The success of a dental implant, its ability to support a dental restoration, is very much dependent upon how much bone is available in the site where the implant is placed. There are lots of things that affect the bone volume including things like periodontal disease, trauma and infections and it is not unusual to open up a site in the mouth for implant placement and find out that some of the critical supporting bone is missing. No problem. We have great techniques available to us to replace missing bone. We can increase the height of bone and the width of bone. We can fill in anatomical voids in bone thereby creating new bone and we can fill in all sorts of defects that develop when teeth are lost. We can even use Bone graft techniques to prevent the loss of bone in circumstances where bone would normally be lost like the extraction of a tooth. Replacing missing bone or adding to existing bone is very often essential to the success of a dental implant and the ensuing restoration. The techniques to do this are well documented and should be used when indicated by any dentist who places dental implants. Most of us will have a good idea when additional bone or bone repair will be necessary before actually starting the placement of a dental implant and the patients should be informed of this possibility. Sometimes, however, we do get fooled and run into areas where unexpected bone grafting is indicated. As long as the dentist is prepared to replace or add to the existing bone and the patient understands the bone grafting procedure, there should not be any problem with these techniques.

When there is adequate bone height and width and when the density of the bone is acceptable, implant placement and ensuing success is almost a foregone conclusion. However, many of our patients are deficient in bone and in order for the implant placement to be successful, we have to select a means of regenerating this missing bone. While this is not necessarily an easy task, it does have a high degree of success when carried out with skill and knowledge.