Why measure bone width and height before an implant?
Because there needs to be enough bone around the screw for the implant to bond to the bone and last a long time. Before asking, “Where's a good place for implants?”, the first thing to look at is your own bone. If I were sitting in the chair as a patient, I would look in the same order: bone width and height, gum thickness, the nerve and sinus, and where the tooth will eventually sit.
If these four are sufficient, we place the implant; if even one is lacking, we supplement it or postpone. How bone is added when it's lacking is summarized separately in bone grafts for implants.
| Check first | If sufficient | If lacking |
|---|---|---|
| Bone width and height | Place as is | Add bone or postpone |
| Gum thickness | Maintain the gum line | Also consider reinforcing the gum tissue |
| Distance to the nerve and sinus | Match the screw length | Consider a short screw or a sinus lift |
| Where the tooth will sit and the bite | Set the direction to fit that position | Sort out the bite first |
Are implants difficult if the gums are thin?
They can be placed, but it's harder to maintain the gum line over time. If the gums are thin, the metal color of the screw may show through, or the gum line may appear to recede over time. On front teeth, that difference is especially noticeable. If thickness is lacking, we also consider ways to reinforce the gum tissue.
If there is gum inflammation, we treat the cause before placement. If an implant is placed after cleaning only the surface and leaving tartar deeper down, the area around the implant tends to swell later.
Why are the nerve and sinus checked together?
Because the inferior alveolar nerve, which handles sensation, runs through the bone in the lower molar area, and the maxillary sinus (the hollow space beside the nose) sits right above the upper molars. If the screw is made too long, the nerve can be injured or the sinus membrane can be perforated.
For upper molars, a sinus lift (surgery that raises the sinus floor and fills in bone) is added only when bone height is lacking. If the height is sufficient, we don't lift it. Details are in upper molar implants and sinus lifts.
How is the screw direction decided?
Not by where the bone is thickest, but working backward from where the tooth will eventually sit. We have to look at the force of the upper and lower teeth meeting so the screw doesn't tilt to one side and take force unevenly. When placing several at once, the bite has to be looked at more broadly than for one.
What should I check during an implant consultation?
Rather than the price figure, check what's included in it.
- Whether the quoted amount covers only the screw, or also the abutment (the part connecting the screw and the restoration) and the restoration
- When a bone graft or sinus lift might be added
- Whether imaging and follow-up checks are included
- Whether they tell you it can't be done where the bone won't allow it
How we do it at Wonjin Dental
We check the width and height of the bone and the distance to the nerve and sinus with panoramic and three-dimensional (CT) imaging, and explain in that order. We don't leave out necessary steps or add unnecessary items. We use Osstem implants, and implants covered by Korean National Health Insurance are also available. Check amounts for each item on the full fee list. Before placing, we look at the bone and gums first.
Frequently asked questions
How long after an extraction is the implant placed?
Depending on the bone and inflammation, it is sometimes placed on the day of extraction, and sometimes after waiting a few weeks to a few months. Where inflammation was severe or a lot of bone has been lost, waiting is safer.
Can I get implants if I have diabetes or high blood pressure?
If they are well controlled, it's often possible. If they aren't controlled, bonding to the bone and wound healing can be slower, so please tell us your medications and recent readings.
What is checked after placement?
We continue to check whether the screw has bonded well to the bone, whether the surrounding gums are receding, and whether the bite is concentrated on one side. Receded gums don't come back up, so the gum line is also part of the checkup.
Can I get implants at an older age?
Overall health and bone condition matter more than age itself. Even at an older age, it's often possible if the bone and gums provide support and systemic conditions are well controlled. Be sure to tell us about medications you're taking, especially those that affect bone.
