Bone grafting from a restorative perspective--are we winning the space race?

The edentulous maxilla presents diverse and complex rehabilitation problems for the clinician that are often not addressed with a conventional removable appliance. Implant therapy, although revolutionizing the management of the edentulous mandible, has yielded less than favourable treatment outcomes in the maxilla. Poor bone quality and small bone volume in the maxilla, at the time of implant surgery has been associated with more implant and prosthesis failure. Bone grafting appears to improve the survival rate of implants in the atrophic maxilla and many studies have been published outlining techniques in which various types of implants have been used in conjunction with grafting materials. It is as yet not clear from the studies of maxillary grafting, whether various grafting materials are equally capable of supporting implants. The small number of patients and implants evaluated in many studies makes it difficult to predict specific outcomes for a single patient. The occurrence and frequency of complications with endosseous implant placement and with bone grafting is generally poorly defined. In the year 2000, our patients, third party insurers, the legal system and the scientific community are expecting more evidence to support the effectiveness of dental health care strategies. Evidence-based practice has become the catch cry for therapeutic intervention and yet the dental literature reveals a wide range of treatment modalities for which research can be at best considered weak. Studies to date into patient-based assessment of implant therapy provides little scientific evidence of substantially more benefit to edentulous patients with severe alveolar loss from implant therapy than was gained from alternative forms of treatment. Bone grafting and bone regenerative procedures do hold promise for the rehabilitation of the edentulous maxilla, however the Space Race is far from won.