Patient Questions: the true answers of implantology

These are the questions that patients really search online when they have little bone, implant failures or dentures for years. Every answer is based on the real procedures of the Bilateral Sinus Solution™ (BSS) and the All-on-Full™ of the Nicola Lettera Network, to allow the reader to learn about the true implantology and understand without mistakes.

1 Implants without bone

1. What to do if there is no bone for the dental implant?

When the alveolar bone is resorbed, you are not condemned to grafts, sinus lifts or dentures. The Bilateral Sinus Solution™ (BSS) anchors to the basal bone: the deep and stable bone that never resorbs. With 2 posterior basal implants in 18/28 and 2 in 15/25 a complete fixed rehabilitation is built, in a single procedure of about 2 hours.

If they told you "there is no bone", they only spoke to you about the alveolar bone, the superficial one that resorbs. The basal bone, deep, is always there. That is where the BSS anchors.

2. How to put fixed teeth without bone?

With the BSS: 2 posterior basal implants (18/28) of 19-21 mm in the cortical plates of the sphenoid, 2 implants in 15/25 in the retrocanine fossae and custom solutions for the premaxilla. Immediate loading in 1 hour: the patient leaves with the fixed temporary already without fake gum.

No zygomatic, no grafts, no sinus lifts. See the surgical procedure and the BSS page.

3. Is it possible to perform implantology if the bone is missing?

Yes, with basal implantology. The traditional techniques use the alveolar bone (soft, it resorbs); the Network protocols use the basal bone (hard, deep, stable), the only one that allows real, immediate and durable rehabilitations.

4. How much do dental implants without bone cost?

The cost depends on the complete project: number of implants, surgery, ceramic prosthesis, temporaries, controls and maintenance. The Nicola Lettera Network applies the principle of the understandable and closed quote: you know exactly what the price includes. Send your panoramic X-ray on WhatsApp +39 388 7527525 for a free evaluation and a clear quote.

See also prices and financing.

5. Can dental implants be placed without bone?

Yes: the BSS was born exactly for this. Even in the cases where "everything is missing, behind and in front", with the subperiosteal grid and the posterior basal pillars the base is rebuilt and the fixed teeth are loaded the same day.

6. Why does the bone resorb after tooth loss?

The alveolar bone exists to support the teeth: when the teeth disappear, the bone no longer receives stimuli and resorbs progressively. The basal bone, instead, is part of the load-bearing structure of the facial skeleton and does not wear out: it is the key of basal implantology.

7. How much bone is needed for a dental implant?

With the traditional techniques 8-10 mm of alveolar bone are needed. With the BSS only the available basal bone is needed: the 19-21 mm basal implants anchor in depth (tuber, sphenoid, retrocanine fossae) without the need for superficial bone volume.

8. What happens if I do not put implants after tooth loss?

The alveolar bone continues to resorb, the chewing moves all in front, the masseter loses function and the denture (if present) worsens the situation. The more you wait, the more complex the case becomes: but with the BSS it is recoverable even after decades.

9. Can the bone regenerate by itself?

The resorbed alveolar bone does not come back by itself. The regeneration techniques (grafts, membranes) are invasive, expensive and not guaranteed. The biological solution is to use the bone that is always there: the basal bone.

10. Who is the ideal patient for implants without bone?

Anyone with severe bone atrophy, previous failures, dentures for years or a "it cannot be done" diagnosis. The BSS rehabilitates even the patients that the traditional surgery refuses. Send your panoramic X-ray for a free evaluation.

2 Techniques and protocols

11. What is the Bilateral Sinus Solution™ (BSS)?

It is the biological surgical and prosthetic protocol developed by Nicola Lettera with his team of maxillofacial surgeons: 2 posterior basal implants in 18/28, 2 implants in 15/25 in the retrocanine fossae and custom solutions for the premaxilla (with grid in the most severe cases). Immediate loading in 1 hour, without fake gum, with all molars.

Deepen on the dedicated page: Bilateral Sinus Solution™ (BSS).

12. What is the All-on-Full™?

It is the total rehabilitation without fake gum and with all complete molars. It is the technique that allows young people to do a single implantology in a lifetime: if you can chew behind, you do not overload the anterior implants, you do not deform the bone in front, you do not wear the anterior teeth and you do not lose them over time.

13. What are basal implants?

They are implants that anchor in the basal bone (compact cortical D1-D2) instead of the alveolar bone. Longer and with specific geometries, they guarantee excellent primary stability and allow immediate loading.

14. What are pterygoid implants?

They are 19-21 mm implants that cross the maxillary tuber and anchor in the cortical plates of the sphenoid. They are the posterior pillars of the BSS in zone 18/28: the base of chewing. See pterygoid implant.

15. Zygomatic or basal implants: what to choose?

The BSS never uses zygomatic implants. The zygomatic are extra-long screws (up to 50 mm) that cross the face to anchor to the zygoma: invasive surgery, high risks. The basal implants in 18/28 and 15/25 achieve the same stability staying in the oral cavity, without demolitive procedures.

