# Dental Implants With Bone Loss: What Are the Options?

Source: https://vitasmile.istanbul/dental-implants-with-bone-loss

Patient guide

Bone loss does not always rule out implants. After a 3D scan, your surgeon can rebuild missing bone with a graft, raise the sinus floor in the upper back jaw, or work around the gap with short, narrow or tilted implants, as in All-on-4. Grafting adds healing time. The right option depends on where, and how much, bone is missing.

[Published by Vita Smile Dental Clinic](https://vitasmile.istanbul/about-us) October 6, 2026 Sources (16)

## Key takeaways

- Within 6 months of an extraction, the ridge lost 29–63% of its width and 11–22% of its height in human studies [1].
- Implants placed in bone rebuilt from the side had survival and success rates above 95% in a review of 40 studies [6].
- Short implants (6 mm or less) had a mean survival of 96%, against 98% for longer ones, over 1–5 years [9].
- Across 44 publications, tilted implants failed about as often as straight ones: 1.63% against 1.81% [11].

Clinically reviewed by

[Dr. Saffet Ekinci](https://vitasmile.istanbul/our-doctors/dt-saffet-ekinci)

Oral and Maxillofacial Surgeon · Implant & Surgical Dentistry Specialist

  Last reviewed October 7, 2026

  Sources 16 sources cited

Why it happens

## Why does the jaw lose bone?

The bone around your teeth, the alveolar ridge, is there to hold them. The two most common reasons it shrinks are tooth loss and gum disease.

- After a tooth is removed: a 2012 review of 20 studies found that the ridge lost 29–63% of its width and 11–22% of its height within 6 months [1]. Loss was fastest in the first 3–6 months, then slowed [1].
- Gum disease (periodontitis): in advanced gum disease, the gum tissue and bone holding the teeth are destroyed, and teeth can loosen and fall out or need to be removed [2].
- In the upper back jaw: the bone is limited both by the sinus above it and by the loss of ridge height [8], which makes this one of the hardest areas for implants [3].

Gum disease matters after treatment too. A history of periodontitis, poor plaque control and no regular maintenance raise the risk of peri-implantitis, which destroys bone around an implant [14]. Active gum disease is therefore treated first: see [gum treatment (periodontics)](https://vitasmile.istanbul/treatments/periodontics).

- 29–63%

    of ridge width lost within 6 months of an extraction [1]
- 3–6 months

    when bone loss is fastest after an extraction [1]

Measuring the bone

## How do you know if you have enough bone for implants?

A standard X-ray shows the bone in two dimensions. Before an implant, the surgeon also needs to know how wide and how tall the bone is, and where the nerves and sinus lie. The American Academy of Oral and Maxillofacial Radiology recommends a cross-sectional scan of every implant site, with cone beam CT (CBCT), a 3D scan of the jaw, as the method of choice [4].

The scan shows whether the bone is wide and tall enough for a standard implant, and whether it is missing in one small area or along most of the jaw. You also need healthy gums, free of gum disease [3]. An X-ray sent before you travel gives a first idea; the final plan comes after the examination and scan.

Rebuilding bone

## Bone grafting and guided bone regeneration

When part of the ridge is too thin or too low, it can be built up: the gum is lifted and the space where bone is missing is filled with bone or a bone substitute [3]. Graft material can come from your own body, another person, an animal or a synthetic source, and acts as a scaffold that your own bone grows into [7]. In guided bone regeneration (GBR), the graft is covered with a barrier membrane that protects it while new bone forms [6][7]. The graft is done either with the implant or months before it.

What does the research say?

- Widening works well: a 2015 review of 40 studies found that grafting the ridge sideways before implants added on average 3.90 mm of width. Grafts with a barrier membrane did better, and implants in the rebuilt bone had survival and success rates above 95% [6].
- Adding height is harder: a Cochrane review of 13 randomised trials found that it is unclear which technique works best, and that complications are common, especially when height is added [5]. In a resorbed lower jaw, short implants appeared to be a better alternative to grafting height [5].

A graft can cause swelling, bruising and pain [16], and smokers have a higher risk of graft failure [7].

