Approximately 90% of all anterior maxillary implant sites do not have adequate bone for correct positioning of the implant. This, coupled with the intense interest in posterior maxillary and mandibular reconstruction with implant therapy, has significantly increased the number of graft procedures performed by implant surgeons. These graft procedures have led to an overall increased platform for implant placement and have facilitated an increased number of implants being placed. Many of the grafts fail in their early stages or do not provide the full potential of the desired result. This discussion focuses on the reasons for grafting and more importantly on the reasons that grafting fails both in the hard tissue and soft tissue windows. Graft success protocol will be stressed and the reasons for failure outlined. A list of complications will be delineated and a subsequent outline for avoidance of failures will be reviewed. Preoperative, intraoperative, and postoperative timetables will be used to compartmentalize the grafting failures. Finally, a comparison of grafting materials and embryonic origin will be reviewed as to indications for implant platform site formation.
Jay P. Malmquist, DMD, is associate professor of oral and general pathology and oral and maxillofacial surgery at Oregon Health Sciences University. He also maintains a private practice limited to oral and maxillofacial surgery in Portland, Oregon. Dr Malmquist is a diplomate of the American Board of Oral and Maxillofacial Surgery, the National Dental Board of Anesthesiology, and the International Congress of Oral Implantologists.