Bone loss in teeth and the different treatment optionsBone loss in the teeth can affect everyone at some point in their lives, whether due to periodontal disease, trauma, tooth loss, or aging.
The problem with this condition is that the longer you leave it untreated, the greater the damage will be.
Today, different treatment options are available to restore lost bone. Find out in this article everything you need to know about bone loss around the teeth and the different treatment options and techniques available.
What is alveolar bone?The bone surrounding our teeth, also called alveolar bone, plays an important role in holding our teeth in place. Its ability to change shape in response to external factors makes it unique. The forces transmitted by the teeth during chewing will stimulate and shape it.
This explains why teeth move during orthodontic treatment. The forces applied to the teeth through braces will be transmitted to the bone. In response, the bone will adapt and change its shape.
After tooth loss, the bone will no longer be stimulated and eventually shrink.
Bone loss also occurs in periodontal or gum disease. It is due to the reactions triggered by our immune system in the presence of virulent bacteria. Certain molecules called inflammatory mediators, when released in excess, can destroy our tissues and lead to tooth loss.
The causes of bone loss in teethBone loss occurs naturally with aging - a normal, physiological process in our body. However, some factors will cause premature and rapid bone loss, while others worsen the problem. Among these factors:
Direct causes of bone loss
Gum diseaseBacterial plaque is a whitish and sticky deposit rich in bacteria. Poor oral hygiene will cause it to accumulate on the teeth and gum surface.
If not removed, dental plaque will spread below the gum line and attack the deep tissues that support the tooth, including the bone.
At the early stage, gum inflammation is triggered to push back the infiltrated bacteria. This stage is called gingivitis and is reversible with good oral hygiene.
If left untreated, gingivitis will turn into periodontitis where immune reactions will lead to bone destruction and widening of the spaces between the teeth and the gum, forming periodontal pockets.
Dental infectionDental infection occurs when the pulp, which contains the nerves and blood vessels of the tooth, is affected. It is due to the bacteria infiltration through a cavity or a fracture. The prolonged infection of the tooth will lead to the death of the pulp (pulp necrosis) and its spread to the tissues surrounding the tooth. Gradually, pus will accumulate near the root tip associated with localized bone loss.
Tooth lossOur natural teeth stimulate the bone and prevent it from resorbing. They maintain its height and thickness.
Following the loss of a tooth, the alveolar bone is no longer sufficiently stimulated and gradually shrinks. Bone loss is even more significant when several teeth are missing.
OsteoporosisOsteoporosis is a condition that causes bones to become less dense and more porous. In Canada, it is estimated that one in four women and one in eight men will be affected by osteoporosis in their lifetime.
The jawbone is not immune to this condition. Osteoporosis can cause teeth to loosen and spaces to widen between teeth. Weakened teeth can fall out.
TraumaSevere impact on the teeth can result in a fracture of the alveolar bone. Dental trauma is often associated with mobility or even teeth loss.
General disease that compromises the immune systemSome conditions such as diabetes, blood disorders, or HIV infection aggravate bone destruction by weakening our immune system. Bacteria will invade periodontal tissues and cause more bone destruction.
StressVarious factors can trigger stress, such as work overload, losing a loved one, or social circumstances.
Stress will increase the inflammatory mediators in the body that are responsible for bone destruction. Studies have shown that stressed people with periodontal disease have more severe tissues destruction than people with optimal stress control.
SmokingSmokers have compared to non-smokers:
- 6 times more likely to have periodontitis
- More bone loss
- More gums recession
- More tooth loss
The good news is that its effects on periodontal tissue are reversible, so quitting smoking will improve your periodontal health.
NutritionNutrition can impact dental plaque formation and composition. An Extreme diet can weaken our immune system and worsen bone loss.
Studies have shown that adequate calcium and vitamin D intake can reduce bone loss and improve remineralization.
Vitamin C is also important. It is an antioxidant that strengthens our immune system and promotes collagen synthesis. In periodontal diseases, it inhibits bone destruction.
Teeth crowdingTeeth crowding will promote plaque accumulation by making some areas inaccessible to brushing. This will increase inflammation and thus aggravate the periodontal disease.
BruxismBruxism or teeth grinding causes excessive stress on the teeth. This will apply tension in the periodontal tissues causing tooth mobility and aggravating bone loss in periodontal disease.
