Advances in bone augmentation to enable dental implant placement: Consensus Report of the Sixth European Workshop on Periodontology

Abstract

Background: Bone augmentation procedures to enable dental implant placement are frequently performed in practice. Methods: In this session the European Workshop on Periodontology discussed the evidence in support of the procedures and examined both adverse events and implant performance in the augmented bone. While the available evidence improved both in quantity and quality since previous workshops the conclusions that could be drawn were limited by elements of design and/or reporting that are amenable to improvement. Results: With regards to lateral bone augmentation, a sizable body of evidence supports its use to enable dental implant placement. The group recognized the potential for vertical ridge augmentation procedures to allow implant placement in clinical practice but questioned the applicability of these data to a wider array of operators and clinical settings. With regards to sinus floor augmentation, perforation of the sinus membrane, graft infection and graft loss resulting in inability of implant placement were the major reported adverse events. In cases with <6 mm of residual bone height, 17% of subjects experienced implant loss in the first 3 years following lateral window augmentation. After trans‐alveolar sinus floor augmentation 11% of subjects experienced implant loss over 3 years. Significant research activity (both pre‐clinical and clinical) was identified in the area of growth factors‐induced bone augmentation. Initial clinical trials support the potential of BMP‐2. Conclusions: Clinically, the consensus highlighted that bone augmentation procedures can fail and that implants placed in these areas do not necessarily enjoy the high long‐term survival rates of dental implants placed in pristine sites. The consensus emphasized the research need to answer questions on: (i) long‐term performance of dental implants placed in augmented bone; (ii) the clinical performance of dental implants placed in augmented or pristine sites; and (iii) the clinical benefits of bone augmentation with respect to alternative treatments.

Influence of rhBMP-2 on bone formation and osseointegration in different implant systems after sinus-floor elevation. An in vivo study on sheep

“…In 2008, the Consensus Report of the Sixth European Workshop on Periodontology recognised that initial clinical trials support the potential of rhBMP-2 in this field, however it was emphasised that the research needed to answer questions about the clinical benefits of bone augmentation with respect to this alternative treatment (Tonetti and Hämmerle, 2008).…”

Treatment Options for the Atrophic Posterior Maxilla

“…(21,22) The most commonly utilized augmentation method for maxillary sinus reconstruction was first presented by Tatum 19772, and published by Boyne and James in 19801, using a window through the lateral wall of the alveolus for sinus access. The LWSFE technique has been widely described in the literature and is recommended with a residual bone height less than 4 to 5 mm.…”

Use of platelet rich fibrin and Bio-OSS/SINT-Oss for implant-prosthetic rehabilitation in maxillary atrophy with sinus pathology: A 48-month follow-up

“…5 The complication rate is low, but some cases may require additional surgery, and the outcome of oral rehabilitation may be affected. 6 The use of Piezosurgery involves considerable advantages for the oral surgeon: an osteotomy with micrometric cut for complete surgical accuracy and a high intraoperative sensibility; a site-specific selective cut to minimize the damage to the soft tissues, which is an important quality to preserve the sinus membrane while creating the transcortical access window in sinus lift; and an excellent intraoperative visibility thanks to a bloodless surgical field, ensured by the effect of cavitation.…”

“…4 Because dental implantation and sinus augmentation have been widely performed in recent years, one of their possible complications, maxillary sinusitis, has become a major concern for both dentists and otolaryngologists. [4][5][6] A widely used technique for augmenting bone tissue volume in the maxilla is maxillary sinus lifting, in which, by means of osteotomy of the anterior maxillary sinus wall, the sinus membrane is exposed, and must be divulsed to obtain a receptor site for the bone tissue. 7 One of the most common accidents in this technique is perforation of the sinus membrane while performing osteotomy which, in some cases may make a further surgical procedure unfeasible.…”