Many patients often confuse dental implants as being the whole tooth or the whole set of teeth.  This is incorrect. Dental Implants are essentially titanium screws that integrate with your bone.  

We have to think of the dental implant like any other post we use as support.  Think or a mail box post.  Think of a fence post.

Your bone volume (how long and wide your bone is) and bone quality (how hard or soft) are the two most important factors when considering dental implants. Just think of drilling a screw into a wall to support a heavy painting.  We want to drill into the stud and not the drywall.  That’s because we’re concerned about the quality (how hard it is). We also want to drill into the stud with as long and wide of a screw as possible.

The quality (hardness) of your bone matters. Some people genetically have hard bone, some have genetically soft bone.  In the mailbox example, would it be best to not just bury the mailbox post in concrete rather than just soil?

Bone quality can also be affected by disease, medications, etc. Lower jaw bone (mandible) is more dense than your upper jaw bone (maxilla).

Why does this matter?  It’s the same as if you wanted to mount something in the wall.  Ideally you want to be in a stud versus drywall.  Because your upper jaw bone is softer, you typically want to place a larger implant (as long and wide) as possible to compensate for the softer bone. Ideally better to be burying a mailbox post in concrete versus soil.

The volume of your bone matters.  If we want to place as long and wide of an implant as possible, we need to have as much as bone possible to surround the implant.

Your jaws can produce a ton of force.  You need your implants to have as much surface area in contact with the surrounding bone.  We call that BIC (bone implant contact). We can accomplish more BIC (bone implant contact) by having a wider implant and/or a longer implant. If I stick my toe in the wet concrete and it sets, it is easier to pull out after than had I stuck my whole foot in the wet concrete and it sets.  Has to do with surface area.

The amount of bone people have is based off of two things:  genetics and if you have been missing the tooth. Nothing we can do about genetics.  Some people genetically have a lot of height and thickness of bone for us to place long and wide implants in. Some people genetically have very short bone or very thin bone or a combination of short and thin bone.  These people would then have a non ideal implant size because we would have to place a skinny or short implant in the bone.

The good news is we can add more bone, especially in thickness, to help these people get dental implants.  We will discuss this in a following video. Also some people genetically have nerves and sinuses in different positions that affect how long of an implant we can place.  We will discuss this in a following video.

Bone is living tissue.  If you don’t stress the bone, your bone can diminish in size and density.  This is similar to what happens to muscles.  If you don’t work out, your muscles atrophy.  

If you don’t have a tooth, you don’t transfer stress from the tooth, to the root, to the bone.  Good news is we can increase the width and height of bone through a procedure called bone grafting.

I will discuss bone grafting options on another video. (You will want to know this because bone grafting comes in different options and therefore different costs).

• We discussed we want to use the longest and widest implant as possible, but its not as simple as that.
• We will discuss the guiding principles of how we determine the proper sizing of your implants.  
• Heres an example of an implant that was too wide for the space