A tooth that was taken out five, ten or even twenty years ago can usually still be replaced with an implant. What time changes is the amount of bone left in the gap, and that decides whether the implant can go in on its own or whether the site needs to be built up first. A 3D X-ray answers that question far better than looking at the gap in a mirror.
The jaw starts to reshape as soon as a tooth comes out
The bone that surrounds a tooth root exists largely to hold that tooth. Once the tooth is gone, the body gradually remodels the area and the ridge becomes narrower and, to a lesser extent, lower. Most of the change happens early. A systematic review in Clinical Oral Implants Research (Tan and colleagues, 2012) found that in the six months after an extraction, the ridge lost roughly 29% to 63% of its width and 11% to 22% of its height, with the fastest change in the first three to six months and slower shrinkage after that. Our article on bone loss after an extraction explains the process in more depth.
So a gap that has been there for years has usually lost more bone than a recent one, but most of that loss happened in the first months. The difference between a five-year-old and a fifteen-year-old gap is often smaller than people expect.
Other things that change in an old gap
Bone is not the only thing that moves. Over time the teeth on either side can tip into the space, and the tooth that used to bite against the missing one can drift up or down into the gap. If that has happened, there may be less room for an implant crown, and sometimes the neighbouring teeth need adjusting or straightening first. In the upper back jaw, the sinus above the gap can also extend lower over the years, leaving less bone height. In the lower jaw, the position of the nerve that runs through the bone sets a limit on implant length.
A 3D scan shows what is really there
A standard dental X-ray shows height but not width. A cone beam CT scan shows the ridge in three dimensions, along with the sinus and the nerve, so the dentist can see whether an implant of a suitable size fits within the bone. At Lumi Dental this scan is taken in the practice on an Orthophos 3D X-ray unit, usually at the assessment appointment.
Three ways the plan can go
Most assessments of an old gap end up in one of three places.
Enough bone for an implant on its own
Some long-standing gaps keep a good ridge, particularly where the bone was thick to begin with. The implant can then be placed without extra steps, and the usual healing time applies before the crown is fitted. Our guide to how implants fuse with bone explains that healing stage.
A graft at the same time as the implant
Where the ridge is a little narrow, bone graft material can often be added around the implant during the same surgery.
Rebuilding the site first
Where too much bone has gone, the ridge may need to be grafted, or the sinus floor raised with a sinus lift, and left to heal for several months before the implant is placed. This adds time and cost, but it allows many sites that look unpromising to take an implant. Our article on bone grafts and sinus lifts describes what each involves.
Your health matters as much as the bone
Gum disease elsewhere in the mouth needs to be under control before an implant goes in, because the same bacteria can affect the tissues around an implant. Smoking and poorly controlled diabetes slow healing and are linked with more implant problems. Some medicines, including bone-strengthening drugs such as bisphosphonates, need to be discussed before any surgery. Our guide to who is a good implant candidate covers these factors, and how dental implants work walks through the procedure.
What it costs
As a general guide, a single implant with its crown typically costs about $4,000 to $7,000 across the Australian market. This is a market range, not a Lumi fee. Grafting or a sinus lift adds to the total, which is one reason an old gap can cost more to restore than a recent one.
Questions about old gaps
Is there a point where it is too late?
Rarely, as far as the bone is concerned. Even sites with a lot of bone loss can often be rebuilt. General health and the condition of the rest of the mouth are more likely to set limits than the age of the gap.
Will I definitely need a bone graft?
Not always. Some old gaps still have enough bone. The 3D scan is what decides.
Does a graft hurt?
Grafting is done under local anaesthetic. Swelling and tenderness for a few days afterwards are common and usually manageable with ordinary pain relief. If you are anxious about surgery, Lumi offers happy gas, inhaled pain relief, oral sedation and IV sedation.
How long will the whole process take?
Without grafting, usually a few months from placement to the final crown. If the site needs rebuilding first, allow several more months.
If you have a gap from a tooth lost long ago and would like to know where you stand, our dentists place implants at our Melrose Park practice and can assess the site with a 3D scan. Implant consults are free; see our implants page or our current offers.
This article is general information and not a substitute for personal dental advice. Please see a dentist for an assessment tailored to your situation.