- 3.90 mm

    average width gained by grafting before implants, across 40 studies [6]
- > 95%

    survival and success of implants placed in the rebuilt bone [6]

Upper back jaw

## Sinus lift: making room above the upper back teeth

After upper back teeth are lost, there is often not enough bone below the sinus to hold an implant [7]. A [sinus lift](https://vitasmile.istanbul/treatments/sinus-lift) gently raises the sinus lining and places graft material beneath it, through a small window on the cheek side or through the implant site when only around 3 mm of extra height is needed [7].

If the implant cannot go in during the lift, the graft matures for 4–9 months first, and from the lift to the final tooth usually takes 6 to 12 months, sometimes longer [7]. The main risk is a tear in the sinus lining: 19% with the side-window approach and 3.8% through the implant site, according to a Cambridge University Hospitals NHS leaflet [7].

When some bone remains, a short implant may avoid the lift. A Cochrane review of 4 trials compared short implants (5 to 8.5 mm) with a sinus lift in bone 4 to 9 mm high: there was not enough evidence of a difference in failures one year after loading, but more complications at the lifted sites [8].

- 4–9 months

    for a sinus graft to mature, when implants are not placed during the lift [7]
- 6–12 months

    from sinus lift to final tooth, sometimes longer [7]

Avoiding a graft

## Short or narrow implants: when do they work?

Sometimes the implant can be adapted to the bone, instead of the bone to the implant.

- **Short implants**A 2018 meta-analysis of 10 randomised trials in the back of the jaw found a mean survival of 96% for implants of 6 mm or less and 98% for longer ones, over 1 to 5 years [9]. Results varied more with short implants, and the authors advise choosing them carefully [9].
- **Narrow implants**A 2018 review of 76 studies found that implants 3.0 to 3.5 mm wide survived as well as standard ones, but mini-implants under 3.0 mm survived significantly less often [10]. Solid long-term data are still missing [10].

They suit some sites and some bites, not every case; your surgeon weighs them against grafting on your scan.

Full arch

## Tilted implants and All-on-4

When most or all teeth in a jaw are missing and the bone at the back has shrunk, the implants can go where the bone is. In [All-on-4](https://vitasmile.istanbul/treatments/all-on-4-dental-implants), the two back implants are angled, usually at about 30° and sometimes up to 45°, to shorten the part of the bridge behind them and avoid grafting where possible [12]. In the upper jaw, angled implants beside the sinus can avoid a sinus lift [7].

- A 2015 meta-analysis of 44 publications found 1.63% of tilted implants failed, against 1.81% of straight ones: no significant difference overall, although in upper-jaw-only studies tilted implants failed more often [11].
- A 2021 review of 25 All-on-4 studies found 94–98% of implants still in place after 6 to 11 years, and concluded the concept can be used in jaws with resorbed bone [13].

For severe bone loss in the upper jaw, zygomatic implants, long implants angled into the facial bones behind the upper jaw, are another option [7]. Our [full mouth dental implants](https://vitasmile.istanbul/treatments/full-mouth-dental-implants) page explains the full-arch plans.

- 1.63% vs 1.81%

    failures of tilted vs straight implants across 44 publications [11]
- 94–98%

    of All-on-4 implants still in place after 6 to 11 years, in 25 studies [13]

Side by side

## Bone graft vs sinus lift vs short or narrow implants vs tilted implants

Each option answers a different kind of bone loss. This table sums up the sources; your surgeon confirms what applies to you after examining your mouth and your scan.

|  | Bone graft / GBR | Sinus lift | Short or narrow implants | Tilted implants (All-on-4) |
|---|---|---|---|---|
| Suited to | A thin or low ridge in one area | Too little bone under the sinus | Bone a little low or a little thin | Most or all teeth missing in a jaw |
| Extra healing time | Yes, when done before the implant | 4–9 months if implants go in later | No graft to wait for | No graft where possible |
| Research | Over 95% implant survival in rebuilt bone | No technique clearly better than another | Short: 96% vs 98% survival; 3.0–3.5 mm as good as standard | Similar failures to straight implants overall |
| Main trade-off | Complications common when adding height | Sinus lining tear | More variable results | More failures in upper-jaw-only studies |

Grafting: [5][6]. Sinus lift: [7][8]. Short implants: [9]; narrow implants: [10]. Tilted implants: [11][12].

Step by step

## What the timeline looks like with bone loss

A graft adds a healing stage, so treatment usually takes longer and may need more than one visit. Implants themselves usually need around four months to bond with the bone [15].

