Peri‐Implant Bone Augmentation by the Sub‐Periosteal Peri‐Implant Augmented Layer Technique and a Bovine‐Derived Bone Block: A Case Report

Abstract

Background: When used with deproteinized bovine bone mineral (DBBM) delivered as a particulate, the subperiosteal peri-implant augmented layer (SPAL) technique was effective in completely correcting up to 92% of peri-implant buccal bone dehiscences. The use of a DBBM block (bDBBM), however, may result in an improvement of the peri-implant bone dehiscence as well as a relevant lateral bone augmentation since its mechanical properties may ensure a better dimensional stability at flap manipulation than particulate DBBM. The aim of the present a proof-of-principle case report is to investigate if SPAL may be successfully used to obtain bone augmentation at peri-implant dehiscence sites when used with bDBBM.Case presentation: Lateral bone augmentation was performed using the SPAL technique at two implants showing a buccal peri-implant bone dehiscence immediately after their placement. A partial-thickness flap was elevated, leaving the periosteal layer on the buccal cortical bone plate. The periosteal layer was, in turn, elevated to create a pouch, which was used to stabilize a bDBBM graft at the peri-implant buccal bone dehiscences. At re-entry, exposed implant surfaces were completely covered by new thick hard tissue up to their most coronal portion. A free epithelial-connective tissue graft was used to augment the peri-implant soft tissue phenotype. Conclusion:When used to accommodate bDBBM over the most coronal portion of an exposed implant, SPAL may successfully lead to an increase in peri-implant buccal tissue thickness. Clin Adv Periodontics 2021;0:1-6.

Minimal invasiveness in lateral bone augmentation with simultaneous implant placement: A systematic review

“…Costs deriving from the loss of working days due to post-operative discomfort should also be evaluated. In this respect, simplified procedures using patient's periosteum, rather than a membrane, to stabilize the bone graft, such as the Sub-periosteal Peri-implant Augmented Layer (SPAL) technique 5,23,43,44,45,46,47…”