Progress in laboratory investigation of the biologic basis of osseointegration coupled with an extensive world-wide clinical experience have created a better understanding of implant and tissue integration and has allowed expanded clinical applications. Techniques are now available to provide alloplastic tooth replacements that are biomechanically stable and predictable and provide adequate masticatory, phonetic, and esthetic function approximating that of the normal dentition. Computed tomography is now used to assist the surgeon in determining available recipient bone sites and to determine the exact three-dimensional positioning of endosseous implants in the jaw bone. Surgical management of bone volume deficiencies, utilizing grafting techniques with bone and bone substitutes and guided tissue regeneration with membrane barriers, have given previously rejected patients an opportunity to benefit from osseointegrated implants. Congenital and acquired bone defects may now be managed and reconstructed with techniques that include dental implant surgery. Osteoinductive and osteoconductive substances are now available to assist in accelerating healing and present great promise for future applications.