Dental Health Library Article
Bone Density Loss Issues
Jawbone Resorption Analysis
Bone density problems can occur in both the Maxilla (upper jaw) and Mandible (lower jaw) for a number of reasons. A condition that becomes more prevalent as we age, it is a complicated and serious issue that many patients don't understand well.
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Healthy jawbone structures are required for the retention of teeth and for maintaining good oral health. Periodontal disease is only one of several conditions that will, if left untreated, will slowly attack and destroy otherwise healthy bone tissues.
The Knowledgeable Few
Most of the intricacies and important things to know about bone density don't gain most people's attention however, until they actually have it. Bone density problems involving internal resorption and rapid bone deterioration begins almost immediately.... depending upon what treatments a patient has received.
It is this patient group that unfortunately becomes knowlegeable, after the fact, about the relationship between sensible, informed dental treatment and jawbone preservation.
Jawbone Integrity - Understanding Bone Stimulation
Natural teeth are attached to our jawbones via a root structure. Depending on the location and size of any given tooth, these root structures will vary in size, depth and complexity. The behaviors of biting and chewing (forces of mastication) produce physical stimulation of each and every root structure which in turn stimulates the immediate bone material that the root is attached to.
As long as we have our natural teeth and the absence of any disease process, our mandibular (lower jaw) and maxillary (upper jaw) bone structures can be expected to remain healthy and intact.
Common Causes of Jawbone Deterioration
Numerous events, oral disease, dental conditions and a patient's history of dental treatments can compromise important jawbone characteristics. Some of the more common causes are listed here:
- Trauma: Events that cause a tooth to be knocked out or broken off to the extent that no biting surface exists (such as broken off at the gum line), bone stimulation ceases.
- Extractions: As soon as an adult tooth is removed, and not replaced, bone stimulation ceases for that particular site.
- Dentures: Low cost, unanchored dentures are designed to ride or rest on top of gum tissue. Contrary to what many people want to believe, there is no direct stimulation of jaw bone material. Rather, there may be accompanying loss of gum tissue while the all important underlying bone structure slowly resorbs.
- Bridgework: Custom bridges are a popular treatment for replacing missing teeth. The bone structure underlying the span of missing teeth will undergo deterioration (only the anchoring teeth continue to provide important bone stimulation.
- Gross Malalignment: Alignment issues due to growth factors, trauma and untreated extractions can cause situations where certain tooth structures do not have an opposing tooth structure. The unopposed tooth may super erupt and also undergo underlying bone deterioration.
- Abnormalities in the Bite Occlusal Relationship: Dentists routinely maintain a close focus on bite and occlusion. Assessment of the biting surfaces assures normal bite characteristics, overall dental function and patient comfort. Long standing occlusal issues arising from lack of treatment, normal wear and tear and certain TMJ-TMD problems can cause abnormal physical forces that disrupt the balance of the occlusal relationship. When significant, bone deterioration can occur with certain tooth structures.
- Advanced Gum Disease: Periodontitis, if left untreated, causes wholesale devastation of all tissues at the site of infection. Bone tissue, gingival tissue and connective tissue all undergo destructive changes that may or may not be fully restorable
Controlling or Stopping Jawbone Deterioration - Resorption
Using the format outlined above describing different cause and effect relationships with bone loss, treatment suggestions are listed below:
- Trauma: A combination of single or multiple implants is efficient... as is a fixed bridge.
- Extractions: Depending on the site and need (e.g., wisdom versus anterior (front tooth) replacement of the root-jawbone stimulation is best restored via an implant.
- Dentures: Edentulous patients should consider implant anchored dentures whenever possible, using the largest practical number of implants possible (2 is good, 4 is better, more than 4 better still.
- Bridgework: Follow dentist's best recommendation for type, size and location.
- Gross Malalignment: Alignment should be restored using whatever treatments are appropriate (orthodontics, tooth extractions, implants, onlays, etc).
- Abnormalities in the Bite Occlusal Relationship: Sometimes difficult to treat without intensive study and use of articulators. Treatments might include new fillings, onlays, new crowns, bite appliances, night guards (treatment for bruxism and teeth clenching).
- Advanced Gum Disease: Seek immediate treatment. Stopped and controlled early enough, a patient may have treatment choices that can restore a substantial percentage of function. Tissue grafting and specialized implants are possible in some cases.
Healthy Jawbone Structures - Maintaining The Natural Order of Things
Mother Nature developed a system of opposing physical forces that promotes optimal dental function and long term oral health. Chewing and eating behaviors (with normal occlusion) serve to stimulate the bone tissue and keep our jawbones healthy.
Disruptions that occur, as outlined above, have the potential of altering the physical forces that science has proven to be essential.
Jawbone integrity is best maintained by keeping a mindful eye on the physical forces that should be operating on each and every tooth in a patient's mouth.
Implant Dentistry, now represented with a growing number of specialized treatments, products and specialized adaptations, has become one of the single most popular and most effective technologies for reinstating what Mother Nature originally provided.
Combined with advanced bone grafting and specialized soft tissue grafts, doctors can virtually recreate lost tissues and use artificial root form implant devices (commonly known as dental implants) to take the place of natural teeth, thereby reestablishing the critical physical forces needed for maintaining good bone density.
It is not uncommon for patients to experience a healthy reversal of the bone loss process that is so easily initiated by the factors mentioned above.
Severe Bone and Tissue Loss Treatment Example
Implant reconstruction combined with custom fixed bridge and denture components is one example of how doctors can treat a serious bone, teeth and tissue loss problem for some patients.
Avoiding Recommended Extractions
Extractions, for some patients who have already suffered extensive bone loss, should be avoided for some patients. Specialized attachment systems can be created by some doctors that can take advantage of healthy root systems of teeth that have deteriorated above the gum line.
As a rule, although implants are an ideal technology (the Gold Standard of tooth replacement), healthy natural roots always surpass the value of an artifical (titanium implant) root.
Treatment solutions do exist for many of the conditions described. Access to technologies and the degree of creative experience a doctor has accumulated determines the number of choices a patient can have for resolving certain bone issues in their oral health care needs.
The picture below provides an illustration of how bone tissue can resorb in the upper and lower jawbones. This patient is quite obviously missing several teeth. Note the corresponding loss of bone tissue where teeth don't exist.
The upper two lines represent the upper, maxillary jaw. The blue line indicates where bone should be, while the red line indicates where the bone tissue currently is, for this patient.
The lower two lines pertain to the mandibular, lower jaw. Again, the blue line indicates where bone should be, while the red line indicates where the bone tissue currently is.
Wisconsin Reconstructive Implant Dentistry
Richard Winter, DDS MAGD
Winter Dental Associates
Hampton Dental Associates
5323 W. Hampton Avenue
Milwaukee Wisconsin WI 53218
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