Autogenous bone grafts for endosteal implants--indications and failures

The use of autogenous bone grafts (ABG) combined with endosteal implants permits to restore patients with conditions of extreme bone atrophy or with very demanding final results. The improvement of the biomechanics conditions, moment forces, C/I ratio, ridge relationship, length, diameter, number and location of the implants and esthetics improve the prognosis of the restoration. Large segments of autogenous bone is harvested from the iliac crest or cranium. Excellent autogenous membranous bone can be obtained intra-orally from the mandibular symphysis when smaller dimensions are needed. Indications for treatment with autogenous bone grafts are presented following the Misch/Judy available bone classification. In division C-w ridges, ABG improve the width of the ridge to permit the placement of root form implants. In Division C-h ridges, ABG improve the height available for implant placement, and permits to obtain a FP-1 or FP-2 result. In Division D ridges, ABG represent the treatment of choice. RP-4 restorations are encouraged. High success rates obtained by the author depend upon strict patient evaluation, treatment planning, careful placement of the minimum number of implants with the bone grafting procedure only to immobilize the grafted segment, progressive bone loading during the prosthetic phase, proper soft tissue management and sufficient number of implants for the planned prosthesis.