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It happens that, having lost a tooth, a person thinks about prosthetics only after a few years. Chooses a reliable modern technology - dental implantation. And he discovers that over the past time the bone tissue has “relaxed” - its volume and density have become insufficient for a full-fledged implant installation. About why there is a rarefaction of the jaw bone tissue and whether implantation without bone tissue augmentation is possible - read in our review.

What is jaw bone atrophy

Bone tissue is a complex, living, constantly changing structure. As in any living tissue, it contains water - about 10%. On average, 25% of the composition of the bone is an organic, “living” component. These are proteins, mainly collagen, and cells that regulate the composition and structure of tissue. The remaining share is inorganic substances (mainly hydroxyapatites). These are the substances that give bone tissue strength and rigidity. The percentage may vary depending on whether we are talking about spongy or compact bone tissue:

  • spongy bone- porous and light, in it between the bone structures (trabeculae) there is a lot of free space where blood vessels pass. The structure is dominated by organic components.
  • Compact (cortical) bone- densely arranged and very strong. It is dominated by inorganic substances.

Living bone tissue is formed by bone cells: osteocytes and osteoclasts.

Osteocytes- These are the cells of the bone tissue that form it and regulate the process of calcification. They synthesize the protein structures of the bone, regulate mineralization - the concentration of calcium and phosphorus salts, thus maintaining a balance between the organic and inorganic components.

osteoclasts destroy "used out" or damaged bone structures.

In the normal state of a living organism, a balance between destruction and creation is continuously maintained - in order to create something new, you need to “clear the site”. But when, for some reason, the process of resorption (resorption) of bone tissue begins to predominate, bone tissue atrophy occurs.

Most often, bone loss develops after tooth extraction. In order to maintain a normal state, any organ must work, and non-working structures atrophy - the body does not have the opportunity to spend nutrients and energy to maintain a non-functioning organ in a healthy state. The bone tissue of the jaw is maintained in a “working” state by a load that is transmitted during chewing through the roots of the teeth. As soon as the tooth is removed, the load disappears. Gradually, the vessels that fed the removed tooth cease to function, which means that nutrition also ceases to flow into the jaw tissue. The jaw tissue in the area of ​​the extracted tooth begins to dissolve - to atrophy. According to a study by German scientists, after the loss of teeth, such changes occur in 95% of cases. Within 1 year after tooth loss, bone volume decreases by 25%. That is why dentists recommend putting an implant in its place as soon as possible after losing a tooth.

In clinical practice, there are 4 degrees of atrophy:

  • insignificant;
  • moderate;
  • expressed;
  • rough.

With a slight decrease in bone density, implantation of teeth using optimally sized dental implants is possible. With severe atrophy, implantation is possible only after the reconstruction of the jaw.

Causes of loss of density and loss of jaw bone

Loss of a tooth is not the only reason for changes in bone structure. Such reasons may be:

  • inflammation of the gums and periodontium - structures that surround the teeth and ensure their stability;
  • cysts and inflammation in the area of ​​​​the roots of the teeth or maxillary sinuses;
  • jaw injuries;
  • osteoporosis;
  • congenital anatomical features.

Nevertheless, the main reasons for the development of atrophy of the jaw bone tissue are untimely prosthetics after tooth extraction.

Consequences of "relaxation" of bone tissue

Atrophy of the alveolar processes is not only a problem of a "local" scale. Gradually intensifying, the process causes irreversible changes:

  • The facial expression changes. Depending on where the defect is located, the upper or lower jaw is “shortened”, the lips sink in, and wrinkles form around them. The face acquires a characteristic "senile" appearance.
  • The teeth begin to move towards the "empty" space. The likelihood of loss of neighboring teeth also increases. Due to the fact that the location of the teeth changes, food remains are trapped between them: the development of caries is accelerated. Yes, and chewing itself becomes less effective, as a result - problems with the gastrointestinal tract.

