Q&A: When a tooth gets knocked out is there bone loss?

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If you lose a tooth. is there bone loss in that area? or does it fill in with bone? i have small knowledge about this subject but i lost a tooth and need an implant but there is an issue with not having enough bone? delight clarify this to me
thanks

Answer by Ivan
Yes, you will lose bone in that area as long as there is nothing occluding with it, but having an implant will really stimulate bone regeneration. Don’t worry, you will have plenty of bone for the implant.

Answer by xaris x
Depends on lot of thinks and is trying for my english to clarify but I ll try.
Tooth and bone are two different thinks. when we extract a tooth of course we dont extract bone. now the empty hole will fill with bone.
BUT
1.how deep is this hole ? if the tooth was extracted becase of periodontal desease and it was more or less loose then that “hole” is not deep and may not exist at all
2. how vital is the remaning bone ? if the tooth is lost after an extensive absses then the bone is not so vital to fill the “hole”:
3. your age ! I m 50 and at least my bones were stronger when i was 20.
I reckon this is the way you should approach you question. I reckon many other reasons may affect how much bone will made in the socket and nobady can tell exactly.
In such cases I give the patent 4 to 6 moths after the extractin of the tooth so that the trauma heal and see the case again

Answer by Dr. Albert, DDS (UNITED STATES)
THE AMOUNT OF BONE TO HOLD AN IMPLANT DEPENDS ON WHERE THE IMPLANT IS TO BE PLACED.
IF THE IMPLANT IS TO BE PLACED IN THE UPPER JAW, IT SOMETIMES CANNOT BE PLACED WHERE THE UPPER SINUSES ARE INVOLVED. THE AMOUNT OF BONE PRESENT IS IRRELEVANT. THE AREA WHERE A TOOTH HAS BEEN LOST WILL EVENTUALLY FILL WITH BONE BUT BECAUSE OF ANATOMIC RESTRICTIONS AN IMPLANT MAY NOT BE POSSIBLE.

Answer by Biologic Dental Consultant
it is not really bone loss, per sey. the tooth is in a socket and there is bone around it. when it is pulled or falls out, the bone fills into that spot via osteoblasts, which are specialized cells that form bone. at least it that is the way it is supposed to work. unfortunately, non-biologic dentists do not know to pull out the periodontal ligament to allow the bone to form. that makes a cavitation. you should not get an implant. they are not a excellent thing.

CAVITATIONS

A cavitation is an unhealed hole in the jawbone caused by an extracted tooth [or a root canal or an injury to a tooth]. Since wisdom teeth are the most commonly extracted teeth, most cavitations are found in the wisdom tooth sites. Delight see the graphic and photo below to get a glimpse of what may be in your mouth and the effects it is having. The photo and diagram demonstrate the destructive and pathologic consequence of a routine tooth extraction. Dentists are taught in dental school that once they pull a tooth, the patient’s body heals the resulting hole in the jawbone. Though, approximately 95% of all tooth extractions result in a pathologic defect called a cavitation. The tooth is attached to the jawbone by a periodontal ligament which is comprised of “jillions” of microscopic fibers. One end of each fiber is attached to the jawbone and the other end of the fiber is attached to the tooth root. When a tooth is extracted, the fibers break midway between the root and the bone. This leaves the socket (the area everywhere the root was anchored in the bone) coated with periodontal ligament fibers.

There are specialized cells in the bone called osteoblasts. Osteoblasts make new bone. The word “osteoblast” means bone former. They are active during growth and maintenance. Though, the periodontal ligament prevents the osteoblasts from filling in the tooth socket with bone since the periodontal ligament fibers lining the socket act as a barrier beyond which the osteoblasts cannot form bone. In other words, an osteoblast “sees” a tooth when it “sees” periodontal ligament fibers. Since there are billions of bacteria in the mouth, they easily get into the open tooth socket. Since the bone is unable to fill in the defect of the socket, the newly formed “cavitation” is now infected. Since there is no blood supply to the “cavitation” it is called “ischemic” or “avascular” (without a blood supply). This results in necrosis (tissue death). Hence we call a cavitation an unhealed, chronically infected, avascular, necrotic hole in the bone. The defect acts to an acupuncture meridian the same way a dead tooth (or root canal tooth) acts. It causes an interference field on the meridian which can impair the function and health of other tissues, organs and structures on the meridian. Significantly, the bacteria in the cavitation also produce the same deadly toxins that are produced by the bacteria in root canals (see Root Canals). These toxins are thio-ethers (most toxic organic substance renowned to man), thio-ethanols, and mercaptans. They have been found in the tumors in women with breast cancer.
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Implants:

