A 5-year clinical and computerized tomographic implant follow-up in sinus-lifted maxillae and native bone

Short (≤6 mm) compared with ≥10-mm dental implants in different clinical scenarios: A systematic review of randomized clinical trials with meta-analysis, trial sequential analysis and quality of evidence grading

AIM

To systematically identify, synthesize and critically summarize the available scientific evidence from randomized controlled trials (RCTs) regarding whether short (≤6 mm) perform as well as long (≥10 mm) implants regarding implant survival, marginal bone loss, and biologic and prosthetic complications in different clinical scenarios.

MATERIALS AND METHODS

Cochrane Collaboration's risk of bias tool and the GRADE approach were applied. Results were synthesized using random-effects meta-analyses assessed by trial sequential analyses.

RESULTS

Forty reports on 19 RCTs comprising 2214 (1097 short; 1117 long) implants were included. Moderate/high certainty/quality evidence demonstrated similar 5-year survival rates for ≤6-mm and ≥10-mm implants in non-augmented bone and full-mouth rehabilitation in either jaw, and for 6-mm implants in the maxilla instead of sinus lift. Nevertheless, the evidence for 5-year survival rates remains inconclusive or insufficient for the remaining combinations of implant lengths and clinical scenarios. They include 4-mm and 5-mm implants as alternatives to sinus lift as well as placing all implant lengths ≤6 mm instead of vertical ridge augmentation with long implants. Marginal bone level and short- and long-term biologic or prosthetic complications were similar.

CONCLUSIONS

Based on moderate/high certainty/quality evidence from 5-year RCTs, implants ≤6 mm may be viable alternatives to ≥10-mm implants in either jaw in native bone and full-arch rehabilitation, and 6-mm implants may be used as an alternative to sinus lift.

TRIAL REGISTRATION

PROSPERO ID: CRD42021254365.

Long-Term Volumetric Stability of Maxillary Sinus Floor Augmentation Using a Xenograft Bone Substitute and Its Combination with Autologous Bone: A 6+ Year Retrospective Follow-Up Study Using Cone Beam Computed Tomography

Deproteinised bovine bone (DBB) is widely used as bone substitute in maxillary sinus floor augmentation (MSFA) surgery. No previous studies have shown the long-term volumetric changes in the augmented bone when using DBB. The selected patients had MFSA performed using a lateral window technique and a xenograft, alone or in combination with the patient's autologous bone from the mandible. Cone beam computed tomography (CBCT) images were used to compare the volumetric changes in the augmented bone for patients over a period of 6 or more years. No significant bone reduction was seen in the augmented bone region when comparing MSFA after 7 months and 6 or more years after dental implantation.

15-Year Retrospective Study on the Success Rate of Maxillary Sinus Augmentation and Implants: Influence of Bone Substitute Type, Presurgical Bone Height, and Membrane Perforation during Sinus Lift

Objectives

To evaluate the success rate of bone grafts and implants carried out at the Latin American Institute for Research and Dental Education (ILAPEO), considering the following: (i) the different pure bone substitutes (autogenous, xenogeneic, and alloplastic), (ii) the presurgical bone height, and (iii) how the treatment is compromised when membrane perforation occurs during sinus lift in maxillary sinus surgeries. Material and Methods. The initial sample comprised 1040 records of maxillary sinus lifting surgeries. After evaluation, the final sample retained 472 grafts performed using the lateral window technique with a total of 757 implants. The grafts were divided into 3 groups: (i) autogenous bone (n = 197), (ii) xenogenous bovine bone (n = 182), and (iii) alloplastic material (n = 93). One calibrated examiner classified the sample into two groups based on the residual bone height (<4 mm and ≥4 mm) of the area of interest measured on parasagittal sections of tomographic images. Data on membrane perforation occurrences in each group were collected; qualitative variables were described using frequency, expressed as percentages. The Chi-square test was used to analyze the success of the graft types and the survival rate of the implants as a function of the grafted material and the residual bone height. The Kaplan-Meier survival analysis was used to calculate the survival rate of bone grafts and implants according to the classifications adopted in this retrospective study.

