Simultaneous implant placement and bone grafting with particulate mineralized allograft in sites with buccal wall defects, a three-year follow-up and review of literature

Objectives: To assess the relationship between the vertical buccal defect size and the outcome of single-stage (non-submerged) implant placement and simultaneously augmentation of sites with mineralized particulate allograft (Puros Cancellous) using collagen membranes (Ossix Plus). Subjects and methods: Records of 108 partially edentulous patients with localized, buccal bone defects in the posterior maxilla and/or mandible [156 tissue-level Straumann implants, 38 male, 70 female, average age = 46.7 (6.4) years] were used for this study. Sectional CBCT scans were used to evaluate ridge forms before implant placement and after bone grafting (36 +/- 2.2 months). The initial vertical buccal wall defect was recorded by measuring the amount of vertical Implant Platform's Rough Surface Exposure (IPRSE) when implants were placed [small (<3 mm), medium (3-5 mm), and large (>5 mm)]. The ridge contour at 36 (+/- 2.2) months was classified into 3 categories [completely corrected (no IPRSE seen on CBCT), partially improved (some IPRSE seen on CBCT), no difference/worse]. Results: Complete defect correction occurred in 66 (61.1%) patients followed by improved ridge contours in 38 patients. Significant differences were observed in the outcome of simultaneous grafting of sites with different pre-treatment vertical defect sizes (chi-square = 69.394, df = 4, P < 0.001). Two graft failures (one needed regrafting) and 2 implant failures were also seen. Treatment was effective in complete correction of 100% and 79.3% of small and medium-sized vertical defects, respectively. Large-sized defects showed only partial improvement in 90% of cases, without any complete correction. Cumulative implant and graft survival was 98.1%. Conclusions: Single-stage implant placement and simultaneous grafting with mineralized particulate allograft showed promising outcome in correcting small and medium sized vertical buccal wall bone defects (<5 mm). (C) 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.