Need for grafting
- Reduced bone volume or unfavorable shape of alveolar bone may require grafting or bone augmentation prior to implant placement
- Depending on shape of bone defect lateral or vertical graft procedures are applied
- For a better diagnosis 3-D computed tomography is preferrable
Indication for grafting - Anatomical
There are three main indications for grafting from an anatomical perspective:
- Vertical bone deficiency
- Horizontal bone deficiency
- Local bone defect
Indication for grafting - Clinical
From a clinical perspective, two additional considerations are important factors when considering the need for grafting:
- Inadequate bone volume for reliable implant insertion
- Excessive risk of intra- or postoperative mandibular fracture
Is grafting necessary?
In a patient-centered approach, avoiding bone grafting must be considered when alternative options offer a predictable outcome: use of less/short/narrow implants, use of zygomatic anchorage.
To ensure the correct diagnosis and need for grafting, 3-D CT images should preferrably be available. Some examples of grafting need and process include:
- Lateral grafting in case of Cawood class 4 with a marked knife-edge ridge of the alveolar process (Fig 1 & Fig 2).
- No grafting necessary in case of Cawood class 5 (Fig 1). Insertion of implants without grafting is feasible.
- Vertical grafting in case of Cawood class 6 with complete absence of the alveolar process and extreme atrophy of the mandibular body (Fig 1 & 3). In such cases a height of the mandible of >7 mm and of the horizontal width of >6 mm is considered a clinical indication for grafting.
- Vertical grafting is indicated in case of extensive local bone defects.