I was told I did not have enough bone: are fixed teeth still possible?

People nearly always reach this question by the same route: a sentence heard at a consultation — ‘there is not enough bone’ — which has weighed on them ever since. From that point, the subject often stops dead, sometimes for years.

Two things are worth separating. A clinical opinion is about a plan — that plan, with that image, on that day. It says that this route cannot be taken with that information. On its own, it does not close every route.

That is not the same as saying the first opinion was wrong. A second assessment may confirm it entirely, and that is an answer too — one that arrives sooner, and at lower cost, than a trip undertaken on the strength of a doubt.

The full-arch protocol does not spread implants along the whole length of the jaw. It groups a small number of them at precise points. According to the technical description of the protocol, the two back implants are placed at an angle, up to 30 degrees, to use the bone that is already there.

That is the origin of the sentence that matters to anyone asking this question: placed this way, All-on-4 avoids a bone graft in most cases. It is the description of a technique, not a statement about the reader’s own case. And ‘in most cases’ has to be read in full: there are cases where it does not avoid one.

On what is done when it does not, this page puts nothing forward. No fact published by the Instituto AreLuna concerns other techniques for marked bone loss, so none is named here. What a graft adds to the quote is covered on the page about bone grafting.

Everything turns on the 3D X-ray. The CBCT scan shows the height and thickness of the bone present at every point, and that information is what says whether there is support where the plan needs it. A flat X-ray, or the memory of an old consultation, cannot carry a decision like this.

The Instituto AreLuna describes an implant protocol in which the case is planned on a computer before surgery, from that image. Anyone who already has scans would do well to bring them: they help and can avoid repeats. The decision itself is made on the current image and with the person present.

Nobody can say whether there is enough bone in a jaw without having examined the person and read their image. A clinic that claimed to know without having seen anything would be claiming what it has no way of knowing.

That also needs saying. There are arches for which this protocol is not indicated, with or without a graft. And what weighs in that conclusion is not only bone: general health and habits that interfere with healing count too.

Taken on its own, none of these factors settles the matter. They are pieces of an assessment, and the assessment is individual — so there is no list here of who can and who cannot. Like any procedure, it depends on a prior individual assessment and diagnosis.

The diagnostic consultation is booked on +351 220 430 090, for the establishment at Rua de Júlio Dinis, 194, 4050-327 Porto, where dental care is provided. What comes out of it should be in writing: the plan, the scans it rests on, and what changes if the examination reveals more than expected.