Results

The success rate of grafts and implants was 98.3% and 97.2%, respectively. There was no statistically significant difference in the success rate among the different bone substitutes (p = 0.140). Only 8 grafts (1.7%) and 21 implants (2.8%) failed. There was a greater success rate for both grafts (96.5%) and implants (97.4%) when the bone height was ≥4 mm. The success rate in the 49 sinuses in which the membrane was perforated was 97.96% for the grafts and 96.2% for the implants. The follow-up periods after rehabilitation ranged from 3 months to 13 years.

Conclusions

Within the limitations of the data analyzed in this retrospective study, maxillary sinus lift was a viable surgical technique that enabled implant placement with a predictable long-term success rate, regardless of the type of material used. The presence of membrane perforation did not interfere with the success rate obtained for grafts and implants.

Sinus augmentation procedure via the lateral window technique-Reducing invasiveness and preventing complications: A narrative review

Sinus augmentation has become an integrated surgical phase in posterior maxillary implant prosthesis reconstruction. Since the residual alveolar bony height usually requires additional volume particularly at this anatomical region, sinus floor augmentation is advocated routinely. Over the years, Implant success rate is proved to be comparable to the one in the pristine bone, which is well documented in the literature. Anatomical aspects as well as surgeon skills are at most importance to achieve predictable outcome. In this narrative review, the different osteotomy techniques, the indications toward 1 or 2-stage approaches, the control of the Schneiderian membrane integrity as well as the management of intra- and post-operative complications are thoroughly discussed according the current data. In light of the excellent long-term implant success rate concurrent with the application of contemporary advanced techniques of the sinus augmentation via the lateral wall osteotomy approach, reduce invasiveness and less complication occurrences are well documented. A well-codified patient selection involving the rhinologist as an integral medical team would be significantly beneficial toward early diagnosis. In-depth knowledge of the anatomy, execution of a well standardized surgical technique, and understanding the complication etiology and their management are prerequisites for reducing patient morbidity to minimal discomfort and predictable successful outcome.

A WNT protein therapeutic accelerates consolidation of a bone graft substitute in a pre-clinical sinus augmentation model

AIM

Autologous bone grafts consolidate faster than bone graft substitutes (BGSs) but resorb over time, which compromises implant support. We hypothesized that differences in consolidation rates affected the mechanical properties of grafts and implant stability, and tested whether a pro-osteogenic protein, liposomal WNT3A (L-WNT3A), could accelerate graft consolidation.

MATERIALS AND METHODS

A transgenic mouse model of sinus augmentation with immunohistochemistry, enzymatic assays, and histology were used to quantitatively evaluate the osteogenic properties of autografts and BGSs. Composite and finite element modelling compared changes in the mechanical properties of grafts during healing until consolidation, and secondary implant stability following remodelling activities. BGSs were combined with L-WNT3A and tested for its osteogenic potential.

RESULTS

Compared with autografts, BGSs were bioinert and lacked osteoprogenitor cells. While in autografted sinuses, new bone arose evenly from all living autograft particles, new bone around BGSs solely initiated at the sinus floor, from the internal maxillary periosteum. WNT treatment of BGSs resulted in significantly higher expression levels of pro-osteogenic proteins (Osterix, Collagen I, alkaline phosphatase) and lower levels of bone-resorbing activity (tartrate-resistant acid phosphatase activity); together, these features culminated in faster new bone formation, comparable to that of an autograft.

CONCLUSIONS

WNT-treated BGSs supported faster consolidation, and because BGSs typically resist resorption, their use may be superior to autografts for sinus augmentation.

Retrospective evaluation about morse taper versus external hexagon implants placed after maxillary sinus lift

BACKGROUND

The objective of this study was to retrospectively evaluate the success and survival rate of implants with different types of prosthetic connections inserted in the posterior maxilla in native bone or in sinuses previously grafted with different biomaterials.

METHODS

A total of 310 implants inserted in 113 patients were evaluated, 87 of which were inserted in association with grafted maxillary sinuses (56 morse taper (MT) implants and 31 external hexagon (EH) implants) in 37 patients, and 223 implants were inserted in native bone areas (112 MT and 111 EH implants) in 76 patients. Peri-implant clinical analyses were performed (bleeding on probing, probing depth, clinical insertion level, peri-implant marginal level, and the presence of mobility or suppuration), and the radiographic bone level was evaluated.

