Contour bone augmentation in implant-prosthetic rehabilitation

Abstract

Introduction. In cases of moderate lateral atrophy of the crest bone splitting, sausage technique or other grafting procedures like bone blocks are recommended. However, in case of ridge expanding, subcrestal positioning of implants is necessary while in case of bone blocks the terms of rehabilitation are longer. Aim of the study. To evaluate the possibility of contour buccal grafting with simultaneous implants placement in one and two surgical steps. Materials and methods. The study was performed on 5 patients in which 10 implants were installed in one and two surgical steps in the lateral sides of the jaws. Due to horizontal bone atrophy, grafting procedures were performed with simultaneous implants placement. In one case, collagen membrane was used to isolate the grafting material and non submerged technique was applied for implant. In the others, implants were installed in one and two surgical steps with grafting material (collagen and hidroxyapatite) without collagen membranes. At the end of healing, for the implants installed in two-steps, the second stage was performed and the evaluation of the grafted volume was appreciated. In cases with one step protocol, the level of buccal soft tissues was appreciated. Results. All implants successfully integrated. In one case, solitary graft particles were observed in the soft tissues. The augmented sites shrank insignificantly, and a good profile from buccal site was observed in all the cases. No significant effect was observed in the usage of collagen membrane as well as in one or two-steps protocol. Conclusions. The usage of contour grafting in case of implants placement in posterior sides of the jaws seems to be a good method of augmentation. In case of a good periosteum, the collagen membrane isolation is not mandatory. Due to the lack of difference between one step and two steps protocol, the one step placement is more favorable because of the reduced number of surgeries and a mature biological width at the end of healing period. Further studies are necessary to appreciate indications and contraindications for such kind of augmentation.