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When too many people agree on the same subject, it is high time to call it into question. Few other areas of medicine are better characterized by this statement than dental implantology. Why? Because both academic “researchers” and practitioners focus their efforts solely on crestal implants. In other words, they completely ignore any designs or concepts other than screws and cylinders, which guide the masticatory forces, into bone areas that mainly consist of cancellous tissue. If the available vertical bone supply is insufficient, measures are taken to rebuild the morphology of the bone tissue – whether by transplantation, by augmentation or by induced growth. Unless aesthetic considerations play a major role, these modifications of the bone situation are performed solely to facilitate the use of crestal implants, which would be impossible to insert otherwise. In many cases, these adjuvant measures are considerably more time-consuming and more expensive than the patient can afford. Meanwhile, no implant treatment is performed whatsoever , and the patient is left without an adequate fixed restoration. At the same time, the focus of dental implant treatment tends to shift away from the dental offices as these adjuvant measures gain respectability, towards the specialists capable of performing them. Due to the additional cost of these adjuvant measures, many patients are unable to afford adequate implant treatment. The consequence is that their masticatory function cannot be restored in a truly comprehensive manner.

It has been a long tradition in medicine that new ideas and treatment concepts are hardly ever invented inside the universities. Usually, practitioners – because they really face the patients’ problems day-to-day – are the ones to develop new solutions. Not until later are the techniques adopted by universities, and usually it will be necessary, of course, to pay the universities to change their way of thinking, working and teaching. The history of BOI implantology reflects this situation, as can be seen looking at the patent situation in this field. Patents applied for and, of course, patents granted are relatively objective criteria to go by. They help us judge who the people were that have genuinely set scientific milestones and broken with traditional thinking in a constructive way.

Chapter 2 provided an overview of the different types of lateral implants devised, introduced and employed over the past 30 years. The present chapter will provide the reader with the necessary background to understand the differences and commonalities of these designs, as well as their applications in clinical practice. Today it is almost impossible to draw a clear line between «disk» implants and BOI implants. Over the last few years in particular, the similarities between those designs have increased in various ways. The same development has also taken place in crestal implantology. While implants of the Diskimplant type are basal implants and while they take into account the concept of bicortical support, these rigid Diskimplants do not implement the concept of isoelasticity with the bone to the same extent of actual BOI implants with a skeletal design.

To insert BOI implants a T-shaped osteotomy has to be cut into the bone. The instruments used for this are usually designed to cut either the vertical or the horizontal part. There are also instruments, however, that are designed to cut the vertical and horizontal parts simultaneously. Within limits these instruments can be replaced (e.g. with a tungsten carbide cutter) if required for intraoperative accessibility.

People tend to think it is rather logical that installing fixed teeth is an advantage. But often enough it almost seems that the jaw that is receiving the requisite implants begs to differ. It is any implantologist’s desire for the jawbone to enter into a state of peaceful coexistence with the implanted object. In our opinion, this works best if the basic functions of the bone are not impaired. These basic functions include the motor function that is required for the survival of any bone and the unimpeded flow of nutrients, gases, and waste products.

The purpose of diagnosis is to explore an objective against the background of a strategic task. In accordance with this “military” definition, the dentist will not consider all the factors that may conceivably be relevant to the treatment, but only those that will help him to achieve the treatment objective. By the same token, the fact that a treatment objective can be achieved is not enough, but the dentist will only consider those objectives that will actually benefit the patient.

Thanks to the technique of basal osseointegration, we are today in a position to treat 95% of completely or partially edentulous patients with fixed restorations. This goal can only be achieved if a number of rules are observed with regard to where the implants should be placed and when and how they should be combined with residual teeth. Most importantly, the implantologist must understand the functional requirements of the treatment and perform occlusal adjustments in a timely manner.

This chapter discusses various BOI treatment options in patients with periodontally involved dentitions.

In this chapter, we shall explain bone properties based on a number of concepts, each illuminating one specific aspect of the osseous life cycle. All of these concepts are applicable at the same time, and they are indeed relevant for our implantological work.

While it is easily possible for trees to adapt to the harsh realities of life, for example by growing diagonally, following the prevailing winds, the human body is able to achieve similar feats only at tremendous cost in terms of energy. By contrast with the continuous skeleton of trees, the bony skeleton of the human body consists of separate segments that are spread wide open by and between the muscles. A slanted posture or asymmetrical function requires an extra amount of energy, since the centre of gravity of the body easily threatens to wander off the human body’s relatively small base area. To avoid this and to balance the body, body mass must be relocated, resulting in local overload.