RESULTS

Two implants were lost, yielding a survival rate of 99.35 %. The MT implants had lower probing depths and peri-implant bone levels than the EH implants in both grafted areas and native bone areas (p <0.05). No statistically significant differences in any parameter evaluated were found between implants inserted in native bone and those inserted in grafting areas. EH implants inserted in native bone areas showed higher periimplantitis rates.

CONCLUSIONS

It can be concluded that the MT implants connection reduce periimplant bone loss, but implants inserted in maxillary sinuses previously grafted with osteoconductive biomaterials do not predispose patients to peri-implant bone loss.

Long-Term Comparison of Survival and Marginal Bone of Implants with and without Sinus Augmentation in Maxillary Molars within the Same Patients: A 5.8- to 22-Year Retrospective Study

Maxillary sinus floor augmentation (MSFA) is widely used and considered a predictable procedure for implant placement. However, the influence of MSFA on implant survival and marginal bone loss (MBL) is still inconclusive. The purpose of this retrospective observational study is to evaluate the long-term genuine influence of MSFA on the survival and MBL of implants by comparing those with and without MSFA only in maxillary molars within the same patients. Thirty-eight patients (28 male and 10 female), with a total of 119 implants, received implants with and without MSFA, and were followed up for 5.8 to 22 years. Patient- and implant-related factors were assessed with a frailty model for implant survival and with generalized estimation equations (GEE) for MBL around the implant. No variables showed a statistical significance for implant failure in the frailty model. In GEE analysis for MBL, MSFA did not show any statistical significance. In conclusion, MSFA demonstrated no significant influence on implant failure and MBL in posterior maxilla in this study.

The rehabilitation of posterior atrophic maxilla by using the graftless option of short implant versus conventional long implant with sinus graft: A systematic review and meta-analysis of randomized controlled clinical trial

Aim

The purpose of systematic review and meta-analysis was to compare the efficacy of short implant versus conventional long implant with sinus graft in patients rehabilitated for posterior atrophic maxilla.

Setting and Design

Systematic review and meta analysis.

Materials and Methods

Electronic searches were conducted in Pub Med, Embase, and Medline with supplemented by manual search up to December 2019. The randomized controlled trial (RCTs) comparing short implant (<8.5 mm) and long implant (>8.5 mm) with sinus graft were included. (Prospero CRD42020186972).

Statistical Analysis Used

Random-effect model, fixed-effect model, A funnel plot and the Egger's test.

Results

Twenty-two Randomized controlled trials (RCTs) were assessed with 667 patients and 1595 implants (short implant:767, Long implant:835). No significant difference of implant survival rate was recorded for short and long implant (at patient level: RR: 1.01, 95% CI = 0.52-2.0, P = 0.87, I2 = 0%, at implant level RR = 1.09, 95% CI = 0.6-2.0, P = 0.7, I2 = 0%). Similarly marginal bone resorption was reported no difference for short and long implant (MD = 0.16. 95% CI: -0.23 = -0.08, P = 0.00, I2 = 74.83%). Biological complications were marginally higher for long implant (RR = 0.48, 95% CI = 0.23-0.8, P = 0.13, I2 = 29.11%). and prosthetic complications were marginally higher for short implants (RR=1.56, 95% CI=0.85-3.15, P = 0.43, I2 = 0%).

Conclusion

There was no significance difference in implant survival rate and marginal bone resorption recorded for both the short implant and long implant with sinus graft, in the patients rehabilitated with posterior atrophic maxilla. Hence, short implant is a suitable alternative to long implant with sinus graft, for the rehabilitation posterior atrophic maxilla.

Dimensional changes following alveolar ridge preservation in the posterior area using bovine-derived xenografts and collagen membrane compared to spontaneous healing: a 6-month randomized controlled clinical trial

OBJECTIVES

To assess dimensional changes following alveolar ridge preservation using bovine-derived xenograft with 10% collagen and collagen membrane compared to ridge preservation by means of bovine-derived xenograft particles and collagen membrane or spontaneous healing in posterior sites.

MATERIALS AND METHODS

Forty subjects with 40 posterior teeth or roots candidate to extraction and presenting integrity of alveolar bone walls were randomly allocated into three groups. Patients of test group were treated by ridge preservation technique using bovine-derived xenograft with 10% collagen and collagen membrane; patients of control group 1 were treated by means of bovine-derived xenograft particles and collagen membrane while in patients of control group 2, no grafting was performed. Changes in vertical and horizontal bone dimensions were compared at baseline and after 6-month observation time.

