Objectives To analyse the evidence regarding the efficacy of lateral bone augmentation procedures in terms of defect resolution in cases of horizontal ridge deficiencies after implant placement. Materials and Methods Included studies met the following inclusion criteria: randomized controlled trials (RCTs) or controlled clinical trials (CCTs), re‐entry procedure to assess defect resolution, minimum of 10 patients (5 per group). Meta‐analyses were performed whenever possible, including subgroup analysis based on membranes and grafting materials. Results Twenty‐eight publications (20 short‐term, 8 follow‐up studies) were included. The most often used type of intervention was a xenogeneic particulated grafting material (XE) and a resorbable collagen membrane (CM). The mean defect height at baseline amounted to 5.1 mm (range 2.4–7.8) and decreased to a mean of 0.9 mm (range 0.2–2.2) at re‐entry, and the mean defect resolution was 81.3% (range 56.4%–97.1%). Defect height reduction was not significantly different using CM+XE as control treatment compared to the combined data of the respective test groups [n = 11; weighted mean difference (WMD) = −0.006 mm; 95% CI, −0.61, 0.60; p = 0.985]. The absence of any lateral bone augmentation was less favourable than the conjunction of a membrane and a bone grafting material (n = 1; MD = −1.96 mm; 95% CI, −3.48, −0.44; p = 0.011). The lack of a grafting material was less favourable than the conjunction of grafting material and membrane (n = 1; MD = −2.44 mm; 95% CI, −4.53, −0.35; p = 0.022), and the addition of a membrane compared to a grafting material alone was more favourable (n = 3; WMD = 0.97 mm; 95% CI, 0.31, 1.64; p = 0.004). Conclusions Lateral bone augmentation is a successful treatment modality. For optimal defect height reduction, a barrier membrane and a grafting material should be combined.

Daniel S (2017). Volumetric changes and peri-implant health at implant sites with or without soft tissue grafting in the esthetic zone, a retrospective case-control study with a 5-year follow-up. Clinical Oral Implants Research, 28(11) Materials and methods:In 18 partially edentulous patients, dental implants were placed in the esthetic zone (15-25) with simultaneous guided bone regeneration, followed by submerged healing. During the healing phase, eight patients (test) received a subepithelial connective tissue graft, whereas 10 patients (control) did not receive any soft tissue augmentation. Subsequently, abutment connection was performed and final reconstructions were inserted. Impressions were taken 1 week after crown insertion and at 5 years. Obtained casts were scanned and superimposed for volumetric and linear measurements. The mean distance (MD) in the midbuccal area between the two surfaces and the differences in buccal marginal mucosal level (bMML change ) and in ridge width (RW change ) were evaluated. Peri-implant health was assessed using probing pocket depth (PPD) values, plaque index (PlI) and bleeding on probing (BOP). None of the comparisons between the groups revealed statistically significant differences (p>0.35). A small sample size must be considered, however. Results Conclusions:Limited by a retrospective case-control study design, implant sites with and without soft tissue grafting on the buccal side revealed only minimal volumetric and linear changes and stability of peri-implant parameters over 5 years.3

Objectives To compare two ridge preservation techniques and spontaneous healing in terms of soft tissue thickness, contour changes, and soft tissue handling two months after tooth extraction. Methods Thirty‐six patients were included with buccal bone plate dehiscences of up to 50% after single‐tooth extraction in the esthetic zone. They were randomly assigned to receive one of three procedures: a deproteinized bovine bone mineral with 10% collagen (DBBM‐C) covered with a collagen matrix (DBBM‐C/CM), DBBM‐C alone, or spontaneous healing (SH). Two months later, the status of soft tissue healing was assessed, and the thickness of the mucosa was measured at the center of the site. Thereafter, implants were placed and the need for further guided bone regeneration (GBR) to cover exposed implant surfaces was assessed. Results Thirty‐six patients were evaluated at the day of implant placement. An invagination of the soft tissues was recorded in 41.7% (n = 12), 53.8% (n = 13), and 90.9% (n = 11) of the sites in groups DBBM‐C/CM, DBBM‐C, and SH, respectively. The median thickness of the mucosa measured was 3.0 mm in group DBBM‐C/CM, 2.1 mm in group DBBM‐C, and 1.5 mm in group SH. Additional GBR was necessary in 66.7% (n = 12), 53.8% (n = 13), and 90.9% (n = 11) of the sites in groups DBBM‐C/CM, DBBM‐C, and SH, respectively. Conclusions The present explorative study revealed slight tendencies for more favorable soft tissue conditions with less invaginations as well as increased soft tissue volume and thickness in groups having received an alveolar ridge preservation procedure compared to spontaneously healed sites at 8 weeks of healing.

Both treatment modalities were successful in regenerating bone to place dental implants. PROMs did not reveal any significant differences between the groups except for pain during surgery at the recipient site (in favour of the test group). Histologically, a higher amount of mineralized tissue was observed for the control group at 4 months.

