I was told I do not have enough bone. Can I still have fixed teeth?

Most of the time the path is the same: a sentence heard at a consultation, somewhere between Geneva and Neuchâtel, and the subject stops there — sometimes for years.

Two things deserve to be untangled. A clinical opinion always concerns a specific plan, drawn up with a specific image, on a specific day. It means that route is not practicable with what was then known. It does not, on its own, close every other.

That is not to say the first opinion was wrong. A second assessment may confirm it entirely, and that too is an answer — one that arrives sooner and more cheaply than a journey undertaken on a doubt.

In Switzerland, asking for a second dental opinion is paid for like the first: basic insurance does not cover this care in practice, so nothing is cushioned. That explains why so many people stay with a single opinion, and why a second assessment is so often put off.

It is also what makes it useful to have that second assessment coincide with a journey already planned, rather than organising one for it alone. What is brought along counts: existing images spare a repeat of what has already been done.

The full-arch protocol does not spread implants over the whole jaw. It groups them on a reduced number of supports. According to the technical description of the protocol, the two rear implants are placed tilted, by up to 30 degrees, to make use of the bone already present.

From that comes the sentence that matters to anyone asking this question: All-on-4 avoids bone grafting in most cases. What is described there is a technique, not the case of the person reading. And ‘in most cases’ has to be read to the end: some cases fall outside it.

On what is done when it does not avoid it, this page puts forward nothing. No fact published by the Instituto AreLuna concerns other techniques in cases of marked bone loss, and none is therefore named here.

It is the 3D X-ray that settles the matter. The CBCT shows the bone in volume — the height and width present in each zone — and that information tells whether there is support where the plan needs it. A flat X-ray, or the memory of an old consultation, is not enough.

The Instituto AreLuna describes an implant protocol in which the case is planned on a computer before surgery, from that image. The decision is still taken on the current image and with the person present.

There are also cases where an arch is not indicated for this protocol, with or without a graft. What weighs in that conclusion is not only the bone: it is also general health and habits that interfere with healing. Taken alone, none of these decides anything. The diagnostic consultation is booked on +351 220 430 090, for the establishment at Rua de Júlio Dinis, 194, 4050-327 Porto; what comes out of it must be written down, and the amount that goes with it depends on a prior individual assessment and diagnosis.