RESULTS

Statistically significant differences between baseline and 6 month were observed in all groups in terms of vertical and horizontal bone resorption (p < 0.001), except for vertical resorption in control group 2. After 6-month intergroup comparisons showed not statistically significant changes between test and control groups in terms of alveolar bone changes (p > 0.05).

CONCLUSIONS

Within the limits of this study, the sites grafted using bovine-derived xenograft with 10% collagen in combination with a collagen membrane showed no statistical differences in terms of vertical and horizontal bone resorption compared to control groups.

CLINICAL RELEVANCE

Ridge preservation in posterior area failed to show clinically relevant benefits in sites presenting integrity of alveolar bone walls and adequate buccal bone wall thickness.

Computed tomography-aided descriptive analysis of maxillary and mandibular atrophies

INTRODUCTION

The aim of the present retrospective chart review was to analyze by Computed Tomography (CT) scan technique the degree of maxillomandibular atrophies, searching for differences between totally- and partially-edentulous subjects, and possibly identify and classify maxillomandibular atrophy staged patterns for implant planning in both totally- and partially- edentulous jaws.

MATERIAL AND METHODS

CT scans of 89 mandibles and 77 maxillae from 111 patients were classified according to six different patterns of residual ridge resorption and to two different groups of edentulism (totally- and partially-edentulous). Maxillomandibular absolute linear dimensions were calculated and results compared for statistically significant differences by Wilcoxon tests.

RESULTS

Maxillomandibular CT cross-section interpretation showed different patterns of linear bone remodelling (height values) between the two groups of edentulism joined with specific positions in the maxilla or mandible. The judgment of the investigator was uncertain in the analysis of the mandibular posterior areas with similar percentages for both totally- and partially-edentulous groups (12.5% and 11.5%, respectively).

DISCUSSION

The 3D analysis is self-explanatory and easy to apply, aided by CT scans. The measurements between the referring planes and inviolable anatomical structures (nasal floor NFD, lower border of mandible LBD, inferior alveolar nerve AND, and sinus floor SFD), showed that class III may not guarantee an optimal implant placement, especially in the totally-edentulous group, due to a major degree of pneumatisation.

Simultaneous and delayed direct sinus lift versus conventional implants: Retrospective study with 5-years minimum follow-up

Background

To compare the radiological parameters and success of posterior maxillary direct sinus lift with simultaneous or delayed implant placement, or implant placement in native bone, after a minimum follow-up period of 5 years.

Material and Methods

A retrospective cohort study was carried out in a university clinic, selecting patients subjected to implant treatment in the posterior maxilla between the years 2005 and 2011. The patients were divided into three groups: 1) implants placed in native bone; 2) direct sinus lift with simultaneous implant placement; and 3) direct sinus lift with delayed implant placement. Bone crest level, bone loss, vertical bone gain, and implant success and survival after a minimum follow-up period of 5 years after prosthetic loading were analyzed.

Results

A total of 163 patients and 329 implants were included in the study. The mean duration of follow-up was 7.0 ± 1.9 years. Bone loss and implant success and survival were very similar in all three groups, with no significant differences among them. Graft reabsorption was greatest during the first 12 months, though graft stabilization was confirmed after 5 years of follow-up.

Conclusions

Bone loss and percentage success and survival proved very similar for the implants placed in native bone and for sinus lift with simultaneous or delayed implant placement. The height of the graft material decreased mainly in the first 12 months, and continued until stabilization after 5 years, with no significant variations thereafter.

Key words:Sinus lift, pristine bone, native bone, dental implants, marginal bone loss, radiological study, implant survival, implant success.

