Bone grafting is a cornerstone procedure in reconstructive oral surgery, yet selecting the optimal graft material remains a critical and complex decision. Clinical and radiographic evaluations, while valuable, provide only a partial assessment of regenerative success. This lecture emphasizes the importance of histological evaluation for truly optimizing patient outcomes. Microscopic analysis, through core biopsies and histomorphometry, offers definitive, quantitative evidence of new bone formation and graft integration. The presentation will compare the biological performance of different grafting materials—from autografts to synthetic alloplasts—demonstrating how histological findings reveal healing dynamics not visible on imaging. Case examples will illustrate how integrating histopathological evidence into the decision-making process enables oral surgeons to make more precise, evidence-based choices that improve the reliability and long-term prognosis of implant therapy. This talk underscores histology as an indispensable guide for therapeutic decisions, elevating treatment from a visual assessment to a definitive biological evaluation.

Objectives:

1. To evaluate the limitations of clinical and radiographic assessments in determining the true regenerative success of bone grafting procedures.
2. To highlight the role of histological and histomorphometric analyses in providing definitive, quantitative evidence of new bone formation and graft integration.
3. To demonstrate how histological findings can guide evidence-based decision-making in graft material selection, ultimately improving implant reliability and long-term patient outcomes.

Methodology:

Primary: Histomorphometric % new vital bone, % residual graft, % marrow/connective tissue.