1. Before you travel

    ### Online consultation

    Send a recent X-ray or photos of your teeth. A dentist replies with a personalised plan and a written quote, confirmed after the examination.
2. First visit

    ### Examination and 3D scan

    Your bone is measured and the nerves and sinuses located [4]. Any gum disease is treated first [3].
3. If needed

    ### Bone graft or sinus lift

    Missing bone is built up before the implant or in the same surgery; a sinus graft placed alone matures for 4–9 months [7].
4. Surgery

    ### Placing the implants

    At Vita Smile, implant surgery takes 1–3 hours; without a graft, the first visit in Istanbul usually lasts 3–7 days.
5. Usually 3–6 months

    ### Healing and new teeth

    In our typical plan the implants heal for 3–6 months before the final teeth. With All-on-4, temporary teeth can be fitted on the day of surgery in selected cases.

With a graft, your plan takes longer than these typical times; your surgeon tells you how much after the scan and examination.

Making the choice

## How does the surgeon decide?

There is no single best answer, and research has not found one grafting technique clearly better than the others [5][8]. Your surgeon weighs:

- **Where bone is missing**The upper back jaw (sinus), the lower back jaw (nerve) or the front.
- **How much**A little width, a lot of height, or most of the jaw.
- **How many teeth**One tooth with [dental implants](https://vitasmile.istanbul/treatments/dental-implants), or a full arch.
- **Health and habits**Smoking raises the risk of graft and implant failure [7][16], and past gum disease the risk of problems around implants [14].
- **Time and travel**A two-stage sinus lift means a second operation months later [7].

The cost depends on the number of implants, any graft or sinus lift and what goes on top: see [dental implant prices and packages](https://vitasmile.istanbul/prices/dental-implants-costs-and-packages-in-turkey). For what keeps implants healthy afterwards, read [how long do dental implants last](https://vitasmile.istanbul/how-long-do-dental-implants-last). Your dentist confirms the right option after an examination and X-rays.

From our surgeon

> “Being told there is not enough bone is where the planning starts, not where it ends. On the scan I look at where the bone is missing and how much: sometimes a shorter, narrower or angled implant can do the job without a graft, and sometimes rebuilding the bone first is the safer route. A graft adds healing time, so I lay out both paths with their timelines, and you can plan your trips knowing what each one involves.”

  [Dr. Saffet Ekinci](https://vitasmile.istanbul/our-doctors/dt-saffet-ekinci)  · Oral and Maxillofacial Surgeon · Implant & Surgical Dentistry Specialist

Questions

## Dental implants with bone loss: frequently asked questions

Can't find your answer? Our coordinators are happy to help on WhatsApp.

[Ask on WhatsApp](https://wa.me/905434595095)

  Can I get dental implants if I have bone loss?Often, yes. Missing bone can be rebuilt with a graft or a sinus lift [3], or the plan can use short, narrow or tilted implants that fit the bone you have [9][10][11]. Your surgeon decides after a 3D scan of the jaw [4].

   What happens if you do not have enough bone for implants?The surgeon either builds the bone up first or adapts the implants to it. In the upper back jaw that may mean a sinus lift or angled implants beside the sinus [7]. Where neither suits you, a bridge or a denture can still replace the teeth [7].

   How long after a bone graft can implants be placed?It depends on the graft. Some grafts are placed at the same time as the implant, the simultaneous approach [6]. After a sinus lift without implants, the graft usually needs 4–9 months to mature first [7]. Your surgeon confirms the timing for your case.

   Are short implants as good as long ones?Nearly, in the right case. In 10 randomised trials, mean survival was 96% for implants of 6 mm or less and 98% for longer ones over 1–5 years [9]. Results varied more with short implants, so they are chosen carefully [9].

   Does All-on-4 work with bone loss?It was designed for it: the back implants are tilted to reach available bone and avoid grafts where possible [12]. A review of 25 studies found 94–98% of implants still in place after 6 to 11 years and concluded it can be used in resorbed jaws [13].

   Can gum disease cause bone loss around teeth and implants?Yes. Advanced gum disease breaks down the bone that supports the teeth [2], and around implants, peri-implantitis causes progressive bone loss [14]. A history of periodontitis raises that risk, so gum disease is treated before implants [14].