The Influence of Prosthesis Design on the Outcomes of Tooth Implants Immediately Placed and Loaded by Means of One-Piece Titanium Machined Restoration

Our purpose was to evaluate the occurrence of complications and the degree of bone loss in a cohort of patients treated with fixed prostheses supported by immediately loaded dental implants. The primary aim was to compare partial versus full-arch fixed dental prostheses. We then tested the effect of sinus lifting. In the present retrospective cohort study, the patients had their implants restored with fixed dental prostheses supported by dental implants positioned in the posterior maxilla and mandible. When necessary, the maxillary sinuses were grafted with particulate autogenous bone. Patients were then ranked according to the following predictors: length of prosthesis, crown-to-implant ratio, number of crowns to number of implants ratio, and presence of sinus lifting. Outcomes were evaluated for up to 2 years regarding the peri-implant marginal bone loss and implant/prosthesis survival rates. Fifty-eight subjects (209 implants) were rehabilitated with 25 fixed full-arch prostheses and 33 partial fixed dental implant bridges (16 supported by implants placed in grafted sinus). The mean marginal bone loss for implants supporting partial fixed dental prostheses amounted to 0.81 mm, whereas that for implants within the group of full-arch fixed dental prostheses was 1.21 mm; the comparison of the levels in the 2 groups showed a significant difference ( P = .0055). A statistically significant difference ( P = .0006) was found between the bone loss around maxillary implants (1.53 mm) and the bone loss around mandibular implants (1.10 mm). Two implants and 4 prostheses failed; 2-year survival rates of partial and of full-arch fixed dental prostheses, respectively, were 94.1% and 96%. Bone loss in full-arch prostheses appeared to be higher than in that of partial prosthesis. Implant-supported prostheses in the maxillae exhibited a bone loss higher than that registered in mandibles.

Short implants to support mandibular complete dentures - photoelastic analysis

This study evaluated the stress behavior around short implants in edentulous atrophic mandibles. Six groups included implants with two diameters regular and wide (4 and 5 mm) and three lengths (5, 7 and 9 mm) as follows: Ci9 (9 x 4 mm), Ci7 (7 x 4 mm), Ci5 (5 x 4 mm), Wi9 (9 x 5 mm), Wi7 (7 x 5 mm) and Wi5 (5 x 5 mm). These groups were compared to the control group CG (11 x 4 mm). The analysis was performed with the photoelastic method (n = 6). Each model comprised 4 implants with the same length and diameter connected by a chromium-cobalt bar that simulates a fixed denture. A 0.15 kg force was applied at the end of the cantilever (15 mm), and the maximum shear stress was recorded around the distal and subsequent implants. The stress values were determined, and the quantitative data (Fringes®) were submitted to statistical analysis with one-way ANOVA and the Dunnett test (p < 0.05). It was observed that the reduction in implant length increased stress values with a significant difference (p < 0.05) between CG Ci7 and Ci5, while the increase in implant diameter reduced the stress values without any differences found between short and long implants. Implants with 5 and 7 mm with regular diameter increased stress levels while short implants with larger diameters experienced similar stress to that of longer implants.

Implantology and Periodontal Disease: The Panacea to Problem Solving?

INTRODUCTION

The specialty of periodontology has changed dramatically in recent years. With the long-standing goal of retaining teeth in a functional and esthetical state, the periodontology has developed a high level of expertise in the regeneration of bone and connective tissues that support the teeth. However, periodontists have also joined maxillofacial surgeons as the primary providers of implant surgery.

METHODS

The tremendous innovations of periodontists induced also by the marketplace resulted in predictable periodontal treatment outcomes for most patients by the implants led to a dramatically different marketplace in which many patients with periodontitis can be treated by the implants rather than the traditional periodontal treatment.

RESULTS

The aim of this article is to focus on the innovator's dilemma for periodontists today is that key elements of our rewarding contributions to dentistry in recent decades are unlikely to be part of a strong and rewarding future for the profession.

CONCLUSIONS

With the intriguing role of the personalized medicine approach that integrates genomic and clinical information to predict a possible predisposition, we do not suggest a reduced role for periodontists in dental implant surgery but rather a more prominent role in complex cases to achieve surgical implant needs and proper reconstruction and long-term maintenance of the patient's health.