And the main problem faced by patients of dental clinics is the impossibility of implanting teeth. According to Russian doctors, in 35% of patients it is impossible without reconstruction of the jaw bone tissue.

How to prevent the process of atrophy?

Since bone atrophy most often develops due to the extraction of a tooth (or several teeth), it is obvious that in order to prevent it, teeth should be restored as soon as possible. Several methods are traditionally used:

  • installation of a bridge structure;
  • installation of a removable prosthesis;
  • implantation.

The first two methods are relatively inexpensive. But, unfortunately, they do not restore the load on the bone in the place of the extracted teeth. The load falls on healthy teeth that fix the prosthesis, in the case of a removable bridge - on the gums. As a result, atrophy continues to develop. Often it negates the results of prosthetics - the gum "sags" after the bone tissue, a gap appears under the prosthesis. This is not only unaesthetic, but also dangerous - food remains accumulate in the resulting space, on which microorganisms that provoke inflammation actively multiply.

Dental implantation, unlike other methods of prosthetics, allows you to create a load directly on the bone tissue in the area of ​​the extracted tooth. Thus, the bone tissue continues to work in a normal mode, which means that all the necessary metabolic processes are preserved in it. This prevents thinning of the jaw bone.

Options for restoring the dentition with significant atrophy

But what to do if time is lost and the degree of bone tissue atrophy does not allow implantation of teeth? Today, there are two main methods to deal with this problem.

Restoration of the jaw bone tissue with subsequent implantation with delayed loading.

This is a classic technique that has stood the test of time. First, an operation is performed to increase the volume of bone tissue. There are different methods: sinus lift, splitting of the alveolar process, bone graft or artificial tissue infusion. Which of them will be optimal in this particular case, only the attending physician can decide. After the operation, it will take from several months to six months to restore bone structures, after which implants are implanted into the jaw, while without crowns - and again it takes about six months for their engraftment. Only after that, crowns are placed on the titanium base of the implants and the jaw finally receives a load.

Immediate Load Implantation

This relatively new technique has become possible thanks to special implants that are fixed not in the alveolar part of the jaw, but deeper, in its basal part, which consists mainly of a compact substance. Implants are selected based on the individual characteristics of the patient's jaw. They require a minimum time for healing - the prosthesis is installed already on the 3-5th day after the fixation of the implant itself. Due to the fact that the bone immediately receives a load, it maintains blood circulation, normal metabolism, which accelerates regeneration.


In order for an organ to maintain its structure and functions, it must work. This also applies to the bone tissue of the jaw. Loss of teeth leads to atrophy of the jaw bone. To prevent this process, it is necessary to replace it with a prosthesis as soon as possible after tooth extraction. Dental implantation is the closest to natural way to restore them, allowing you to save the volume and density of bone tissue.

How to choose a dental clinic?

About what to look for when planning dental implantation, Oleg Vladimirovich Filimonov, an implantologist at the Dental Implantation Center, tells:

“At least take an interest in the equipment on which the clinic operates, what materials it uses. For example, dentistry SMILE-AT-ONCE - official partner of well-known implant manufacturers: Nobel Biocare, Oneway Biomed, Straumann. Our website has detailed information about the tools, equipment, software and technologies we use. You can also find our licenses, certificates and awards there.

For the success of the treatment, it is important how long the clinic has existed, what is the experience of the doctors, whether they take advanced training courses. The specialists of our clinic have more than ten years of experience and regularly participate in scientific and practical conferences, training programs, and other educational events. Thus, all SMILE-AT-ONCE implantologists have valid certificates from the International Implant Foundation, which confirms their right to work in this field. The clinic is a member of the international community of implantologists (International Team for Implantology. ITI), which has existed for 30 years. We provide a full range of services for dental prosthetics using implants in seven days and give a lifetime warranty on implants, as well as offer a convenient treatment regimen for both patients from Moscow and nonresidents.”