Next steps

## Related treatments

### [Dental Implants](https://vitasmile.istanbul/treatments/dental-implants)

Single and multiple implants, step by step.

### [Sinus Lift](https://vitasmile.istanbul/treatments/sinus-lift)

Building bone in the upper back jaw before implants.

### [All-on-4 Dental Implants](https://vitasmile.istanbul/treatments/all-on-4-dental-implants)

Four implants, the back two tilted to use the bone you have.

### [How Long Do Dental Implants Last?](https://vitasmile.istanbul/how-long-do-dental-implants-last)

What the research says about implant lifespan.

## Sources

Studies and patient guides this page is based on.

1. [1] [Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clinical Oral Implants Research, 2012](https://doi.org/10.1111/j.1600-0501.2011.02375.x) · doi.org
2. [2] [Gum Disease Information — American Academy of Periodontology](https://www.perio.org/for-patients/gum-disease-information/) · perio.org
3. [3] [Dental Implant Procedures — American Academy of Periodontology](https://www.perio.org/for-patients/periodontal-treatments-and-procedures/dental-implant-procedures/) · perio.org
4. [4] [Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2012](https://doi.org/10.1016/j.oooo.2012.03.005) · doi.org
5. [5] [Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P. Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment. Cochrane Database of Systematic Reviews, 2009](https://doi.org/10.1002/14651858.CD003607.pub4) · doi.org
6. [6] [Sanz-Sánchez I, Ortiz-Vigón A, Sanz-Martín I, Figuero E, Sanz M. Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension: A Systematic Review and Meta-analysis. Journal of Dental Research, 2015](https://doi.org/10.1177/0022034515594780) · doi.org
7. [7] [Sinus lift procedures — Cambridge University Hospitals NHS Foundation Trust (patient information)](https://www.cuh.nhs.uk/patient-information/sinus-lift-procedures/) · cuh.nhs.uk
8. [8] [Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database of Systematic Reviews, 2014](https://doi.org/10.1002/14651858.CD008397.pub2) · doi.org
9. [9] [Papaspyridakos P, De Souza A, Vazouras K, Gholami H, Pagni S, Weber HP. Survival rates of short dental implants (≤6 mm) compared with implants longer than 6 mm in posterior jaw areas: A meta-analysis. Clinical Oral Implants Research, 2018](https://doi.org/10.1111/clr.13289) · doi.org
10. [10] [Schiegnitz E, Al-Nawas B. Narrow-diameter implants: A systematic review and meta-analysis. Clinical Oral Implants Research, 2018](https://doi.org/10.1111/clr.13272) · doi.org
11. [11] [Chrcanovic BR, Albrektsson T, Wennerberg A. Tilted versus axially placed dental implants: a meta-analysis. Journal of Dentistry, 2015](https://doi.org/10.1016/j.jdent.2014.09.002) · doi.org
12. [12] [Soto-Penaloza D, Zaragozí-Alonso R, Penarrocha-Diago M, Penarrocha-Diago M. The all-on-four treatment concept: Systematic review. Journal of Clinical and Experimental Dentistry, 2017](https://pmc.ncbi.nlm.nih.gov/articles/PMC5347302/) · pmc.ncbi.nlm.nih.gov
13. [13] [Gaonkar SH, Aras MA, Chitre V, Mascarenhas K, Amin B, Rajagopal P. Survival rates of axial and tilted implants in the rehabilitation of edentulous jaws using the All-on-four concept: A systematic review. Journal of Indian Prosthodontic Society, 2021](https://pmc.ncbi.nlm.nih.gov/articles/PMC8061444/) · pmc.ncbi.nlm.nih.gov
14. [14] [Schwarz F, Derks J, Monje A, Wang HL. Peri-Implantitis. Journal of Clinical Periodontology, 2018 (2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases)](https://doi.org/10.1111/jcpe.12954) · doi.org
15. [15] [Implants — Oral Health Foundation](https://www.dentalhealth.org/dental-implants) · dentalhealth.org
16. [16] [Dental implants: overview, having a dental implant and after having a dental implant — Guy's and St Thomas' NHS Foundation Trust](https://www.guysandstthomas.nhs.uk/health-information/dental-implants) · guysandstthomas.nhs.uk