Need for grafting

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.