A titanium dental implant is usually made out of an alloy of this metal along with numerous other metals blended together. The most common alloy used has a ratio of 90 parts titanium, 6 parts aluminum and 4 parts vanadium

titanium implants are putting metal and a high milliamperage close to the brain. i have seen a woman who measured nearly 400 milliamps positive charge, and 30 neg charge who had three in her mouth; she paid $ 9,000 for them. the dr said she could have ran a stereo off her teeth. we removed them. our body runs on electrical impulses, so this can disrupt them (and brain waves). also, dentists and drs will tell you that bone grows to titanium implants. well, it will grow around it. but, it is a foreign object and the body will build up antibodies to it. over time, it will pull away from the bone and can be converted into loose. if you will notice, they say implants last about 15 being or so. they are working on an implant made of diamond, supposed to be available in 5 yrs. but, it will still be a foreign object and pull away from the bone.
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Risks of Removable Appliance / Denture Bone loss Periodontal problems (irritation of gum tissue) Wear and tear on natural teeth Possible speech problems Will need adjustments evenly Comfort tends to be an issue. Block Bone Graft of my bone from Chin, Jawbone, or Hip (High Risk) Chin This procedure requires cutting through the inside of the bottom lip (he cannot cut along my gum line) and removing the bone from your chin. I do not have enough tissue in my gum area to take in the surgical site. Tissue may be used from underneath the tongue to make the flap. The surgical site needs to be covered for at least four months. There will be a scar in front of my lower teeth and this should not bother me. If you lose sensation because of nerve hurt, your muscle tone you should not be affected. You will have 1-2″ along the inside of my lower jaw and chin. The area may tingle and burn, but apparently You can get used to this? Also, the surgical sites may open up and need to be addressed with antibiotics, drainage, etc. This block of bone would be held in house with small titanium screws. It will take approx. 6 months to 1 year for these grafts to heal and integrate into your jawbone and the surgical sites will be kept covered with my tissue House 2 more implants and have all 3 implants functioning separately. It will take approx. 6 months to 1 year for the implants to integrate into my jawbone. Crown all 3 implants separately. Keep yourself strong and healthy and hope that it works for a very long time. Have frequent cleanings (each 3 months). I have chose to not use bone from my face or hip. I will attempt either remains or artificial bone grafting.
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2.7.6. Titanium
It is generally accepted that pure titanium is extremely well tolerated by local tissues and induces neither toxic nor inflammatory reactions (Branemark et al. 1969, Toth et al. 1985, Linder et al. 1988, Pfeiffer et al. 1994). The normal tissue concentration of titanium in humans is 0.2 ppm. Around the titanium implants no clinical tissue toxicity has been observed even at local concentrations higher than 2000 ppm (Hildebrand et al. 1998). In optimal situations, titanium is able to osseointegrate with bone, thus forming a direct contact with bone at the set alight microscopy level (Branemark et al. 1969). The excellent bone contact may be due to the ability of titanium to form a Ca-P rich layer on its surface (Hanawa 1991). Titanium is bacteriostatic (Elagli et al. 1992) and does not significantly activate or inhibit different enzyme systems specific to toxic reactions, e.g. β – glucuronidase, lactate dehydrogenase, glucose-6-phosphate dehydrogenase and acid phosphatase (Elagli et al. 1995). The excellent biocompatibility and corrosion resistance are due to the naturally forming stable titanium oxide (TiO2) film on titanium surfaces (Zitter et al. 1987, Kasemo et al. 1991).