Symptoms of bone loss in teethIt is easy to notice bone loss after losing one or more teeth. But, bone loss around the teeth due to periodontal disease can be asymptomatic, making it difficult to spot, especially in its early stages.
If bone loss produces symptoms, the most common are:
- Receding gums: receding gums are a sign of periodontal destruction. It exposes the teeth roots causing sensitivity to cold.
- Swelling, bleeding, and redness of the gums: These are the classic signs of inflammation. In the early stage, it is called gingivitis. The symptoms are limited to the gum. The bone is not yet affected. Gingivitis is reversible after improving your oral hygiene. Untreated, these signs will progress to the deep tissues that support the tooth, including the bone, and lead to periodontitis. The disease is no longer reversible and requires a deep dental cleaning.
- Abscess and pus drainage: The formation of an abscess and the drainage of pus through the tooth indicates a severe form of periodontal disease. It indicates a rapid and severe bone loss.
- Teeth shifting: After losing bone, teeth will be looser and will tend to shift gradually. You may feel that your bite is not like it used to be.
- Tooth mobility: Tooth mobility means that more than one-third of the bone has been lost.
- Tooth loss: This is the final stage of periodontal disease. The tooth is supported by only a small amount of bone and will inevitably fall out.
Why is it necessary to treat bone loss?If you have periodontal disease and leave it untreated, the bone loss around your teeth will continue to progress deeper with the risk of periodontal abscess. Teeth will become more mobile, and you may eventually lose them.
After losing one or more teeth, the alveolar bone begins to shrink. It will lose 40-60% of its height and thickness in the first two or three years, then continues at a rate of 1% per year.
The longer you delay, the greater the bone loss and the more difficult the treatment will be.
The reasons why you should treat the bone loss as early as possible are
- To keep the tooth in the mouth as long as possible.
- To be able to place an implant in case of tooth loss when the bone mass is insufficient to guarantee its stability.
- To maintain the bone volume after an extraction.
- To restore bone volume after surgery.
- To preserve aesthetics and avoid deformation of facial features.
The different treatment optionsWhether you want to keep your teeth longer or place dental implants, different solutions are available to treat bone loss.
Before looking for solutions, you must first know the cause:
In case of bone loss due to periodontal diseaseTreatment of bone loss during periodontal disease depends on the type and severity of the lesion. Some of the options available to restore bone loss in periodontal disease include:
Deep teeth cleaning
If you have periodontal disease, your doctor will recommend a deep tooth cleaning or scaling and root planing.
It helps remove plaque, tartar, and infected tissue accumulated below the gum line at the root.
Your periodontal tissues will then have the right conditions to regenerate. You will gain a significant amount of bone as long as you maintain good oral hygiene and follow your dentist's advice.
Treatment of bone loss with graft material
If the bone loss is extensive, your doctor may suggest a bone graft. It involves placing bone or synthetic material on the affected sites. Different types of grafts can be used.
Autogenous grafting involves collecting bone from a part of your body. When the amount of bone needed is relatively small, the preferred sites for bone harvesting are the chin and the area around the lower molars. If more bone is needed, bone can be harvested from other areas, such as the skull or the iliac crest.
Autogenous grafting is the most effective method of inducing new bone formation. Bone will first be removed from another surgical site (donor site), reduced to small particles, and then transplanted into the affected site (recipient site).
Unlike autogenous bone, allogenic bone and xenogenic bone are not collected from your body. These are bone preparations that come from other people or different species. They are commercially available in large quantities.
There are also synthetic biomaterials that are not bone-derived. They fill the periodontal defect and help maintain space and stabilize bone loss. But, unlike autogenous bone, do not induce new bone formation.
Guided tissue regeneration
This technique consists of placing a physical barrier inside the bone defects. The goal is to guide the healing process and promote the regeneration of the destroyed periodontal tissues harmoniously and uniformly.
Growth factors and matrix proteinBiological substances such as growth factors, matrix proteins, and blood platelet growth factors can be used to promote bone regeneration. But the key to successful treatment is the complete removal of the root cause of periodontal disease, including plaque, tartar, and infected tissue.
Bone loss after losing one or more teethIf you have lost one or more teeth and have waited too long to replace them, the bone loss will be significant. The space left by the teeth is called the bone ridge.
Afte bone loss, if you want to replace the missing teeth, you may need to go through a surgical step to increase the amount of bone available.
