Ever since the appearance of implants, correction of bone resorption following the loss of teeth has always been an important consideration. When planning the placing of an implant, checking the availability of the necessary amount of bone is imperative. Objectively measurable minimum values must be met in all three dimensions. If the amount of bone is not sufficient in a dimension but we are still planning an implant, a bone grafting operation needs to be performed. There are cases when the amount of bone is insufficient in more than one dimensions – rebuilding will be more complex there and we will have to reckon with a longer convalescence period.

As long as no implants are used for tooth substitution, physiological bone loss does not really have to be dealt with and there is no mind in substituting it because if a grafted area remains „unused” for a long while, that is, no implant is placed there, bone resorption will proceed unabated. If, however, the placing of an implant is coupled with bone grafting and the bone tissue is once again used physiologically – the implant transfers mastication force to the surrounding tissue – bone resorption is supplemented with the same level of bone development and biological equilibrium is thus restored.

Today’s implants are screws produced of titanium that function by the same principle irrespective of brand. Implants are driven into a bore prepared in the jawbone and are fixed there first by biomechanical retention (providing primary stability). Then, after a few months, an extremely strong cellular bond develops between the bone tissue and the implant (osseointegration). Proper primary stability is a precondition for osseointegration, that is, a successful implant fixation. This, however, is not enough. In order for the implant to function perfectly in the long run, a proper amount of bone is needed around it that can be provided for by bone grafting. Minor bone insufficiencies can usually be supplemented during the process of implantation while in case of major bone loss, bone grafting has to be done prior to it.

When planning tooth substitution anchored on implants, the existing bone volume of the patient has to be defined in the most exact manner. In such cases, we are making use of one of the modern examination methods, the so-called Cone Beam CT with help of which any oral surgery intervention can be planned for millimeters. The irradiation dose of Cone Beam CT equals that of a panorama X-ray (orthopantomograph) but it offers much more detail about the condition of the teeth and bone structure. If, at the first visit, it is clear that the patient will most probably need bone grafting, they have to be referred to a 3D CBCT scan so as to plan the intervention as exactly as possible. This is how we can prepare better for the intervention and minimize complications during or after it.

 Bone grafting is fortunately not always a must and if a patient decides on implantation in time, he/she will have a greater chance for having sufficient bone volume for the implant. Patients should always be encouraged to think in advance and if a tooth cannot be saved and needs to be removed, the intervention should be performed by the oral surgeon who will do the implantation as well. Protecting and preserving the bone is always cheaper than bone grafting later on. And it starts with extraction. In certain cases, protection of the bone is facilitated by having the implant placed right at time of tooth removal. The type of temporary replacement used for the convalescence period makes a difference too. Creating the best treatment plan always calls for personal consultation.