I was told I have too little bone. Are fixed teeth still possible?
A ‘no’ from another practice refers to a particular procedure and to a finding at a particular time. The All-on-4 protocol tilts the two rear implants by up to 30 degrees in order to use the bone that is there, and according to its technical description it avoids a bone graft in most cases. Whether that applies here is shown by a new 3D scan — and decided after a prior individual examination and diagnosis.
What a ‘no’ says, and what it does not
It says that a particular procedure did not seem possible at a particular time. It does not say that every procedure is ruled out, and it says nothing about today if it was said years ago.
This distinction matters more than it sounds. Many people carry such a no with them for years and stop asking. Yet the statement was never meant as a final verdict on all possibilities, but as a finding on a specific question.
What this page does not say: that it will work in your case after all. No page can say that, and whoever does promises something they cannot know. What it says is what the decision depends on and who makes it.
What the technique changes about the bone
In the All-on-4 protocol, the two rear implants are not placed straight but tilted by up to 30 degrees. The purpose of this tilt is to use the bone that is there anyway, instead of first building up bone that is missing.
From this design comes the most frequently quoted statement about the protocol: that in most cases it avoids a bone graft. It comes from the technical description of the procedure. What matters in it are the words ‘in most cases’ — not in all, and not a statement about any single case.
Then there is the planning. The case is planned on a computer before any work is done on the bone; the positions are chosen on the scan. That is exactly where it shows whether the bone present supports the planned positions.
The image can answer, memory cannot
The scan on which this question is decided shows the bone as a volume and not as a shadow — called CBCT in the clinic’s documents and DVT in German practices. An older panoramic X-ray is not enough for it, and a sentence one remembers certainly is not.
That also means: anyone who wants to ask the question seriously needs a new finding, not a new argument. The order is examination, scan, plan — and only then an answer worth anything.
What to bring: any existing scans, the list of medicines being taken and, if available, the earlier finding. Not to refute it, but because it shows what has changed since.
When the answer is still no
Such cases exist, and a page that concealed it would be incomplete. If the bone is not sufficient at the places the protocol needs, no tilt changes that. Then other routes come up for discussion, or a graft, or both.
General health and habits that affect healing also enter the decision. None of these points is on its own a yes or a no: they are put together, and by the person who examines.
The diagnostic consultation is booked by telephone, on +351 220 430 090. Dental care is provided by the Instituto AreLuna at Rua de Júlio Dinis, 194, 4050-327 Porto.
Frequently asked questions
Is my old X-ray enough for an assessment?
As a rule not for this question. It is decided on a 3D scan that shows the bone as a volume. It is still worth bringing — an older image shows what has changed.
Does ‘avoids the bone graft’ mean I do not need one?
No. The technical description of the protocol says ‘in most cases’, and that is not a statement about a specific case. Whether a graft is needed is shown by the scan after a prior individual examination and diagnosis.
Is a no from five years ago still valid?
It was a finding at one time and on one specific question. Whether it still applies today can only be answered with a new examination, not with a text.