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

Whoever reaches this question almost always arrives by the same road: they heard at a consultation that there is not enough bone, and the sentence stayed with them. From then on, the subject often stops dead, sometimes for years.

It is worth separating two things. A clinical opinion is given on a plan — that plan, with that image, on that day. What it says is that this path is not viable with this information. It does not say, on its own, that no other path exists.

That is not the same as saying the first opinion was wrong: a second assessment may confirm it entirely, and that is also an answer.

The full-arch protocol does not spread implants along the whole length of the jaw. It concentrates them on fewer points. 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 that already exists.

That is where the sentence that interests whoever asks this question comes from: in this way, All-on-4 avoids bone grafting in the majority of cases. It is the description of a technique, not a statement about the case of whoever is reading. And ‘in the majority’ is to be read in full: there are cases in which it does not avoid it.

On what is done when it does not avoid it, this page puts nothing forward. There is no fact published by the Instituto AreLuna on other techniques for marked bone loss, and none is therefore named here. What a graft adds to the quote is the subject of another page.

The assessment is made on the 3D X-ray. The CBCT shows the bone in three dimensions — the height and width present in each area — and it is that information which says whether there is support where the plan needs it. A plain X-ray, or the memory of an old consultation, is not enough for this decision.

The Instituto AreLuna describes its implant protocol with the case planned on a computer before the surgery, from this image. Anyone who already has examinations does well to bring them, but the decision is taken on the current image and with the person present.

There is no way of answering this question without an examination. Nobody can say, from a description or from an old X-ray, whether there is enough bone in the jaw of someone they have not examined. A clinic that states it without having seen anything is saying what it cannot know.

That too must be said. There are cases in which an arch has no indication for this protocol, with or without a graft. And what weighs in that conclusion is not only the bone: it is also general health and the habits that interfere with healing.

None of these points is, on its own, a yes or a no. They are pieces of an assessment, and the assessment is individual — so there is no list here of who can and who cannot. Like any procedure, it depends on a prior individual assessment and diagnosis.

The diagnostic consultation is booked on +351 220 430 090, for the establishment at Rua de Júlio Dinis, 194, 4050-327 Porto, where dental care is provided. What comes out of it should come in writing: the plan, the examinations it rests on, and what changes if the examination reveals more than expected.