Bertil Friberg: Achieving surgical success for compromised bone - graft or not graft

Implant treatment in compromised bone situations can be managed with different techniques, with and without grafting protocols. Supported by broad literature and meta-analysis data, Dr Friberg reviews experiences with grafting and implants in the field of grafting procedures since 1980, and graftless solutions with today's implant designs. In the early days failure rates were higher than today, after the year 2000, with the TiUnite surface, early failure rates went considerably down. Treatment options in the posterior maxilla comprise inlay grafts, onlay grafts, use of short, tilted and zygomatic implants, and the use of tooth-connected implants. Avoiding rotating instruments, piezo surgery devices assist in lower invasive and safer techniques. In the mandible, Dr Friberg emphasizes to take the anatomic location of the alveolar nerve into account, especially in the absorbed mandible, and in situations with an anterior loop of the nerve, the proximity of the nerve to implant sites has to be considered. Mandibular nerve transpositions have been abandonned today. Treatment with short implants is faster, cheaper and associated with less morbidity in comparison to bone augmentation protocols. The mandibular arch can be functionally strengthened by physiological loading with implant based treatment.