See zygomatic implants and Quad-4 zygomatic.

16. What is the maxillary sinus lift (sinus lift)?

It is the procedure that detaches the Schneiderian membrane and fills the sinus with artificial bone. It requires months of waiting, risks perforations and sinusitis, and the result is not guaranteed. The BSS bypasses the sinus instead of touching it: zero sinus lifts, zero risks. See sinus lift.

17. What are bone grafts and why avoid them?

The grafts (from chin, hip or bone bank) are bone blocks that are screwed into a mouth that no longer has support: double procedures, months of waiting, they tend to resorb under load. The BSS completely eliminates them by anchoring to the native pillars of the basal bone.

18. What is the subperiosteal grid?

It is a customised CAD/CAM structure, designed on the morphology of the patient, that recreates the missing bone base in the premaxilla. In the most severe BSS cases: behind 2 basal implants support the chewing, in front the grid with 4/6 implants rebuilds the support. See subperiosteal grid.

19. What is immediate loading?

It is the application of the fixed prosthesis within 24-48 hours (with the BSS: in 1 hour). It is possible thanks to the bicortical anchorage in the basal bone: the patient leaves the clinic with already functioning fixed teeth. See immediate loading.

20. Is the BSS suitable for everyone?

The principle of the Network is: first the patient, then the anatomy, then the technique. Every case is evaluated collegially on CT and panoramic X-ray. The BSS covers the vast majority of the cases, even the most complex: the free evaluation of the panoramic X-ray says if and how to proceed.

3 Failures and retreatments

21. Why do dental implants fail?

The main causes: implants placed in resorbing alveolar bone, fake gums that make food stagnate (peri-implantitis), overload of few anterior pins, prostheses without molars that concentrate all the force in front, commercial materials and plannings.

See implant failures.

22. What to do if an implant has failed?

You are not condemned to the denture. The Network analyses the case from scratch, understands what happened and designs the retreatment with the BSS: removal of the compromised implant and rehabilitation on the basal bone. See failed implant removal and how the BSS solves the failures.

23. My All-on-4 has failed: can I redo it?

Yes. The BSS was born exactly for the All-on-4 and All-on-6 failures. With the posterior pillars in 18/28 and the load distribution over the whole arch, a complete chewing on 14 teeth is obtained, without the compromises of the 4 anterior pins.

24. What is peri-implantitis?

It is the inflammation and infection of the tissues around the implant, the first cause of failure. It is favoured by the prostheses with fake gum that make food stagnate. The BSS and the Circolare d'Autore® eliminate the hidden areas: simple hygiene, no stagnation, no peri-implantitis.

25. I have worn the denture for 20 years: can I still have fixed teeth?

Yes. It is one of the most frequent cases treated by the Network: after twenty years of denture, with the BSS you go back to a complete fixed dentition with all molars. The documented result in the treated cases has become one of the strongest elements of the Network: even the severely atrophic patient can go back to imagining a complete fixed dentition.

26. My dentist proposed the hip harvesting: is it necessary?

In the vast majority of cases no. The hip harvesting (autologous bone) is the solution of the traditional surgery when the alveolar bone is missing. With the BSS it is not needed: the implants anchor to the basal bone in a single procedure.

27. I had a sinus lift that went wrong: what can I do?

The BSS bypasses the maxillary sinus without manipulating it: it is the ideal solution after failures or complications of the sinus lift (perforations, sinusitis). The targeted surgical path uses the basal bone and does not touch the Schneiderian membrane.

28. How long does my rehabilitation last over time?

The basal bone does not resorb, the basal implants have excellent primary stability and the ceramic prosthesis is designed to last: the goal is a single implantology in a lifetime. The periodic maintenance controls are fundamental.

4 Procedure and recovery

29. How long does the procedure for fixed teeth without bone last?

About 2 hours for the procedure, with immediate loading in 1 hour: the patient leaves the clinic with the fixed temporary, stable, aesthetic and already without fake gum. See surgical procedure.

30. Is the procedure painful?

It takes place under conscious sedation: the patient is relaxed and does not feel pain. The post-operative is managed with targeted pain relief therapy. The minimal invasiveness of the technique (no grafts, no sinus lifts) accelerates the recovery.

31. How long does the healing after the implant last?

With the immediate loading you chew right away with the temporary. The healing of the tissues is fast (weeks), while the osseointegration completes in the following months. The definitive prosthesis (Circolare d'Autore®) is delivered when the surgeon deems it appropriate. See post-operative.

32. When can I eat after the procedure?

With the immediate loading, the same day you eat with the temporary, following the surgeon's indications (soft foods in the first days, then progressively all the foods). The recovery of the complete chewing is a journey: the masseter reactivates progressively.

33. Do I have to stay without teeth during the healing?

No. The fixed temporary without fake gum is applied right away: there are no months of waiting without teeth, as instead happens with the traditional grafts and sinus lifts.