Particles from titanium rise from the passivation layer of the implant, but they are not titanium ions, but mostly insoluble titanium oxides or suboxides, which are recognized to be geologically inert. Indeed, the passivation layer is immediately reformed after abrasion because of the high oxidizability of titanium. This behavior protects the alloy and prevents the formation of chemical compounds other than oxides (Hildebrand et al. 1998). Tissue discoloration due to titanium oxide particles is sometimes seen around pure titanium implants, but this seems to have no clinical consequences (Onodera et al. 1993, Rosenberg et al. 1993). Experiments with laboratory animals and some limited analyses of human tissues have also revealed evidence of titanium release into distant tissues (Schliephake et al. 1993, Jorgenson et al. 1997).

Wear particles produced by abrasion appear especially in the vicinity of articular prostheses and implants with certain mobility, e.g. uncemented total hip replacements. These particles may induce multiple tissue reactions, including osteolysis, degradation of normal bone structure, severe macrophagic reactions, granuloma, fibrotic capsules and chronic inflammation, which may produce destabilization and loosening of prostheses and implants (Santavirta et al. 1991, Santavirta et al. 1993, Rubash et al. 1998). Particle size and composition are of elemental importance in that process. Deleterious reactions have been reported with Ti-6Al-4V based prostheses (Nasser et al. 1990, Rubash et al. 1998), but not with pure titanium implants.

In vitro, pure titanium particles have also been shown to have some effects on cells. Low concentrations may stimulate fibroblast proliferation, while high concentrations may be toxic. At high particle concentrations, titanium caused a decrease in proteolytic and collagenolytic activity in the culture medium. Titanium also elevated the lysosomal enzyme marker, hexosaminidase, except at high concentrations (Maloney et al. 1993).

J Bone Joint Surg Br. 2005 May ;87:628-31 15855362
Metal ion levels after metal-on-metal proximal femoral replacements: a 30-year follow-up.
[My paper] E Dunstan , A P Sanghrajka , S Tilley , P Unwin , G Blunn , S R Cannon , T W R Briggs
Metal-on-metal hip bearings are being implanted into younger patients. The consequence of elevated levels of potentially carcinogenic metal ions is therefore a produce for concern. We have determined the levels of cobalt (Co), chromium (Cr), titanium (Ti) and vanadium (Va) in the urine and whole blood of patients who had had metal-on-metal and metal-on-polyethylene articulations in situ for more than 30 being. We compared these with each other and with the levels for a control group of subjects.We found significantly elevated levels of whole blood Ti, Va and urinary Cr in all arthroplasty groups. The whole blood and urine levels of Co were grossly elevated, by a factor of 50 and 300 times respectively in patients with loose metal-on-metal articulations when compared with the control group. Stable metal-on-metal articulations showed much lower levels. Elevated levels of whole blood or urinary Co may be helpful in identifying metal-on-metal articulations which are loose.
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Zirconium dioxide implants are supposed to be the wave of the future. They are still putting a foreign body into the jaw and the immune system will launch an immune response, so they will still loosen over time (15 to 20 being) from that. Contracted, it appears to be better than titanium and they are saying it is a substitute for metal implants, but with the immune response, it isn’t worth it to me.
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Properties

The German chemist M. H. Klaproth learned zirconium dioxide in 1789 although this “miracle material” with its outstanding properties has only been re-learned in the last few decades. For instance, various types of zirconium dioxide have been introduced to dentistry as a substitute for metal. This material is striking because of its extraordinary properties such as high flexural strength (in excess of 1,000 MPa), hardness (1,200 – 1,400 Vickers) and Weibull modulus (10-12). Yttrium partially stabilises zirconium oxide to provide these positive properties. Adding aluminium oxide boosts the flexural strength of the zirconium dioxide alloy once again. Zirconium dioxide is used for manufacturing kitchen knives, industrial cutting tools and components under fantastic thermomechanic stress in the automobile and aircraft industry. Though, it is not only very strong, it is also biocompatible so that zirconium dioxide is also used in medicine (hearing devices and artificial fingers and hips) and dentistry (pins, crowns, bridges and implants). The fact that zirconium dioxide has the same colour as teeth along with its biotechnical characteristics mean it is used for manufacturing biocompatible, high-quality and aesthetic tooth and implant reconstructions. There have only been animal experiments and laboratory examinations on applying dental zirconium oxide implants to date, meaning no long-term data exists on the clinical application of these implants.

