Protocol for Bone Augmentation with Simultaneous Early Implant Placement: A Retrospective Multicenter Clinical Study

Abstract

Purpose. To present a novel protocol for alveolar bone regeneration in parallel to early implant placement. Methods. 497 patients in need of extraction and early implant placement with simultaneous bone augmentation were treated in a period of 10 years. In all patients the same specific method was followed and grafting was performed utilizing in situ hardening fully resorbable alloplastic grafting materials consisting of β-tricalcium phosphate and calcium sulfate. The protocol involved atraumatic extraction, implant placement after 4 weeks with simultaneous bone augmentation, and loading of the implant 12 weeks after placement and grafting. Follow-up periods ranged from 6 months to 10 years (mean of 4 years). Results. A total of 601 postextraction sites were rehabilitated in 497 patients utilizing the novel protocol. Three implants failed before loading and three implants failed one year after loading, leaving an overall survival rate of 99.0%. Conclusions. This standardized protocol allows successful long-term functional results regarding alveolar bone regeneration and implant rehabilitation. The concept of placing the implant 4 weeks after extraction, augmenting the bone around the implant utilizing fully resorbable, biomechanically stable, alloplastic materials, and loading the implant at 12 weeks seems to offer advantages when compared with traditional treatment modalities.

Figure 1

Implant distribution and grafting material used in maxilla.

Figure 2

Implant distribution and grafting material used in mandible.

Figure 3

Case  1: a 47-year-old woman with crown and root fracture in the left mandibular first molar. (a) Clinical view of the site after thorough debridement of the socket. (b) Periapical X-ray of the nonrestorable tooth. (c) Implant placement at the correct 3D positioning. ISQ reading was 48. (d) Grafting with β-TCP/CS (Ethoss). (e) Clinical view after 10 weeks. (f) X-ray 10 weeks after implant placement and grafting showing the consolidation of the grafting material around the implant and new bone formation over the implant head and towards the adjacent interproximal heights of bone. (g) At reentry the site is filled with regenerated bone. Note the head of the implant covered by newly formed bone. (h) After removing the supernatant newly formed bone with a round burr implant stability is assessed (ISQ measurement: 78) revealing a significant increase through the 10-week healing period. (i) Maturation of the soft tissues 2 weeks after placement of the healing abutment. (j) X-ray 9 months after loading.

Figure 4

Case  2: a 28-year-old woman with root fracture in the maxillary right central incisor. (a) Implant placed at the optimum 3D positioning leaving a buccal dehiscence. (b) Reentry after 10 weeks revealing complete bone regeneration of the site. The head of the implant is partially covered by newly formed bone and the ridge is also significantly augmented laterally. ISQ reading was 75. (c) Six months after loading, excellent preservation of the buccal profile.

Figure 5

Case  3: a 62-year-old male with root fracture in the maxillary left second premolar. (a) Implant placed at the optimum 3D positioning with low initial stability, leaving a buccal dehiscence. (b) Reentry after 10 weeks showing excellent bone regeneration of the site. ISQ reading was 76.

Figure 6

Seven-year follow-up clinical picture of a maxillary left canine case treated according to the protocol and grafted with Fortoss Vital.