Edward Brant, DDS, MS
Long Island Bone Grafts
447 Lake Avenue
Saint James, NY 11780
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Jawbone Tissue Health
Density - Height - Width
Bone deterioration both in the Maxilla (upper jaw) and Mandible (lower jaw) is a serious issue that, unfortunately, many patients don't understand well.
Characteristics of jawbone structure and material are critical for the retention of teeth, maintaining good oral health, maintaining a choice of treatment options for treating or replacing teeth and lastly, obtaining dentures that fit well, feel good and preserve basic dental function.
Unfortunately.... most of the intricacies and important things to know about bone density don't gain most people's attention until "it happens." 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 becomes knowledgeable, after the fact, about the relationship between sensible, informed dental treatment and jawbone preservation.
|Normal Jawbone Height and Density
|Moderate Bone Loss
|Severe Losses in Bone Height and Density
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, dental conditions, oral disease and a patient's choice of dental treatment can compromise important jawbone characteristics. Some of the more common causes are listed here:
- 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
- Extractions: As soon as an adult tooth is removed, and not replaced, bone stimulation ceases for that particular site.
- 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.
- 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.
- 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.
- 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.
- 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.
Preventing or Limiting Jawbone Deterioration - Resorption
Using the format outlined above describing different cause and effect relationships with bone loss, treatment suggestions are listed below:
- 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 that can include tissue grafting and specialized implants.
- 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.
- Trauma: A combination of single or multiple implants is efficient... as is a fixed bridge.
- Gross Malalignment: Alignment should be restored using whatever treatments are appropriate (orthodontics, tooth extractions, implants, onlays, etc).
- Bridgework: Follow dentist's best recommendation for type, size and location.
- 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.
- 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).
Healthy Jawbone Structures - The Natural Order of Things
Mother Nature developed a system of opposing physical forces that promotes optimal dental function and long term oral health.
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.