Manufacturing Zirconium Dioxide

The mineral zirconium (ZrSiO4) is the main raw material for zirconium dioxide while melting it with coke and lime (reducing the SiO2) produces ZrO2 for industrial uses. Since extremely pure constituents have to be used for producing high-routine ceramics, special ways to synthesise it have been developed for high-purity ZrO2. This includes production with reactions in molten salts, reactions in the gaseous period, hydrothermal powder synthesis and the sol-gel process. Gaseous period and sol-gel process production provides powder at very small particle sizes ranging from 0.01 to 0.10 µm. This powder is then mixed with additives to make what are renowned as conservational bodies with film casting, slip casting or drying pressing. We distinguish additives such as sintering additives (that have a specific effect on the sintering behaviour and the properties of finished ceramics) and auxiliary materials that facilitate shaping. While the sintering additives stay in the ceramics, all residues of the auxiliary materials (mostly slightly volatile organic compounds along with water) are removed from the moulded component before the sintering process. The conservational body is passed into the raw product by sintering and ground or polished depending upon use. The sintering process can be carried out at atmospheric pressure and under high pressure and it is only with the sintering process that the moulded components receive their actual properties. The ceramic powder particles are compressed by lowering the specific surface with temperature-dependant diffusion processes with alternating components of surface, particle size grading and volume diffusion. If solid body diffusion is too slow, sintering can also be carried out with a liquid period or under pressure, the latter being called hot pressing or hot isostatic pressing (the HIP process). The velocity of solid body diffusion can be boosted with the right selection of sintering additives. A fantastic deal of research needs to be done here since the high sintering temperatures (in excess of 1,200° C) and manufacturing under pressure causes production costs for ceramic components to shoot up. Along with providing systematic clarification of the impact that additives have on the sintering process, there are also attempts to enhance power transmission onto ceramic components by coupling in microwaves for lowering sintering temperatures.

ZrO2 Ceramics

The properties of ZrO2 ceramics substantially pivot on the chemical composition of the material and the manufacturing process. We distinguish fully stabilised ZrO2 (FSZ „fully stabilized zirconia") and partially stabilised ZrO2 (PSZ „partially stabilized zirconia"). It can be partially stabilised by adding 3-6% CaO, MgO or Y2O3 and depending upon the situation of manufacturing this stabilises the cubic, tetragonal or monocline modification. Partially stabilised ZrO2 demonstrates high thermal exhaustion resistance, meaning it fills the bill for use as high-temperature mechanoceramics. Adding 10-15% CaO, MgO or Y2O3 also allows cubic modification of the zirconium dioxide from absolute zero to the solidus (FSZ) and the ceramic material is thermally and involuntarily stable to a temperature of 2,600°. Though, its low caloric conductivity and higher thermal expansion factor as compared with partially stabilised ZrO2 mean that the thermal exhaustion resistance of the fully stabilised zirconium dioxide is lower. The zirconium dioxide that is suited to use as an implant has the following composition: 95% ZrO2 + 5% Y2O3.

Answer by leigh w
When we do an implant in our office, it is always best to house an implant the same day of the extraction.

If an implant is done at a later time, a patient should wait 3-6 months for complete healing, to see how much bone is present. At this time, you may need a bone graft. And again wait in anticipation of the dentist determines when it would be excellent to proceed with implant surgery.

Everyone heals differently, smokers and diabetics are slow healers. So the quantity of bone and the time to re-evaluate differs from patient to patient.

Excellent Luck! Dental Implants are wonderful!

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