License No. LO-77-01-013995 dated March 14, 2017. issued by the Department of Health of the city of Moscow

Editorial opinion

If you decide to install implants or other types of dental prosthetics, visit a periodontist first. If pathologies are identified, they will need to be eliminated. In addition, hygienic cleaning of periodontal pockets and teeth is necessary to eliminate plaque and tartar.

During eating, the bone tissue of the tooth experiences some load. If the teeth have fallen out, then the load is reduced, and the bone is reduced in size. When one tooth is lost, others have to work harder. This can lead to their rapid destruction.

The structure of the bone tissue of the tooth

The structure of bone tissue is different from that of other human cells. Osteoblasts and osteoclasts are special cells found in hard tissues. Osteoblasts produce collagen, which allows bone to continue to grow, while osteoclasts cause bone atrophy. Some cells continue to grow, others reduce the hard part. Joint work provokes a constant renewal of the bone tissue of the tooth.

Bone is made up of two parts:

  • cortical contains a large percentage of minerals;
  • spongy is more like bone marrow and consists of soft parts.

The lower and upper jaws differ from each other in structure. The lower one consists of a cortical layer that surrounds a small spongy layer. Such a structure is required in order for the lower jaw to withstand the load that falls on it. The upper jaw for the most part consists of a spongy layer and a small amount of hard tooth tissue.

Cause of atrophy

A decrease in bone tissue appears after the extraction of teeth. The more gaps in the dentition, the more pronounced the symptoms of atrophy:

  • gum size decreases in volume and height;
  • wrinkles around the mouth may occur;
  • sunken cheeks and lips;
  • drooping corners of the mouth;
  • asymmetry of the face;
  • the appearance of gaps between the remaining teeth.

Atrophy occurs due to several reasons:


The most common reason for bone loss is tooth extraction. The patient himself does not immediately understand that changes are taking place with the jaw. 3 months after the loss of a tooth, part of the gum begins to fail, and a year later, it is no longer possible to insert an implant in place of the gap without additional measures to restore the bone tissue of the tooth.

What causes bone destruction

Atrophy is not only an aesthetic problem; with this pathology, changes occur in the body and difficulties arise in other organs. Restoration of the dentition becomes a complex task and requires bone augmentation during dental implantation.

In the absence of teeth, food is crushed poorly, which eventually leads to a malfunction of the gastrointestinal tract.

The loss of a large number of teeth leads to a violation of diction and causes the appearance of deep wrinkles on the cheeks.

Non-carious lesions of the tooth tissue

One of the reasons for the appearance of bone tissue atrophy is damage for various reasons. This disease ranks second in the number of visits to the dentist after caries. It can affect one tooth or several and manifest itself with various symptoms.

Non-carious lesions of the tissues of the tooth can be congenital or acquired. One of the manifestations of damage can be erosion. Enamel is damaged, which leads to darkening, hypersensitivity and aesthetic problem. The disease can last for a long time and lead to loss of teeth. Sometimes the cause of the development of pathology is nutrition with a high content of acids and salts. Marinades and orange juice provoke the development of the disease. At the initial stage, the disease is not diagnosed, because the loss of enamel luster is not very noticeable. But over time, the patient complains of pain. Prevention of erosion is an important component to prevent the development of damage to the hard tissues of the teeth and atrophy.

Another common cause of damage to the dentition is increased sensitivity of the teeth. Under the influence of temperature, severe pain occurs, which quickly subsides. The disease can disturb one tooth or affect several. If left untreated, there is a risk of surgery or removal. To replenish the missing minerals in the tissues of the tooth, vitamin-mineral complexes are taken.

Bone restoration

The restoration of bone tissue has become possible thanks to the development of medicine. The doctor determines whether restoration is required before the implantation of the tooth. As a rule, this is necessary. Building up the bone tissue of the tooth takes from 6 to 8 months.

