Quote:
> I have worn a full upper denture for a long time (years) and want to
> get a full arch non-removable implant anchored bridge. My oral
> surgeon sent me for a CT scan July 2011 and determined that I did not
> have sufficient bone to support implants. He is very reputable and is
> Board Certified in {*filter*}and maxillo{*filter*} surgery.
> In mid-July 2011, I had a bilateral sinus lift and in October 2011, I
> underwent ridge augmentation surgery using a block graft with bone
> from my chin. For both procedures, healing seemed to go very well
> with no signs of infection or other complications. Several years ago
> I successfully had 2 implants placed in my lower jaw to replace 2
> adjacent molars that needed to be extracted. I had no problems at all
> with these 2 lower jaw implants and no grafting was needed.
> I had another CT scan late last month (February 1012) which showed
> that after the block graft and sinus lift there was now sufficient
> bone in my upper jaw to place the implants. I was scheduled for
> implant placement this week (early March 2012). The treatment plan
> was to place 6 implants. My current denture was to be altered and
> immediately attached to the implants as an interim appliance. Then in
> about 6 months, after the implants had integrated into my upper jaw
> bone, a permanent titanium based fixed bridge was to be installed.
> When placing the implants into my upper jaw this week, the surgeon
> discovered that although the volume of bone was sufficient to place
> the implants, the bone itself was too soft to immediately attach an
> interim appliance (the altered upper denture). He said that if a load
> was placed on the implants the bone would splinter and fail. He did
> place the 6 implants and cover them under my gum to allow them to
> head. In about six months he believes the bone will have integrated
> around the implants and will be strong enough to support a fixed
> bridge.
> Needless to say, this was very disappointing news. Does anyone know
> the success rate of implants placed in soft upper jaw bone? Does
> the placement of the implant generally strengthen the bone in addition
> to increasing volume? If age might make a difference, I am 64 years
> old. Any advice/input would be sincerely appreciated.
> Roberta
In general, the bone of the upper jaw is less dense than that of the
lower jaw. I am not an OMFS, and while you'd expect a block graft from
the chin to be very dense, it is also very likely that the bone which
results from the graft eventually will resemble the bone of the upper
jaw rather than that of the lower jaw.
I am certainly in no position to second-guess your surgeon. In the
"old days" (say, 10 years ago), 6 implants in the upper jaw would have
been considered skimpy to support a full-arch splint. Of course if the
fixtures are long enough this relative lack of support would be
mitigated to some degree. These days they talk about "all-on-4"
restorations in which a full arch splint is supported by only 4
fixtures. Frankly it scares the hell out of me. Maybe I'll be proven
wrong over time, but I wouldn't recommend it.
6 fixtures is a judgment call. In the right patient, with the right
restoration I think it could work. Historically upper implants have a
SLIGHTLY higher failure rate to my knowledge, but I wouldn't worry too
much about the statistics. You clearly have a surgeon who is not
working blindly, or he'd have gone with the immediate load.
The implant does not increase volume--the graft and sinus lift did
that. But the bone that teeth (or implants) are set in (alveolar bone)
is indeed strengthened and retained by the functional forces placed on
it by the implants. There is always SOME bone loss over time, but with
well-integrated implants that bone loss will be far, far slower than
without implants in place.
I have not found that age alone is a hazard in implant placement. I
just received word today that a patient of mine in her mid to upper 80s
had an implant placed. Your health is a bigger factor. Diabetics are
at some risk. Some surgeons are also hesitant to place implants in a
patient on bisphosphonate medication. But if you're a healthy 64 you
should be fine.
Steve
soft bone and dental implants