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Implants in Qualitatively Compromised Bone

Topics covered include factors influencing bone quality; characteristics of compromised alveolar bone; and techniques for bone assessment, bone regeneration, and implant placement in compromised bone. The book also presents specific considerations for placing implants in different types of compromised bone, such as aged, underdeveloped, and irradiated bone. A useful work of reference for implant students, practicing implant clinicians, and implant-oriented researchers.


1 Overview of Factors Affecting Bone Quality/Georg Watzek
2 Mechanisms of Bone Development, Remodeling, and Loss/Reinhard Gruber
3 Structure of Atrophic Alveolar Bone/Christian Ulm and Gabor Tepper
4 Perfusion of Compromised Bone and Implications for Implant Therapy/Gabor Tepper and Christian Ulm
5 Assessment of Bone Quality: Techniques, Procedures, and Limitations/André Gahleitner and Gabriel Monov
6 Surgical Perspectives for Compromised Bone/Georg Mailath-Pokorny
7 Experimental Approaches in Bone Regeneration/Reinhard Gruber and Gabor Fuerst
8 Implants in the Elderly/Robert Haas and Georg Watzak
9 Implants in Children and Adolescents/Thomas Bernhart and Werner Zechner
10 Implants in Irradiated Bone/Michael Weinländer and John Beumer III
11 Lasers in Implant Dentistry/Robert Haas, Orhun Dörtbudak, and Norbert Jakse


Hardly any term in implant surgery has been misused as often as compromised bone. Most attempts to shed light on the concept have been confined to data on changes in bone microstructure, while a comprehensive review of the cellular, microstructural, and gross anatomic pathology and physiology; current diagnostic tools; and treatment options is still not available. Few have attempted to go beyond the four well-known bone quality classes defined by Lekholm and Zarb in 1985, which continue to be the basis of discussions in the literature. One notable exception is Aging, Osteoporosis, and Dental Implants, edited by G. Zarb, U. Lekholm, T. Albrektsson, and H. Tenenbaum (Quintessence, 2002). Although, as the title suggests, the book is focused specifically on age-related changes and their impact on dental implants, contributing to this work inspired me, along with my colleagues at the University of Vienna, to review the problem of compromised bone and its impact on dental implants in a more comprehensive way and to condense our findings in this volume.

Previous to this effort, we had spent almost two decades studying the problem and have contributed a great number of publications in nearly all related fields. These laid the groundwork for the present volume inasmuch as we could draw on numerous experimental studies conducted by our research group, both in vitro and in vivo, to describe what reduced bone quality means and what we can currently do to improve it. Similarly, the clinical section on therapeutic approaches draws heavily on our large and diverse pool of case studies. This enabled us to review in some detail what can be done to improve the quality of the host bone intended to accommodate dental implants. We were assisted in this exercise by our close collaboration with the Institute of Anatomy at the University of Vienna, which provided ample material for the study of microstructural and gross anatomic changes. The University of Vienna’s Department of Radiology also made a significant contribution to the precise and profound review of the diagnostic potentialities presented here. Our one deficiency was a lack of both theoretical and practical experience with the problem of pre-irradiated bone. This was thankfully filled by a former affiliate of the University of Vienna in what has traditionally been a seminal cooperation with the UCLA School of Dentistry in Los Angeles.

This book is intended to provide beginning implant students with a comprehensive review of the current knowledge regarding the placement of implants in compromised bone. We also hope that this volume will serve as a useful work of reference for both practicing implant clinicians and implant-oriented researchers and will provide all readers interested in the subject with new and helpful information. The least we expect is that it will contribute a clear definition of compromised bone so that, in the future, the term will be used properly and serve as a useful rationale for planning an optimal treatment strategy.

Edited by

Georg Watzek, MD, DMD, PhD
Department of Oral Surgery
University of Vienna
Vienna, Austria