The bone-grafting decision tree: a systematic methodology for achieving new bone

Successful bone grafting requires that the clinician select the optimal bone grafting material and surgical technique from among a number of alternatives. This article reviews the biology of bone growth and repair, and presents a decision-making protocol in which the clinician first evaluates the bone quality at the surgical site to determine which graft material should be used. Bone quantity is then evaluated to determine the optimal surgical technique. Choices among graft stabilization techniques are also reviewed, and cases are presented to illustrate the use of this decision tree.