Told You Can’t Have Dental Implants? Here’s What’s Still Possible

Plenty of patients come to us with the same problem: they have been told that implants are not an option for them. The reason is usually a lack of bone. After years of wearing a denture, after periodontitis, or after teeth were extracted many years ago, the ridge recedes and thins. A conventional implant needs enough bone to anchor into, so the conclusion that “there is nothing to place it in” looks logical at first glance. But it holds true for one technique only. The potential for secure bony anchorage also exists in other, higher anatomical regions of the head, and that is where we apply rarely available advanced implantology techniques.

Why “not enough bone” is not the end of the story

When resorption, the receding of the jawbone, advances, the floor of the maxillary sinus in the upper jaw can drop low, and the remaining layer of bone beneath it can become too thin for standard implants to be placed. For a long time one of the main answers was augmentation: raising the sinus floor, the so-called sinus lift, bone grafting or bone augmentation, months of waiting for the bone graft or the bone substitute to fuse with the patient’s own bone, and only then an assessment of whether implants can be placed, the implant surgery itself, and waiting for the implant to fuse with the bone, that is, for osseointegration. For some patients this is still a good path. For others it means more procedures, a longer course of treatment and less predictability at individual stages of treatment, including the possibility that the augmented area does not heal or does not integrate to the expected extent.

What has changed in the meantime is that there are techniques which bypass the need for bone augmentation. Instead of spending months creating a new bed for the implant, we anchor implants in other anatomical regions that can provide firm bony support even when the alveolar ridge is severely resorbed. That is why the sentence “it cannot be done for you” often only means that the clinic you visited does not perform these techniques.

Where we find support for an implant when there is not enough bone in the alveolar ridge

In cases of pronounced jaw atrophy, the approach depends on whether it is the upper or the lower jaw and on where the remaining bone that can provide secure anchorage for an implant is located.

In cases of pronounced atrophy of the upper jaw we can use various anatomical anchorage sites outside the dental ridge itself:

• Zygomatic implants pass at an angle through the area of the former teeth and anchor into the cheekbone, that is, the zygomatic bone. This bone is dense and provides firm anchorage even when the alveolar ridge is severely resorbed.
• Pterygoid implants find their support in the posterior part of the upper jaw, in the pterygomaxillary region. This lets us use firm bony anchorage without the need for a conventional sinus lift and bone augmentation.
• Transnasal implants use a specific anatomical area alongside the nasal cavity, the so-called Z-point, as firm bony anchorage in the anterior part of the upper jaw.
• Trans-sinus implants use a specially planned path through the area of the maxillary sinus in order to make use of the available bony anchorage without conventional bone augmentation.

In cases of pronounced atrophy of the lower jaw we apply different strategies. Where the indication for it is correct, the solution can be customised subperiosteal implants, short and ultra-short implants, and in selected cases also the advanced surgical techniques of lateralisation or transposition of the inferior alveolar nerve (IAN). With these techniques the nerve is carefully moved so that implants can be placed in the available bone.

It is important to stress that these techniques are not interchangeable options to be picked at will. Each has its own clear indication, and the choice depends on the patient’s individual 3D anatomy, the quantity and quality of the available bone, the position of important anatomical structures and the biomechanical plan for the future fixed restoration.

All of these techniques can also form part of a broader All-on-X approach, in which we adapt the number, type, position and angulation of the implants to the patient’s anatomy and to the plan for the future fixed restoration. The method has to be adapted to the patient, not the patient to the method.

Does this really work, or is it an experiment

It is reasonable to ask how reliable these rarer techniques are. They are neither new nor improvised. Zygomatic implants are backed by an extensive body of literature. A 2022 systematic review, which covered 196 published papers, reported cumulative success of 96.1% even after more than five years of follow-up, with a slight decline over the first decade.1 Those are figures comparable to conventional implants, only from a considerably more difficult starting point.

Pterygoid implants have a similar basis. A 2024 systematic review analysed over three thousand such implants and calculated a ten-year cumulative success rate of 92.5%, noting that most failures occur in the first year.2 Tilted implants, which are the foundation of the All-on-4 approach, showed survival of 99.4% in a 2021 meta-analysis, with no statistically significant difference compared with axially placed implants, and with the conclusion that angulation makes it possible to treat an atrophic jaw without complex augmentation.3 Comparative reviews of graftless solutions confirm that both the zygomatic and the subperiosteal approach achieve high survival rates in severe atrophy, so the choice depends on the anatomy and the goal of treatment.4

Who performs them is crucial. These are demanding procedures that require experience and precise planning. At our clinic every such case is planned by Dr Zdenko Trampuš, with more than 35 years of clinical experience in implantology.

What a second opinion with us looks like

Your first examination with us is free, and its only purpose is to answer your question honestly and precisely. As part of the examination we carry out complete X-ray diagnostics, including a 2D panoramic image and a 3D CBCT scan, which gives us a three-dimensional view of the jaw and shows where the bone has remained dense and where it has receded. Only on the basis of the clinical examination, an analysis of the bite and the jaw relationships, and complete digital X-ray diagnostics can we say whether any of the anchorage sites described is applicable in your case.

Sometimes the answer is that the conventional path is the best one after all. Sometimes it is precisely the advanced, rarely available implantology techniques we use that allow us to find a solution for patients who were previously told that implants were not possible. That is exactly why a second opinion can restore hope to patients who believed there was no longer any possibility of fixed teeth for them. What we do not do is make promises before the examination and the diagnostics.

And if you are afraid of the procedure

Fear of the dentist is a common reason why patients postpone treatment, and in the meantime bone loss can continue to progress. For anxious patients we can use analgosedation on the basis of an individual assessment, while for larger and more demanding implant and oral surgery procedures potentiated intravenous analgosedation is part of our protocol.

The depth of analgosedation is adapted to the patient and to the procedure, from lighter sedation, during which the patient breathes independently, cooperates and follows instructions but feels no fear or tension, loses the sense of time passing and usually remembers little or nothing of the procedure, to deep sedation, during which the patient essentially sleeps through the procedure. Throughout, the vital functions are continuously monitored by a specialist in anaesthesiology.

Thanks to the combination of local anaesthesia, potentiated intravenous analgosedation and pre-emptive analgesia, demanding implant procedures are as a rule free of pain, with the aim of providing the patient with the highest level of comfort throughout the whole process.

Additional support comes from individually adapted DENTAL SPA treatments that accompany the patient before, during and after the procedure. Before surgery we carry out lymphatic drainage, during the procedure ozone therapy and intravenous supplementation with vitamins, minerals and amino acids, and after the procedure torsion field magnetotherapy and, where indicated, hyperbaric oxygen therapy (HBOT). The aim is to support healing, recovery and the processes that matter for osseointegration.

A closing thought

If you have been told that implants are not an option for you because of a lack of bone, it is worth checking whether that is a final verdict on your anatomy or the limit of the implantology techniques available. The difference can be considerable.

At Ortoimplant DENTAL SPA we deal specifically with demanding cases of this kind and apply advanced, rarely available implantology techniques with which we can find anchorage even in pronounced atrophy of the jawbone. We do not promise a solution before the examination, but for patients who have previously been told that implants are not possible, a second professional opinion, together with a clinical examination and complete 2D and 3D diagnostics, can restore hope and open up possibilities for fixed teeth they did not know existed.

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