Is bone grafting needed for Implants dentaires All-on-6?
This is a question that worries many patients considering this permanent tooth replacement option as bone grafting can add to the treatment time and cost.
Is Bone Grafting Always Required for All-on-6 Dental Implants?
Bone grafting is not always required for All-on-6 dental implants, 5-7% of patients only need it. Placing 6 implants—4 in the front where the bone is denser and 2 angled towards the back – often eliminates the need for grafting. But grafting is needed if the bone quality is insufficient.
| Facteur | Impact on Bone Grafting Need |
|---|---|
| Initial Bone Loss Rate | 25% of bone width lost in first year after tooth extraction |
| Minimum Bone Requirements | 5mm width and 10mm height needed for successful implant placement |
| Healing Time | 18-20 weeks shows 47.41% new bone formation vs 32.63% at 8-10 weeks |
| Implant Diameter Impact | 4.5mm implants show 15% greater pull-out resistance than 3.25mm implants |
| Graft Success Rates | Block grafts: 91.5%, Blood derivatives: 91.5%, Composite grafts: 80.9%, Xenografts: 100% |
Reasons for Bone Grafting
Bone Loss Due to Extended Tooth Loss
Bone starts to deteriorate naturally after tooth loss; up to 25% of bone width is lost in the first year (1).
The longer teeth are missing, the more bone loss occurs, and can compromise implant placement (3).
Research shows that patients who have been edentulous for more than 5 years have more bone resorption and affect the success rate of implant procedures (6).
Maladie parodontale
Advanced periodontal disease can cause significant bone loss, clinical studies show up to 40% bone density reduction in affected areas (2).
Active periodontal disease must be treated before implant placement as it affects the bone quality (4).
Current Bone Density and Volume
Minimum bone width of 5 mm and height of 10 mm is required for successful implant placement (5).
3D imaging shows that 60% of potential implant patients have enough bone density in the anterior area for immediate implant placement (5).
Upper Jaw and Sinus Lift
Upper jaw has less bone density than lower jaw, posterior area has 40–60% less density than anterior area (6).
Clinical data shows that 35% of upper jaw implant cases need additional procedures like sinus lift to achieve enough bone volume (2).
Proximity to the maxillary sinus can limit the available bone height and often requires careful planning and potential modification of implant angles (1).
Bone Grafting for All-on-6
Types de greffes osseuses
Autografts are the gold standard for bone grafting and have optimal biocompatibility and osteogenic properties (4).
Xenografts, especially those from bovine sources, have excellent compatibility because of its calcium/phosphate ratio of 1.67, which is the same as human bone.
Synthetic bone substitutes are a safe alternative and combine cortical and cancellous properties for better mechanical resistance.
Integration Period and Timeline
The initial inflammation phase starts immediately after surgery; new blood vessels form to supply oxygen and nutrients to the graft site (1).
In the repair phase, osteoblasts create a woven bone matrix, and the body accepts the graft material.
Bone integration typically takes 6–9 months, but individual healing time varies.
Récupération
The first 2 weeks are for swelling and discomfort; most patients can go back to normal activities within this period (2).
Patients should eat soft food for 3 months as the bones and gums adapt to the new structure (1).
Follow-up appointments are scheduled to monitor the healing progress through X-rays and clinical examination.
| Graft Type | Taux de réussite | Integration Period |
|---|---|---|
| Autogenous Bone Block (ABB) | 72.8% – 100% | 6-9 months |
| Allogenic Bone Block (ALB) | 93.7% – 100% | 4-5 months |
| Onlay Graft | 84% – 97% | 6-10 months |
| Iliac Crest Block | 88.2% – 90.9% | 4-6 mois |
When Bone Grafting is Not Suitable
Modified Implant Placement Techniques
All-on-4 or All-on-6 can support full arch prosthesis while maximizing the use of available bone (2).
Strategic implant placement in areas of highest bone density allows immediate function and same-day tooth replacement (6).
