No Bone Solution Article

No Bone Solution

Written by Kristi Runyon
Tuesday, 28 December 2010 11:47
Kristi Runyon

Dental implants keep improving. Now even patients who don’t have enough bone to anchor them can have them.

Denture Wearers

According to the American Association of Oral and Maxillofacial Surgeons, more than two-thirds of adults 35 to 44 have lost at least one permanent tooth. More than one-fourth of those 74 and older have lost all of their permanent teeth. Common causes of tooth loss include tooth decay, gum disease or trauma.

Patients who have lost a significant number of teeth may require dentures, or man-made replacement teeth. Dentures are generally custom made for the patients and designed to be removed for cleaning.

There are two main types of dentures. A conventional full denture is placed in the mouth only after the oral tissues have healed from the extractions, usually after 6 to 8 weeks. An immediate complete denture is placed into the mouth as soon as the remaining teeth are removed. The advantage of an immediate complete denture is that the patient has “teeth” right away and isn’t without teeth until the tissues have healed.

Dental Implants

When a person loses a tooth but the remaining teeth are still healthy, a dental implant may be recommended. A dental implant looks like a natural tooth and is securely attached to the bone.

There are three parts to a dental implant. The anchor, or section that sits below the gums, is made of titanium, a strong metal. It screws into and fuses with the underlying bone, providing a secure hold for the artificial tooth. The abutment is the portion of the implant on top of the anchor. It protrudes from the gum line and provides an attachment surface for the tooth. The visible portion of the dental implant is the crown. This part is personally crafted to match the patient’s real teeth.

The Problem of Tooth Loss

It’s important for people to retain their natural teeth for many reasons. In addition to aesthetics, the roots of the teeth stimulate the bone, keeping the underlying bones strong. When a tooth is lost, the underlying bone is no longer stimulated and the bone may break down.

Dental implants help maintain bone stability, but patients with removable dentures don’t have any structures under the gums to stimulate bone development. Over time, removable denture wearers can develop a significant amount of bone loss. That loss changes the structure of the bones and interferes with how the dentures fit. The dentures can be built up to accommodate some bone loss. In fact, the American Association of Oral and Maxillofacial Surgeons recommends replacing removable dentures every 7 to 15 years. Eventually, however, the dentures may fit poorly, interfering with chewing, swallowing and speech.

Fixed Dentures: The No Bone Solution

Some denture wearers may opt for a permanent denture, or dentures that are permanently fixed in the mouth, like dental implants. However, patients with a significant amount of bone loss may not be good candidates for permanent dentures because there isn’t enough healthy bone in which to anchor the implants. To make it work, patients may need bone grafting or other extensive procedures to build enough bone to hold the implants.

Thomas Balshi, D.D.S., Prosthodontist with Pi Dental Center in Fort Washington, PA, has come up with a surgical solution for patients with significant bone loss. He calls it the No Bone Solution™. A significant amount of planning is done for each patient. First, a thorough oral exam, impressions and cone beam CT scans are performed to assess the health of the patient and obtain images of the oral structures. Next, the information is fed into a computer. Three-dimensional computer models enable the dentist to determine the safest place for the implants. Then, the files are sent to a robotics lab. A model of the skull is built, enabling the dentist to precisely plan the surgery. Finally, using computer-assisted design and manufacturing techniques, a set of temporary teeth is built, using a machine right in the office.

The patient is taken into a surgical suite and the surgeon uses the scans and computer planning to surgically place the implant anchors. The big difference in the No Bone Solution anchors and traditional implants is size. Balshi explains that standard dental implants range from 7 to 18 millimeters in length. The implants used for the No Bone Solution are much longer, ranging from 30 millimeters to 52 millimeters. The longer length enables the dentist to place the anchors into deeper (and stronger) bone, like the cheek bone.

Another advantage of the procedure is that patients leave the office that day with a full set of teeth. However, these are temporary. Once the oral tissues heal, the same computer-aided design and manufacturing process is used to make the permanent teeth.

Balshi says patients may have some discomfort for one to two weeks after the initial surgery. Once the swelling subsides, the new teeth should feel, work and look just like the natural teeth.

The No Bone Solution is usually not covered by dental insurance. The procedure is not recommended for patients who have unstable health problems, blood diseases (like hemophilia), head and neck cancer, or for those who are undergoing chemotherapy or radiation to the face or neck.


More information on No Bone Solution

For general information on tooth care, dental implants or dentures:
American Academy of Periodontology
American Association of Oral and Maxillofacial Surgeons
American Dental Association


Agliardi, E., et al., “Immediate Loading of Full-arch Fixed Prostheses Supported by Axial and Tilted Implants for the Treatment of Edentulous Atrophic Mandibles,” Quintessence International, April 2010, Vol. 41, No. 4, pp. 285-293.

Balshi, Thomas, D.D.S., et al., “No Bone Solution™ Computer Guided Implant Surgery Protocol for Prosthodontic Rehabilitation of the Severely Atrophic Maxilla,” The Journal of Implant and Advanced Clinical Dentistry, April 2009, Vol. 1, No. 2, pp. 11-17.

Balshi, Thomas, D.D.S., et al., “No Bone Solutions for the Severely Atrophic Maxilla,” Dentistry Today, March 2008, Vol. 27, No. 3, reprint.

Katsoulis, J., et al., “Prosthetically Driven, Computer-Guided Implant Planning for the Edentulous Maxilla,” Clinics in Implant Dentistry and Related Research, September 2009, Vol. 11, No. 3, pp. 238-245.

Monik Jimenez, S.M., et al., “Radical/Ethnic Variations in Associations between Socio-economic Factors and Tooth Loss,” Community Dentistry and Oral Epidemiology, June 2009, Vol. 37, No. 3, pp. 267-275.

Penarrocha, M., et al., “Immediate Loading of Immediate Mandibular Implants with a Full-arch Fixed Prosthesis,” Journal of Oral and Maxillofacial Surgery, June 2009, Vol. 67, No. 6, pp. 1286-1293.

Research compiled and edited by Barbara J. Fister.

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Pi Dental Center, Fort Washington, PA