Healthy Smile: What Is the Right Number of Implants?

by Jeffrey Gross, DDS, FAGD of The Healthy Smile

When you think about the question, isn’t it strange? The rule that we use involves replacing a single tooth with an implant. I follow this dictum many times during the week in my office. I remove a hopeless tooth, and then I immediately insert an implant into that area. One tooth goes away, and one dental implant arrives to maintain the health and integrity of the mouth. The principle of one for one has limitations. What will happen when all of the teeth are not there? If I count how many teeth are in a jaw, I arrive at the number of fourteen. This number would exclude wisdom teeth. Should I replace fourteen teeth with fourteen implants?

The answer to that question is no. When all of the teeth are missing, physiology and bioengineering say that the one for one rule is not applicable. If I place fourteen implants, then the patient would struggle every time the teeth need to come out for routine home care. Now you can understand the question from my patient this week. If we don’t replace every tooth with a dental implant, what is the magic number? Maybe all I need is one implant to help support a set of teeth? Just as fourteen implants is too many, one implant is too few.

The solution to our problem revolves around how much support we plan to give to the teeth. If I want a little help to support and stabilize the teeth, then fewer implants are necessary. If I want the teeth to rely on them for the majority of their support, then I will need more dental implants.

To further develop the complexity of the question, the right number of dental implants can vary from the upper jaw to the lower jaw. The bone on the upper jaw is not as dense as the lower jaw. What does the difference in density mean? The denser bone will anchor the implants better than less dense or soft bone. I need fewer implants in the dense bone because the implants are more durable by virtue of the bone. The upper jaw is weaker, so typically, I will need more implants if this is feasible.

I still haven’t answered the question. The short answer is that there is no magic number that is right or wrong. However, I can give you some general rules. In the upper jaw, the minimum that I like to see and provides the patient with the most satisfaction is four implants. On the lower and more durable jaw, I can obtain an excellent result with three implants.

Of course, many other factors play into the best number of implants for a patient. I gave you some solid rules of thumb for outstanding results. If you have a denture and want to add implants to your denture or if you are starting with a denture fabrication, please plan the procedures well. If you are uncertain or confused about which direction to go, I suggest that you call our office at 440-892-1810 and we will help arrange for us to meet. I look forward to meeting you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 •

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