Objectives To test whether or not the use of a xenogeneic block loaded with rhBMP‐2 results in superior radiological and profilometric outcomes compared to an autogenous bone block. Materials and methods Twenty‐four patients randomly received a xenogeneic block loaded with rhBMP‐2 (test) or an autogenous bone block (control) for primary augmentation. The ridge width (RW) was evaluated by means of a CBCT scan after augmentation surgery and at 4 months, prior to implant placement. Surface scans were taken prior to augmentation and at 4 months for profilometric analyses. Data were analyzed with Wilcoxon‐signed rank test, Mann–Whitney test, or nonparametric ANOVA models. Results The median RW after augmentation amounted to 7.13 mm (Q1 = 6.02; Q3 = 8.47) for test and 6.86 mm (Q1 = 5.99; Q3 = 8.95) for control. During 4 months of healing, the total RW decreased statistically significantly and measured 5.35 mm (Q1 = 4.53; Q3 = 6.7) for test and 5.15 mm (Q1 = 3.57; Q3 = 7.24) for control (p = 0.0005). The differences between the groups were not statistically significant (p > 0.5899). The buccal soft tissue contour slightly increased for test (0.83 mm; Q1 = 0.62; Q3 = 1.87) and control (1.16 mm; Q1 = 0.50; Q3 = 1.44). Conclusions Both treatment modalities successfully increased the ridge width to a similar extent. The shrinkage during healing was not greater in the test than in the control group. The impact of hard tissue augmentation on the soft tissue contour was, however, minimal.

Objectives:To assess the early histological, microbiological, radiological, and clinical response to cemented and screw-retained all-ceramic single-tooth implant-supported reconstructions. Materials and methods:Patients with single-tooth implants were randomly allocated to receive a cemented lithium disilicate crown on a customized zirconia abutment (CEM) or a screw-retained crown with a directly veneered zirconia abutment (SCREW). At the screening visit, at crown insertion and at the 6-month follow-up, clinical parameters were measured at the implant and the contralateral tooth.Marginal bone levels, technical parameters, and esthetic outcomes were measured at the implants. At the 6-month follow-up, a microbiological test was performed and a soft tissue biopsy was harvested at the implants for histological analysis. Inflammatory cells and fibroblasts/fibrocytes were analyzed at the level of the sulcular epithelium, junctional epithelium, and connective tissue. The histological parameters were analyzed by means of a linear mixed model. Results: Thirty-three patients completed the study, and implant and crown survival rates were 100% at 6 months. Histologically, the number of inflammatory cells tended to be higher in group CEM (p > 0.05). Moreover, significantly less inflammatory cells and fibroblasts/fibrocytes were found in the sulcular epithelium compared to the junctional epithelium and supracrestal connective tissue (p < 0.001). Four patients were tested positive for periodontal marker pathogens at the 6-month followup, and three of them belonged to group CEM. From crown insertion to the 6-month follow-up, median marginal bone levels changed only minimally and measured 0.31 and 0.32 mm in group CEM and 0.47 and 0.36 mm in group SCREW, respectively.Clinical and esthetic parameters remained stable over time and were comparable between natural teeth and implants as well as between the groups. Conclusions:Cemented reconstructions were associated with more inflammatory cells, and more patients were diagnosed with periodonto-pathogens. Both types of reconstructions resulted in similar radiological (marginal bone levels) and clinical outcomes (bleeding on probing and probing depth). | 997THOMA eT Al.

Aim: To test whether soft-type block bone substitute used for guided bone regeneration (GBR) of peri-implant defects leads to a different dimension of the augmented hard tissue than particulate bone substitute. Materials and Methods:In 40 patients, 40 two-piece dental implants were placed >2 months after tooth extraction. Following random allocation, 20 peri-implant bone dehiscences were grafted with a soft-type block made of synthetic biphasic calcium phosphate (BCP) + collagen and 20 bone dehiscences with particulate BCP. All the sites were covered with a collagen membrane stabilized with titanium pins. Immediately after wound closure and after 6 months, the horizontal dimension (HD) of the augmented hard tissue was measured at the level of implant shoulder using cone beam computed tomography. During re-entry at 6 months, the defect fill was clinically assessed.Results: At 6 months, the median HD measured 1.15 mm (mean: 1.31 mm) in the soft-block group and 0.93 mm (mean: 1.05 mm) in the particulate group (p = .6). At 6 months, 7.1% of contained defects and 61.9% of non-contained defects showed an incomplete vertical defect fill.Conclusions: Soft-type block of BCP + collagen used for GBR of peri-implant defects did not differ from particulate BCP regarding the dimension of the augmented hard tissue after 6 months of healing.

Objective To evaluate volumetric changes of soft tissues at pontic sites in patients treated with or without soft tissue grafting over an observation period of 10 years. Materials and Methods A total of 17 patients receiving a tooth‐borne fixed dental prosthesis (FDP) were enrolled in this study. Nine patients received a subepithelial connective tissue graft (SCTG) at the pontic site (test). Eight patients continued without soft tissue grafting (control). Baseline impressions were taken after delivery of the final FDP and at 10 years. Casts were scanned and digital images were superimposed for volumetric and linear measurements: the mean distance (MD) between the surfaces at the mid‐buccal area, the pontic height (PH) and the ridge width (RW). All comparisons were performed applying the Wilcoxon–Mann–Whitney test. Results The median follow‐up time was 123 months. Median MD between baseline and 10 years was −0.64 mm (Min: −2.39; Max: −0.02) (test) and −0.22 mm (Min: −1.07; Max: 0.06) (control). The change of PH (recession) was −0.33 mm (Min: −0.82; Max: 0.06) (test) and −0.17 mm (Min: −0.8; Max: 0.23) (control). The median differences in RW 1 mm below the crest were −0.62 mm (Min: −1.17; Max: 0.22) (test) and −0.2 mm (Min: −1.9; Max: 0.28) (control). None of the differences between the groups were significant (p > 0.05). Conclusions Limited by a retrospective study design, pontic sites with or without soft tissue augmentation by means of a SCTG underlie minimal changes over an observation period of 10 years.