Bone restoration is necessary in the following cases:

  • absence of a tooth;
  • periodontal disease;
  • removal of the old implant;
  • jaw injury;
  • removal of the cyst in the cavity.

When a tooth is removed, especially during a complex procedure, inflammation may develop, which leads to the rapid erosion of bone tissue. The longer a tooth is not replaced, the more atrophy will appear and the more difficult it is to place a new implant.

In periodontal disease, the bone tissue at the base of the tooth is destroyed. If the disease is not stopped in time, this leads to the loss of the molar, and the restoration will require an increase in the jaw bone.

Removal of an artificial tooth is possible when using poor-quality material or poor-quality work. In such cases, the implant may break and damage the jaw. Therefore, restoration of soft and hard tissues will be required.

If a cyst or tumor was removed, then the bone tissue could be affected. Surgery will then be required to repair the hard parts.

In case of a jaw injury, in particular with a fracture, the restoration of some parts is required for further prosthetics.

Recovery methods

To build up the bone part of the tooth, several methods are used, the use of which depends on the degree of atrophy.

Drug is used at the initial stage of atrophy to slow down the process.

The most common method is operational. Recovery occurs in full with minimal risk of side effects. How to deal with atrophy is up to the doctor, but the method will differ depending on which jaw is being operated on.

Restoration work is carried out under local anesthesia. Ultrasound is used to minimize damage and reduce recovery time. A drug is injected into the bone that stimulates cells to regenerate, and within 8 months the bone tissue is completely restored.

Sinus lift for recovery

The sinus lift procedure is designed to increase bone tissue by lifting the maxillary sinuses. It is used provided that the patient has no pathologies and allergic reactions.

If the patient has a history of chronic runny nose, sinusitis or multiple septa, then the operation will not be performed.

The procedure allows you to increase the missing volume of bone tissue, but there remains a risk of a chronic runny nose or inflammation in the future.

Protection of the jaw against atrophy

Atrophy of the bone tissue of the tooth is treated surgically, but this can be avoided if the destruction of hard tissue is not allowed.

To do this, it is necessary to restore lost teeth in time and prevent the loss of existing ones. Implants are much better than other methods, because they have a root and create a load on hard tissues. Removable dentures do not give a full load on the lower jaw, and over time, atrophy of the hard tissues of the teeth will occur. Treatment occurs similarly with a significant loss of the bone of the jaw. If hard tissues sag gradually, then correction of prostheses without treatment of atrophy will be required.

In the treatment of atrophy, the choice of treatment method depends on the desire of the patient. What does he want to achieve? Complete restoration of bone tissue and its function or to create external beauty?

To prevent atrophy and other diseases of the oral cavity, it is necessary to visit the dentist twice a year.

- This is a progressive pathological process, which is characterized by a decrease in the tissue of the jaw bones. It is characterized by a decrease in the size of the alveolar ridge and the jaw as a whole, an increase in the volume of the maxillary sinuses. Externally, atrophy is manifested by a decrease in the lower third of the face, accompanied by physiological, morphological, functional and aesthetic disorders. Diagnosed by clinical examination, radiography, CT, MRI of the jaws. Treatment consists in restoring the volume of the bone with surgical methods.

ICD-10

K08.2 Atrophy of the edentulous alveolar margin

General information

Jaw atrophy is a chronic irreversible process of bone tissue resorption. The pathological process affects people of any age after the loss of teeth (in 95% of cases - after surgical removal). It is more common in people over 50 years of age. The rate of bone loss is purely individual and varies in different parts of the jaw. During the year after the extraction of the tooth, there is a decrease in bone volume by 25%. With insufficient bone volume, it is impossible to restore lost teeth by prosthetics and implant placement. A person is faced with insufficient fixation and stabilization of prostheses, an aesthetic defect.

