Many patients who are otherwise ideal candidates for implant therapy lack sufficient alveolar bone to support dental implants. This book presents all facets of bone augmentation in preparation for implant placement, including techniques for harvesting bone from the ramus, the anterior mandible, and the tibia; the various types of bone-grafting materials and their indications; step-by-step procedures for grafting the maxillary sinus and anterior alveolar ridge and for subnasal elevation and augmentation; and guidelines for the use of adjuncts such as platelet-rich plasma to enhance healing and predictability. Practitioners of implant dentistry at all levels will learn much from this book.

ISBN: 0-86715-441-1

978-0-86715-441-2 , 9780867154412

279 pp; 692 illus (mostly color)

Contents
Part I: Bone Biology
oBone Physiology for Dental Implantology
o Review of Bone-Grafting Materials
o Barrier Membranes for Guided Bone Regeneration
o Alveolar Ridge Preservation After Tooth Extraction

Part II: Bone Harvesting
o Harvesting Bone from the Ramus
o Harvesting Bone from the Mandibular Symphysis
o Harvesting Bone from the Tibia

Part III: Bone Grafting
o Augmentation Grafting of the Maxillary Sinus for Placement of Dental Implants
o Augmentation and Grafting for the Maxillary Anterior Alveolar Ridges
o Subnasal Elevation and Bone Augmentation

Part IV: Future Directions
o Biologic Growth Factors and Bone Morphogens in Bone Regeneration

Preface
For the past 10 years, many of the questions raised during my hands-on cadaver, live-surgery, and lecture programs have pertained to bone biology, graft materials, membranes, bone harvesting, or bone grafting. While it seems that most practitioners today have been adequately trained in the technical aspects of placing implants, I find that many lack knowledge of the basic biologic processes that allow us to harvest bone from one area of the mouth and graft it in another. Since the format of a short lecture or even a one-day course does not allow me to delve very far beyond the step-by-step procedures associated with harvesting and grafting bone, I conceived the idea of writing a book that would explain not only how to perform these and other procedures, but also why we do them one way and not another and what makes the procedures work. Above all, my aim in writing this book was to arm the clinician with a sufficient understanding of bone and bone grafting to be able to make decisions that will benefit individual patients, without overwhelming him or her with information that is not directly relevant to that purpose.

It is truly remarkable to consider how much implant dentistry has evolved over the past two decades. Today we are able to restore function in patients with as little as 1 mm of crestal bone height, providing they have adequate ridge width to accommodate the intended implant. This has significantly expanded the number of patients who qualify as candidates for implant therapy, but the clinician must be knowledgeable about the needs of these patients and how to meet them successfully. This book is designed to bridge that gap in knowledge. It begins with a broad overview of bone biology to refresh the reader's understanding of how bone develops at the microscopic level. This section also reviews graft materials and membrane barriers and recommends the situations and types of defects for which these materials are best suited. A section on bone harvesting describes surgical techniques and potential complications of harvesting bone grafts from the ramus, the anterior mandible, and the tibia. This is followed by a section on bone grafting for the maxillary sinus, anterior maxilla, and the subnasal area, including methods, materials, techniques, and postoperative considerations, all of them accompanied by numerous clinical photographs. Each procedure is described in the context of the biologic processes that it initiates so that the reader will understand not only how but why it works. The book concludes with a look at the growth factors that are currently available and those being investigated for possible future applications in bone grafting for dental implants. It is my hope that this book will provide the profession with a comprehensive yet concise resource for understanding and providing care to patients who can benefit from bone harvesting and grafting.

This book is intended primarily for the advanced clinician in periodontics and oral and maxillofacial surgery who desires a comprehensive and clinically relevant review of both the background science and clinical applications of bone for dental implants. The book will also be useful for graduate students in oral and maxillofacial surgery, periodontics, and hospital dentistry residency training programs and for the academic surgeon with an interest in this important subject.

As I complete the writing of this book, I must acknowledge my division chief, Dr Robert E. Marx-colleague, teacher, mentor, and (I humbly add) friend. Internationally recognized as a pioneer in the development of major maxillofacial reconstruction, Dr Marx is the consummate academic surgeon, providing the highest quality of medical care, empathizing with patients, accomplishing significant research, and most importantly, teaching brilliantly. Words alone can never express the gratitude I feel for the privilege of sharing my ideas with him, listening to him, witnessing his work ethic, hearing his brilliant and innovative ideas, and applying all of this mentoring experience to the study of bone science generally and the practice of bone harvesting and grafting for dental implants specifically.

I am also deeply indebted to all of the researchers and clinicians whose published results helped me form the scientific basis of my work and of this book. In addition, I would like to gratefully acknowledge the enormous contributions of the students, residents, and colleagues with whom I have had the privilege of collaborating during the past 18 years at the University of Miami School of Medicine.

Thanks go especially to my editors at Quintessence, who constantly pushed me to do my personal best. The book has benefited significantly from their excellent editing and great guidance and ideas on additions and deletions. I also want to thank the entire team at Quintessence Publishing for their excellence in all that they do.

I have been exceptionally lucky to have so many truly talented and creative individuals on my team. I would like to thank my postdoctoral fellow, Dr Aura Picon, for her assistance in patient care and her organizational abilities, diligence, and work ethic. I would like to thank my clinical staff-Cathie Ellyn, RN, Gina Lewis, CDA, and Amy Guerra, CDA-for assisting with the patient care depicted in the book. The care and love they provide their patients is incomparable, and the teamwork and support they provide is appreciated.

I would like to thank Dr Morton Perel for his manuscript review, probing questions, guidance, and encouragement. My heartfelt gratitude goes to the friends and assistants who always stand by me: Rick, Kuy, Lillibeth, Leo, Michael, Karen, Robert, Katrina, Vivian, and Frank.

Finally, thanks to my family-Mom, Dad, Heather, Nathan, Jeremy, Kyle, Lovey, Ravi, Angela, and Anil-for their support and understanding and for providing an oasis of tranquility where I can retreat from my frequently chaotic schedule. Without their help, both directly and indirectly, this book would not have been possible.

Arun K. Garg, DMD
Professor of Surgery
Division of Oral and Maxillofacial Surgery
University of Miami School of Medicine
Miami, Florida