To Graft or Not to Graft? Evidence-Based Guide to Decision Making in Oral Bone Graft Surgery

Rehabilitation of the incomplete dentition by means of osseointegrated implants represents a highly predictable and widespread therapy. Advantages of oral implant treatment over conventional non-surgical prosthetic rehabilitation involve avoidance of removable dentures and tooth structure conservation of the remaining dentition. Implant placement necessitates sufficient bone quantity as well as bone quality, that may be compromised following tooth loss or trauma. Sufficient alveolar bone to host implants of 10 mm in length and 3-4 mm in diameter has been traditionally regarded as minimum requirements to allow bone-demanded implant placement. Three-dimensional bone morphology, however, may not permit favourable implant positioning. In the age of prosthetic-driven implant treatment, bone grafting procedures may be indicated not exclusively due to lack of bone volume, but to ensure favourable biomechanics and long-term esthetic outcome. A vast variety of treatment modalities have been suggested to increase alveolar bone volume and thus overcome the intrinsic limitations of oral implantology. Although success rates of various bone graft techniques are high, inherent disadvantages of augmentation procedures include prolonged treatment times, raised treatment costs and increased surgical invasion associated with patient morbidity and potential complications. Therefore, treatment tactics to obviate bone graft surgery are naturally preferred by both patients and surgeons. Nongrafting options, such as implants reduced in length and diameter or the use of computerguided implant surgery, may on the other hand carry the risk of lower predictability and reduced long-term success. To graft or not to graft? – that is the question clinicians are facing day-to-day in oral implant rehabilitation.