Alveolar Bone Grafting Techniques for Dental Implant Preparation

P re f a c e Alveolar Bone Grafting Tec h n i q u e s fo r D e n t a l I m p l a n t P rep a r a t i o n

Peter D. Waite, MPH, DDS, MD Guest Editor

Oral Maxillofacial Surg Clin N Am 22 (2010) ixx doi:10.1016/j.coms.2010.06.004 1042-3699/10/$ see front matter 2010 Elsevier Inc. All rights reserved.

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Bone grafting for implant site preparation has become a new surgical technique niche similar to what preprosthetic surgery was for removable dentures. Preprosthetic surgery is almost a lost art, but the surgical techniques necessary for alveolar reconstruction or implant site preparation have become much more complex and variable. The surgical art of ridge reconstruction in preparation for dental implants in many ways has become more important and complex than the simple placement of dental implants. The final prosthetic result depends on creating the correct alveolar arch morphology, alignment, and symmetry. Oral and maxillofacial surgeons (OMSs) are best trained to address this unique surgical niche. Bone grafting techniques are not new for the OMS, and therefore basic principles used in alveolar cleft grafting and jaw reconstruction after trauma and oncologic defects are valuable clinical applications. However, bone grafting for implant patients are quite different in many ways. Such patients often expect minimal morbidity, outpatient clinic procedures, and reasonable private financing. The amount of bone required is much less, but the stability and predictability much higher. We now know that just getting an implant in bone is not adequate if the biologic width and soft tissue is insufficient. Cosmetic reconstruction begins with the correct alveolar bone height and contour. The role of the OMS in the dental implant team will become more important as the public comes to expect natural cosmetic, long-term

stability. Much of what we do is pragmatic, and dogma changes from year to year, or speaker to speaker. The purpose of this issue is to lay out a logical approach to alveolar reconstruction and bone grafting for implant preparation. This begins with the basic science of bone biochemistry and physiology. In recent years, we have come to understand bone at a much deeper level. Understanding the human genome has unlocked some of the secrets that regulate bone deposition and resorption. Although the first article may be partially incomprehensible for the surgeon, it is important to know that bone products are developing with sound scientific structure. Bone is a much more dynamic matrix with multiple regulating factors than previously thought. It is exciting to discuss clinical problems with our basic science colleagues and share in the translational research. Basic science understanding does change the surgeons behavior. The principles of bone grafting are applicable for the simple socket graft, sandwich graft, or the sinus lift. We must establish minimally invasive office-based procedures that yield predictable outcomes. Bone must be harvested by predictable surgical techniques, whether from local or distant sites. The OMSs are trained to harvest the best bone indicated, and therefore choice is not limited to just allogenic bone (bottle bone). New procedures such as ridge splitting, distraction osteogenesis, and titanium mesh are examples of this new surgical niche

Preface
that are built on the solid surgical principles of the past. No bone graft or surgical procedure will be successful without adequate vasculature and soft tissue protection. We learn most from our failures, and the article on explantation gives us valuable information on the biomaterials of implants. I hope our specialty finds this issue to be a valuable contribution to the clinical practice of preimplant surgery. I have learned a great deal by editing the articles, and it has already changed my surgical approach and techniques. I want to thank each of the authors who worked so hard over and beyond their normal duties to make this issue possible. Peter D. Waite, MPH, DDS, MD Department of Oral and Maxillofacial Surgery University of Alabama School of Dentistry University of Alabama at Birmingham 419 School of Dentistry Building 1530 3rd Avenue South Birmingham, AL 35294-0007, USA E-mail address: pwaite@uab.edu