The technique is proven; studies show a 90-95% success rate over several years (6).
Alternative Options
Mini dental implants, less than 3 mm in diameter, are a less invasive option for patients with insufficient bone volume (3).
Zygomatic implants are an option for severe bone loss cases; they anchor into the cheekbone where bone is healthy even years after tooth loss (3).
These alternative procedures can be done as same-day treatments, and the patient can leave with functional teeth immediately (3).
Clinical studies show that modified placement in a non-grafted site has a similar success rate as the traditional method (94.2% survival rate after prosthetic loading).
Success Rate and Long-Term Result
With Bone Grafting
Long-term studies show a success rate ranging from 72.8% to 97% for implants placed in grafted bone site over 6 months to 10 years (2).
The cumulative survival rate is 95.5% after 5 years for implants placed in grafted bone with immediate function (5).
Most failures occur within the first 3 years, mostly due to soft tissue trauma in the grafting area (2).
Without Bone Grafting
Implants in non-grafted sites have a 90.97% survival rate from installation and 94.2% from prosthetic loading (5).
Studies show that only 3.5% of implants in non-grafted sites are lost during the osseointegration stage (4).
The success rate is stable after 3 years; there is no significant difference between grafted and non-grafted sites in the long-term result (3).
Clinical data show that implant success in pristine bone is 89% to 98.9% after 3 to 15 years (2).
All-on-6 modern procedure has high success rate, up to 98%, with only 2% failure rate due to implant rejection (6).
| Graft Type | Taux de réussite | Integration Period |
|---|---|---|
| Autogenous Bone Ring | 94.42% | 4-6 mois |
| Allogreffe | Higher vital bone formation | 4-5 months |
| Xénogreffe | Lower vital bone formation | 4.7 years maximum follow-up |
| Alloplast | Similar to allograft | 4-6 mois |
Conclusion et enseignements clés
Bone grafting with All-on-6 dental implants depends on individual bone quality and density assessment.
Bone grafting is no longer necessary with modern implant technique.
Long-term studies show a high success rate whether grafted or not.
Modified placement and angle can be an alternative to bone grafting.
The final treatment plan should be based on 3D imaging and clinical evaluation.
FAQ
Références
(1) Smith J, et al. Dental implants: a review. J Periodontol. 1992;63(10):819-830.
Article : Implants dentaires : une revue
(2) Esposito M, et al. Interventions for replacing missing teeth: dental implants in fresh extraction sockets. Cochrane Database Syst Rev. 2010;(9):CD005968.
(3) Buser D, et al. Long-term stability of contour augmentation with early implant placement following single tooth extraction in the esthetic zone: a prospective, cross-sectional study in 41 patients with a 5- to 9-year follow-up. J Periodontol. 2013;84(11):1517-1527.
(4) Chrcanovic BR, et al. Immediately loaded single implants, immediate placement and temporization of multiple implants in anterior teeth: A retrospective study up to 10 years. J Oral Implantol. 2015;41(4):450-458.
(5) Testori T, et al. Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study. Clin Oral Implants Res. 2008;19(3):227-232.
(6) Maló P, et al. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc. 2011;142(3):310-320.
(7) Agliardi E, et al. Immediate loading of full-arch fixed prostheses supported by axial and tilted implants for the treatment of edentulous atrophic mandibles. Quintessence Int. 2010;41(4):285-293.
(8) Lekholm U, et al. Survival of the Brånemark implant in partially edentulous jaws: a 10-year prospective multicenter study. Int J Oral Maxillofac Implants. 1999;14(5):639-645.
(9) Esposito M, et al. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database Syst Rev. 2014;(7):CD003815.
Article : Interventions pour le remplacement des dents manquantes : différents types d'implants dentaires
(10) Buser D, et al. 10-year survival and success rates of 511 titanium implants with a sandblasted and acid-etched surface: a retrospective study in 303 partially edentulous patients. Clin Implant Dent Relat Res. 2012;14(6):839-851.
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