Causes of jaw bone atrophy

The main cause of bone resorption of the lower or upper jaw is the loss of teeth. At the same time, the start of atrophic processes and the stages of their course do not depend on the cause of tooth loss (trauma, dental disease, removal for medical reasons). There are a number of factors that contribute to the progression of the pathological process:

  • Chronic dental diseases. Chronic periodontitis , periostitis , periodontal disease , osteomyelitis, periradicular cysts and granulomas are accompanied by inflammatory processes in the tissues of the jaws and provoke resorption of the alveolar process. fractures, bruises, mechanical tooth damage and the alveolar process disrupt the processes of osteogenesis.
  • Congenital anatomical anomalies. Underdevelopment of the jaws is a component of some congenital malformations of the maxillofacial region: cleft lip, alveolar process and palate, dysostoses, Robin's syndrome. Some individuals are prone to atrophy due to a genetic predisposition.
  • Oncological diseases. Bone resorption can be caused by various jaw tumors: cancer, odontogenic sarcoma, osteoma , chondroma, fibroma, hemangioma, ameloblastoma , odontoma , myxoma, ameloblastic fibroma, cementoma. Removal of neoplasms leads to a bone defect, which also causes atrophic changes.
  • Diseases of the body. In persons older than 40-50 years, there is osteoporosis- metabolic disorders in bone tissue. The disease is accompanied by a progressive loss of trace elements, the predominance of resorption processes, a violation of the structure of bones, a decrease in their density and mass. The main role in the development of pathology is played by metabolic disorders of calcium, phosphorus, vitamin D, as well as a lack of fluorine, magnesium, bromine, silicon and vitamins. Also, starting factors of atrophy can be diseases of the cardiovascular, endocrine, digestive, and nervous systems.

Pathogenesis

With a decrease or absence of a functional load on the jaw associated with tooth extraction, atrophic processes are triggered in the bones. During chewing, pressure is transmitted through the roots of the teeth to the jaw, which helps to maintain its performance and normal structure. Bone is formed and resorbed depending on the load. In its absence, the activity of osteoblasts decreases, and the process of resorption prevails over the process of osteogenesis. The first signs of atrophy appear as early as 3 weeks after tooth loss, in this area there is a decrease in the density of the trabecular bone network. In the first year of the absence of functional load, irreversible tissue changes occur.

Classification

AT dentistry distinguish between horizontal resorption (occurs along the width of the alveolar process) and vertical (occurs when the height of the ridge decreases). The process of bone loss can be uniform in the distribution of the jaw or uneven. Uneven atrophy of the jaws can be of several types:

  • 1 type- minor degree. The alveolar process of the jaw is well expressed, atrophic processes are minimal. Surgical interventions are not indicated. Prosthetics are needed to prevent the progression of bone resorption.
  • type 2- medium degree. Implant placement is not possible without jaw preparation. Orthopedic prostheses are poorly fixed in the oral cavity. Shown is a preliminary osteoplasty and bone augmentation.
  • 3 type- gross atrophy. The alveolar process is significantly atrophied. Orthopedic treatment is impossible without increasing the volume of bone tissue. To restore teeth and the function of the oral cavity, it is necessary to perform osteoreplacement operations.

Symptoms of jaw bone atrophy

The main sign of atrophy is a change in the appearance of the jaw. The alveolar ridge is significantly reduced in size. With complete adentia of both jaws, senile progeny is observed. Due to atrophy, the lower third of the face is shortened, its appearance changes. Lips sink into the oral cavity, wrinkles form around the mouth. Arise malocclusion, neighboring teeth lean towards the missing ones. The phenomenon of Popov-Godon is observed - opposite teeth are put forward in place of the lost antagonist. There is a violation of the functions of chewing and speech, a deterioration in the aesthetics of the face. A person with jaw atrophy looks older than his passport age.

