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How Much Bone Grafting Will I Need for Dental Implants?

I have a combination of old crowns, a partial denture, and decayed and missing teeth. I saw two dentists, and one of them recommends full-mouth reconstruction that will include six dental implants. The six missing teeth have been gone for almost 12 years. The dentist said I probably would need bone grafting, but he would refer me to a periodontist for the implants. I know I need bone grafting because I can see that the bone is low where the teeth are missing. I’m unsure which dentist I will choose to complete the work, but both visits left me with questions. How much bone grafting will I need? Will this process take more than a year? Thank you. Nathan from Rockville, MD


Thank you for your question.

How Much Bone Grafting Will You Need for Dental Implants?

Your jawbone loss will determine how much grafting you need for dental implants. An implant dentist, oral surgeon, or periodontist must take a 3-D CT scan to measure the bone volume throughout your jaw and identify where to place implants. An American Academy of Implant Dentistry published an article on missing teeth and bone loss. The article states that bone shrinks 25 percent in the first three months after tooth loss and up to 50 percent in the first six months. For denture wearers, dentures resting on the jawbone accelerate shrinkage.

After twelve years, your bone loss may be significant. The 3-D CT scan is a critical factor to successful implant placement that a doctor must not overlook. As you have consultations with different implant dentists, ask whether they use the scans to determine whether patients are eligible for dental implants and where to place them. Find another provider if an implant dentist you consult with does not use a 3-D CT scan for treatment planning.

How Long Does It Take to Get Dental Implants?

The time it takes to get dental implants varies because no two patients’ cases are identical. Depending on the treatment needed, you may expect the following:

  • If you need bone grafting before implant placement, expect four to six months of healing before implant surgery.
  • After implant surgery, your doctor will allow three to four months of healing. You can wear temporary replacement teeth during that time.
  • When a doctor must remove teeth before placing implants, they may complete extractions, bone grafting, and implant placement during one appointment. Healing will take four to six months.
  • After your jawbone and implants integrate, your doctor will expose the implants, attach a connector (abutment), and allow several months for your gums to form around the abutments.
  • Your dentist will attach your final replacement teeth to the abutments.

A full-mouth reconstruction includes a combination of dental treatments. Your dentist and the doctor who places your implants (if different from your dentist) will coordinate your care. Your dentist will give you an estimate of the total time for restoring your oral health and smile.


Before-and-after patient photos for full-mouth reconstruction
Photos of one of Dr. Lim’s full-mouth reconstruction patients

Dr. Heng Lim, an Owasso, Oklahoma dentist, sponsors this post.


Can a Dentist Save My Loose Implant?

I had dental implant surgery in January. A periodontist placed the implant, and I went back to my regular dentist for a temporary crown. The dentist had difficulty getting the temporary crown on and forced it down. The crown hurt the entire time I had it.

My dentist kept saying everything was okay. He could not see anything wrong. Every time he touched the temporary crown, I felt even more pain, and I think he was afraid to try to remove it. I switched to a new dentist to get the permanent crown because I lacked confidence in my prior dentist. My new dentist says that the implant is loose. I know it is loose due to the trouble with the temporary crown. Are you willing to give me an outside opinion on whether this can be fixed without taking the implant out and doing it all over again? Thank you. Demetrius from Ohio


Thank you for your question.

Can a Dentist Save Your Loose Implant?

Dental implant crown, abutment, and root formA skilled implant dentist must take digital x-rays and examine your implant before determining whether they can save it or if they must remove it. Sometimes, removing infection around an implant or adding bone graft material can save it. If a dentist must remove it, you may require bone grafting and healing time before replacing the implant.

Why Do Dental Implants Loosen?

Reasons that a dental implant may loosen include:

  • The crown – The dental crown—not the implant itself—might be loose. If a dentist does not correctly place the crown, pressure can cause it to loosen.
  • Poor placement – If a dentist or surgeon places an implant in the wrong location, it can loosen.
  • Premature loading – Sometimes, pressure from attaching replacement teeth too soon can loosen implants.
  • Smoking – Blood vessels will constrict if you smoke during the healing period, and your jawbone and implant may not fuse.
  • Patient risks or habits during healing – If you grind your teeth, bite your nails, or deviate from a soft-food diet during the healing process, implants can loosen.
  • Gum disease – Infected tissue around implants can prevent your jawbone from integrating with them.
  • Lack of bone density – Jawbone supports implants. The implant fixtures won’t fuse to the jawbone if you lack bone density. They can easily loosen.

Select a dentist with advanced training and years of experience with dental implants or who works with a skilled oral surgeon for implant placement. Schedule at least two second-opinion appointments to compare your options.

Dr. Heng Lim, an Owasso, Oklahoma, cosmetic dentist, sponsors this post.


What Kind of Crowns Can Help Me Avoid Wearing a Night Guard?

Diagram of the side of a skull highlighting the temporomandibular joinI’ve had several crowns for 4 years now, but 2 of them broke. My new dentist said I have TMJ disorder and don’t wear a mouth guard, so the crowns broke. Anyway, I lived in Seattle when I got the crowns, and now I am in Indiana. To make a long story short, I need 2 new crowns. My sister says I should get Lava crowns because they are strong. Do you know anything about these crowns? Are they better than others? Will they last with my teeth grinding, or do I really need to wear a mouth guard?  – Natalia, South Bend, IN


If you have TMJ and you grind your teeth, replacing the crowns is not the complete answer to your concerns.

Have TMJ? Protect Your Crowns

Regardless of the type of crowns you receive, you should protect your investment with a night guard. Teeth grinding (bruxism) can wear down your natural teeth and crowns, even if you have high-strength crowns. Bruxism can contribute to TMJ and make symptoms worse. But wearing a mouth guard at night can ease symptoms and preserve crowns.

Lava Crowns

Although a Lava crown is a durable, all-ceramic crown, it is not among the most beautiful and natural-looking crowns available in most cases. The Lava crown has a zirconia framework, and the outside that shows when you smile is baked feldspathic porcelain. Also, other brands are made with the same materials as the Lava crown and have better aesthetics.

If your replacement crowns are for your molar teeth, you will need durable crowns, especially since you have TMJ and grind your teeth. But you will also need to wear a night guard.

Instead of looking for a specific type of crown, it is best to find a skilled cosmetic dentist who will examine your teeth and determine which crowns are best for your needs. The dentist will choose a crown that they are familiar with and experienced using to give you a natural-looking tooth replacement. If you have concerns about the crown’s durability, your cosmetic dentist will be able to answer your questions.

Durable crowns that fit well and a night guard will help you get relief from TMJ and extend the life of your crowns.

Dr. Heng Lim, an Owasso, Oklahoma dentist, sponsors this post.