The treatment options available to restore the bone ridge include:
Guided Bone RegenerationIt is the same technique used in bone loss due to periodontal disease. Guided bone regeneration involves opening the soft tissue covering the bone. A material will overlay the exposed bone, and then a membrane will cover it to stimulate and guide its regeneration. Finally, the surgical site will be closed with sutures.
There are two grafting techniques to restore bone volume: onlay grafting and inlay grafting.
The onlay grafting corrects the height, the thickness, or both of the shrunk bone ridge. The goal is to obtain a sufficient bone volume for the placement of dental implants.
Inlay grafting consists of cutting the bone and separating it into two parts, and then a bone graft is placed in the space created.
Another alternative that avoids bone grafting is the ridge expansion technique. This technique involves separating the bone ridge into two parts to widen it. Implants are placed in the space created and filled with a biomaterial. After four months of healing, the crowns can be placed.
This technique increases the height of the bone ridge. It consists of cutting a bone segment and moving it upwards to increase the ridge height. Then, it will be stabilized in its final position.
Loss of the upper jaw back teeth is often followed by expansion of the sinus cavity and narrowing of the bone ridge.
This surgical technique aims to create a space between the bone and the sinus that will then be filled with a graft material (bone graft or biomaterial) to increase the height of the bone and prepare the future implant site.
Soft tissue augmentation
Soft tissue augmentation surgery, which involves thickening the tissues surrounding the bone, is sometimes a good alternative if you do not want implants.
Although bone augmentation is important for implant placement, it has its limitations. It is frequently associated with high failure rates of up to 40%, such as bone resorption (18% to 60% grafted bone may be lost), exposure, and infection of the graft material to the oral environment.
Another disadvantage is that it often requires the removal of bone from another part of your body which implies a second surgical site, thus increasing the duration of treatment and healing.
Soft tissue augmentation can be a good choice if your bone ridge has shrunk and you prefer a bridge or dentures. The technique consists of taking a piece of tissue from the palate area and placing it on the bone ridge that you want to thicken.
PreventionUnderstanding the causes of bone loss around the teeth is a good step to prevent it.
- If you have gum disease, make an appointment with your dentist. He or she will suggest a deep tooth cleaning or surgical cleaning if necessary.
- If you have a tooth infection or an abscess, it must be treated immediately because it can spread to the surrounding tissue resulting in cellulite.
- In most cases, the bone begins to resorb quickly due to tooth loss. The best technique to prevent bone loss after tooth extraction is the alveolar ridge preservation.
You want to replace the missing teeth as soon as possible. There are various options for replacing teeth, but the only method that can prevent bone loss is a dental implant.
A dental implant is an artificial root made of titanium that serves the same purpose as a natural root. It prevents the surrounding bone from resorbing.
Once the bone resorbs, it is difficult to restore it without bone regeneration techniques.
Obviously, in cases of periodontal disease, deep dental cleaning, and optimal oral hygiene can induce bone regeneration. But, if the bone has shrunk significantly, bone grafting procedures are needed to rebuild the lost height or thickness.
- Grossi S. G., Genco R. J., Machtei E. E., Ho A. W., Koch G., Dunford R., Zambon J. J., and Hausmann E.Assessment of risk for periodontal disease. II. Risk indicators for alveolar bone loss.J. Periodontol.6619952329
- Bodic F, Hamel L, Lerouxel E, et al. (2005) Bone loss and teeth. Joint Bone Spine 72, 215– 221.
- Jeffcoat MK, Chesnut CH 3rd. Systemic osteoporosis and oral bone loss: evidence shows increased risk factors. Journal of the American Dental Association (1939). 1993 Nov;124(11):49-56. DOI: 10.14219/jada.archive.1993.0225. PMID: 8227773.
- Kalsi, A., Kalsi, J. & Bassi, S. Alveolar ridge preservation: why, when and how. Br Dent J 227, 264–274 (2019). https://doi.org/10.1038/s41415-019-0647-2
- Gabriele Villa, Gionata Bellucci, Simone Magnolo, Farah Asa’ad, "Multilayered Connective Tissue Grafting Technique to Improve Aesthetics after Failed GBR: A Clinical Case Report of 16 Months Follow-Up", Case Reports in Dentistry, vol. 2020, Article ID 3906468, 9 pages, 2020. https://doi.org/10.1155/2020/3906468