make the placement of an implant challenging if not unfeasible.

A ridge augmentation is accomplished by placing bone grafting material on the deformed bone to recreate an adequate new shape and protecting the graft with a collagen membrane. Next, the gum tissue is placed over and secured with sutures. This will create a space to help restore the height and width of the  bone and into which new bone should grow. After approximately 6 months, when the area has fully healed and the bone grown the alveolar ridge can be prepared for dental implant placement.