Complications

The main and most serious complication is the inability to carry out high-quality restoration of teeth. Due to the insufficient size of the alveolar process, it is impossible to carry out treatment by prosthetics or implantation, since there is insufficient fixation and stabilization of orthopedic structures. Prolonged progression of atrophy causes pain due to compression of the mental nerves. The result of a violation of chewing function are diseases of the digestive tract. Increased risk pathological fractures jaws in areas of thinning.

Diagnostics

For the diagnosis of atrophy of the jaw bone tissue, both basic and additional research methods are used. In order to carry out the treatment correctly, it is necessary to determine the degree of atrophy and its exact localization in each part of the jaw using modern diagnostic methods. The following pathology recognition methods are used:

  • External and intraoral examination. The appearance of the face, the clinical situation in the oral cavity, the number of missing teeth are visually assessed. By examination and palpation, the shape and structure of the alveolar processes are determined, the type of resorption is established, and conclusions are drawn about the degree of dysfunction.
  • Radiography. To determine the type and severity of atrophy after the removal of a single tooth, sighting shot. On the orthopantomography the upper and lower jaws, the condition of the teeth and roots, temporomandibular joints are visualized. There is an increase in the pneumatization of the maxillary sinus - an increase in its volume. Due to resorption, there is a decrease in the distance to the mandibular canal and nerve by 7-8 mm. By cephalogram in the lateral projection, the degree of resorption is monitored from the vestibular, occlusal and lingual sides of the alveolar process.
  • MRI and CT of the jaws . They are the most accurate and detailed studies with a high degree of information content. On tomograms, all structures of the oral cavity are visualized, which makes it possible for specialists to correctly assess the severity of atrophy in each part of the jaw, to correctly perform surgery and prosthetics.

Treatment of jaw bone atrophy

Increasing the volume of jaw bone is one of the most difficult tasks in dentistry. To eliminate atrophy, various methods of surgical interventions are used. Reconstruction is carried out using biological and artificial bone material. In every clinical situation dental surgeon individually selects the method and type of material. The following treatments are used:

  • Splitting of the alveolar ridge . The operation of intercortical osteotomy is indicated in the presence of a thin or narrow alveolar ridge. It consists in a longitudinal osteotomy: special instruments are inserted between the cortical plates of the ridge and expand its alveolar part. The space between the plates is filled with osteoreplacement material. The method is distinguished by efficiency, ease of implementation, fast healing, good aesthetics.
  • Sandwich plastic. It is used to treat vertical atrophy, both in the lateral and anterior jaws. The operation consists in making one horizontal or two vertical cuts in the area between the chin holes and implanting the bone material. The advantage of the intervention is the predictability of the results, the absence of displacement or resorption of bone material.
  • Distraction osteogenesis. The method is indicated for congenital and acquired jaw defects. The purpose of the intervention is to activate the process of bone tissue formation. For this, an osteotomy is performed with the installation of a distractor, its activation and removal after bone augmentation.
  • Bone block transplantation. The operation involves increasing the volume of the jaw by bone grafting. The intervention is carried out for all types of atrophy. Autografts are introduced into the required area, fixed with screws or titanium mesh and covered with a protective membrane.
  • Sinus lift . Maxillary sinus floor plasty is indicated for atrophy of the upper jaw in the lateral area. The essence of the operation is to build up the bone of the required size for the installation of implants. Surgical intervention is very popular, effective and makes it possible to implement various implantation techniques.

Forecast and prevention

With timely treatment of bone atrophy, the prognosis is favorable: after osteoplasty, in most cases it is possible to carry out successful prosthetics. In the case of pathological fractures of the jaws, a long and complex treatment is required. Prevention of atrophy of the jaw bone tissue consists in timely dental treatment, visiting dentist 2 times a year for the purpose of inspection. It is necessary to restore defects by the method of prosthetics and implantation within 6 months after the loss of teeth. General prevention measures include sanitation of the oral cavity, treatment of chronic diseases of the teeth and the body as a whole, strengthening the immune system, and giving up bad habits.

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