34. How many implants are needed for a complete arch?

With the BSS: 2 posterior basal pillars in 18/28, 2 implants in 15/25 and 4/5 anterior (or the grid with 4/6 in the most severe cases). The exact number depends on the anatomy: there is no single model, there is the patient.

35. Can I smoke after the procedure?

Smoking is a risk factor for healing and osseointegration: the surgeon will give precise indications. Reducing or stopping smoking during the healing period increases the success chances. See post-operative and risks and complications.

36. How are the fixed teeth on implants cleaned?

The prosthesis without fake gum is cleaned like a natural dentition: toothbrush, dental floss and periodic controls. No acrylic flanges where the food stagnates. See prevention and maintenance.

37. Is the BSS also indicated for the mandible?

The Network protocols cover both arches. The atrophic mandible is rehabilitated with the same anchorage principles to the basal bone, with immediate loading and complete prosthesis.

38. Do I have to remove the compromised remaining teeth?

The project starts from conservation: when compromised elements must be removed, the plan provides for the preservation of the strategic bone volumes and soft tissues for the aesthetics. The final prosthesis starts to be designed even before extracting the tooth.

5 Chewing, molars and masseter

39. Why is it important to have the molars?

The molar is not a decorative tooth: it serves to grind the food and is designed to withstand important forces. Without molars, all the force concentrates on the anterior implants: they overload, the bone in front deforms and the anterior teeth wear out and are lost over time.

40. Does the BSS restore 100% of the chewing force?

Yes: thanks to the basal implants in 18/28 and 15/25, the BSS puts all the molars back and reactivates the masseter, distributing the chewing force over the whole perimeter axis of the Circolare d'Autore®: an arch of 14 ceramic teeth that chews like a complete natural dentition.

Deepen in the dedicated section: Restoration of 100% of the chewing force.

41. What is the masseter?

It is one of the main elevator muscles of the mandible, one of the great protagonists of the chewing force. When the molars are missing it cannot express its function: bringing back the molars with the BSS, the masseter returns to work and the neuromuscular system progressively readapts.

42. What happens if I chew only with the front teeth?

It is the biomechanical short circuit of mass implantology: all the force on few anterior pins, wear of the front teeth, deformation of the bone, failures over time and avoided foods. It is the reason why the All-on-4 "without molars" leads to painful compromises.

43. Does the All-on-4 have the molars?

The All-on-4 prosthesis can have posterior prosthetic elements, but the real question is: what is the really designed and sustainable posterior functional extension? With the BSS/All-on-Full the complete molars are an integral part of the project, not an addition. See techniques comparison.

44. After the rehabilitation will I be able to eat everything?

The recovery of the function is real: the posterior sectors, the grinding, the depth of the chewing return to work. The patient returns to eat foods he avoided for years. The recovery is progressive: the body must adapt, but the documented result is a complete chewing in real life.

45. Is the prosthesis without fake gum more hygienic?

Yes: without acrylic flanges there is no food stagnation, no infections and peri-implantitis are not created. The prosthesis emerges directly from the natural tissues like a real dentition. It is the philosophy of the Circolare d'Autore®.

46. What changes compared to the Toronto Bridge?

The Toronto Bridge is a bar with thick fake gum that covers part of the palate and often without molars: a nest of bacteria. The BSS delivers a prosthesis that rests on the ridge in a hygienic way, with all the molars and without hidden areas. See Toronto Bridge.

6 Costs, contacts and practice

47. How do I know if I can have the implants?

Send your panoramic X-ray on WhatsApp +39 388 7527525 (clear photo, without reflections) together with a photo of the mouth with raised lip (without face): you receive a free evaluation within 24 hours. The visit in the clinic is recommended but not mandatory.

48. What do I have to bring to the first evaluation?

The recent panoramic X-ray (or 3D CT if you have it), the list of the medications you take and your clinical history (procedures, failures, dentures). The more information you have, the more precise the evaluation. See contacts.

49. Is the visit mandatory?

No: the evaluation of the panoramic X-ray is free and done online within 24 hours. The visit in the clinic is recommended to analyse the real bone anatomy and design the surgery in the safest and most precise way.

50. Where is the centre?

Implantologia Bergamo Without Bone — Nicola Lettera Network, Via Don Luigi Palazzolo, 24122 Bergamo (BG), Italy. We receive only by appointment. WhatsApp +39 388 7527525, email consultidentali@gmail.com.

51. Are there financing options?

Yes, the Network offers installment financing plans. The principle is the understandable and closed quote: you know exactly what it includes (implants, surgery, prosthesis, temporaries, controls). See prices and financing.

52. Can I have the rehabilitation if I come from another city or from abroad?

Yes: the Network is a national network with centralised control. The location can change, the team can change, but the project is discussed and planned centrally. For the patients from abroad the pathway is organised to minimise the travels.

53. What does "understandable and closed quote" mean?

It means that the patient knows exactly what he is buying: how many implants, which surgery, which prosthesis, which materials, which temporaries, which controls, which maintenance. No hidden costs, no surprises: the demystification of the "teaser price".

Video: how long does it last?