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This study was performed to address the outcomes of patients treated with onlay grafts from the iliac crest to augment the deficient jaw. The results of 173 consecutive patients who underwent bone grafting prior to implant surgery are presented. The grafts were taken from the anterior iliac crest to repair alveolar bone deficiencies that were too large to be corrected using intraoral bone grafts. Three months postoperatively, 869 implants were placed into 190 onlay grafts (167 grafts in the maxilla, 23 in the mandible). The follow-up ranged from 3 months to 23 years post implantation. All patients received a fixed prosthesis. Parameters examined included healing of the donor site and bone grafts, implant survival, peri-implant condition, and donor site morbidity. The overall survival rate for all implants was calculated to be 95% AE 2.7% according to Kaplan-Meier analysis. The implant survival rate compares favourably with those reported in studies using intraoral and extraoral bone.

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Sound clinical practice in implant dentistry depends upon defining the methodology that can successfully be used. This can be achieved by identifying literature relating to a specific technique prior to its use. However, clinical observations of outcomes within one's own practice are also very effective. This is particularly true as it becomes specific, by eliminating numerous confounding factors. Appropriate documentation, both clinical and radiographic, permits the practitioner to review clinical cases and establish the efficacy of the methodology used. This is most effective in terms of evaluating survival as well as determining aesthetic and functional outcomes. Software programs such as ImpDAT (Kea Software, Poecking, Germany) provide a platform that easily allows both accurate record-keeping and, importantly, retrieval of data for purposes of review and publication. This paper presents a case report that uses radiographic and photographic records to monitor the ongoing response of the patient to the specific treatment that was carried out; in this case, autogenous onlay bone grafts for the management of congenital partial anodontia.

Immediate loading of immediately placed implants is a possible treatment option that might be predictably and successfully achieved. Implants of adequate primary stability coupled with a range of prefabricated abutments permit function to be achieved using transitional restorations. The preliminary results of this clinical case series are very promising.

Safe clinical practice in implant dentistry requires an accurate investigation of the availability of bone for implant placement and the avoidance of critical anatomical structures. Modern imaging techniques using computed tomography (CT) and cone beam computed tomography (CBCT) provide the clinician with the required information. The imaging thus obtained provides accurate representation of the height, width and length of the available bone. In addition, whenever adequate radiation dose is used, accurate information about the bone density in Hounsfield units can be obtained. Important spatial information regarding the orientation of the ridges and the relationship to the proposed prosthetic reconstruction can be obtained with the aid of radiopaque templates during the acquisition of CT scan data. Modern software also provides the facility to decide interactively upon the positioning of the implants and is able to relate this to a stereolithographic model constructed from the imaging data. A surgical guide for the accurate positioning of the implants can be constructed. The construction of screw retained prostheses is fraught with difficulties regarding the accuracy of the construction. Accurate fit of the prosthesis is difficult to obtain due to the inherent errors in impression taking, component discrepancies, investing and casting inaccuracies. CAD/CAM technology eliminates the inaccuracies involved with the investing and casting of superstructures.

The aim of this article is to describe a method for correcting bone deficiencies which may compromise aesthetic, functional or oral hygiene maintenance of implant supported restorations. The generic causes of these deficiencies are mentioned. The use of autogenous block bone grafts is described alongside methods for managing the hard and soft tissues at both the recipient and donor sites. The biomechanical advantage conferred with the use of grafts in reducing the crown:implant ratio is emphasised. The sources of intraoral bone grafts are identified and the risks of damage to adjacent anatomical structures and their avoidance are addressed. The principles of healing are briefly described with an emphasis on the increasing predictability of contact healing, as opposed to gap healing. The impact and inherent risks associated with the supplementary use of membranes for containment is also addressed. Clinical cases have been used to illustrate procedures and outcomes. Previously published data is referenced.