Maxillary sinus grafting with fresh frozen allograft versus bovine bone mineral: A tomographic and histological study

We evaluated histologically and tomographically the effects of fresh frozen bone allograft (FFB) or bovine bone mineral (BBM) in maxillary sinus floor augmentations. In total, 30 maxillary sinuses from 30 patients (mean age = 51.17 ± 10.86 years) underwent sinus augmentation. Patients were divided in two test groups (15 sinuses each). The first group was grafted with allograft bone, and the second group received bovine bone mineral. After 6 months, bone samples from each group were collected for histological examination. Implant survival rates were 97.78% (FFB group) and 100% (BBM group) 6 months after functional loading. Median volumetric reductions of 31.2% (11.33-40.56) and 12.22% (9.91-20.59) were observed in the FFB and BBM groups, respectively. Comparisons between the groups for differences in initial and final volumes of bone (p = 0.015) and the rate of resorption (p = 0.009) showed statistically significant differences. The FFB group showed osteoblastic cells in close contact with osteoid matrix, connected through bridges between allograft bone particles and new bone formation. The BBM group showed BBM particles in close contact with new bone, with visible osteoid matrix bridges and osteoblastic cells surrounding it. None showed signs of acute or chronic inflammatory infiltrate. Despite better results with BBM, both FFB and BBM in maxillary sinus augmentation resulted in high percentages of new bone formation, and allowed implant placement with a low rate of failure of osseointegration at a 6-month follow-up.

Radiographic Evaluation of Crestal Bone Loss Around Dental Implants in Maxilla and Mandible: One Year Prospective Clinical Study

PURPOSE

The aim of the study was to analyze the amount of maxillary and mandibular crestal bone loss around Bredent Sky Blue type of implants of different dimensions one year after implantation.

MATERIALS AND METHODS

36 implants of diameter 3.5 x 10 mm were inserted in the maxilla and 12 in the mandible. 52 implants of diameter 4.0 x 8 mm were inserted in the maxilla, and 61 in the mandible (two-stage implant surgery).

RESULTS

No statistically significant differences were found between the right and left side of the maxilla and between the right and left side of the mandible at the implant sites regarding distal and mesial bone losses as shown by analysis of variance (ANOVA).

CONCLUSION

Statistically significant differences were found between anterior maxilla, posterior maxilla and anterior mandible and posterior mandible at implant sites regarding distal and mesial bone losses as shown by analysis of variance (ANOVA).

Fresh-frozen allografts combined with bovine bone mineral enhance bone formation in sinus augmentation

We evaluated histologically, histomorphometrically, and tomographically the effects of the association of fresh-frozen bone allograft (FFB) with bovine bone mineral (BBM) in maxillary sinus floor augmentation. In total, 34 maxillary sinuses from 29 patients, with a mean age of 51.32 (±6.44) years, underwent sinus augmentation. Patients were divided into control and test groups (17 sinuses each). The controls were grafted with allograft bone, and the test group received a combination of FFB and BBM at a 2:1 ratio. After 6 months, bone samples were collected for histological and histomorphometric examinations. The implant survival rates were 93.02% (control group) and 100% (test group) at 6 months after functional loading. Median volumetric reductions of 28.32% (17.05-44.05) and 12.62% (5.65-16.87) were observed for the control and test groups, respectively. Statistically significant histomorphometric differences were found between the control and test groups regarding newly formed bone 12.54% (10.50-13.33) vs. 24.42% (17.62-35.92), p < 0.001, total bone 48.34% (39.03-54.42) vs. 61.32% (50.61-64.96), p = 0.007, and connective tissue 51.66% (45.57-60.97) vs. 39.30% (35.03-49.37), p = 0.007. The addition of BBM to allograft bone in maxillary sinus augmentation resulted in higher percentages of new bone formation and total bone, and permitted implant placement with a low rate of osseointegration failure at the 6-month follow-up.

A 5-Year Implant Follow-Up in Maxillary and Mandibular Horizontal Osseous Onlay Grafts and Native Bone

The purpose of this study is to analyze marginal bone levels (MBLs) around dental implants positioned in the upper and lower jaw with or without horizontal onlay grafting procedures, and to survey implant survival with a follow-up of 5 years. Seventeen patients were surveyed in the present retrospective chart review. A total of 27 dental implants positioned in pristine bone and 21 in horizontally grafted bone were enrolled. MBLs were recorded for 4 aspects during a radiologic survey of 5 years. Significant differences were searched for among times and surgical procedures with paired and unpaired comparison tests, respectively, and survival rates were calculated for the 2 groups. In the maxilla, no statistically-significant differences between pristine and augmented groups were obtained; the time comparisons for pristine implants showed an affection of palatal, mesial, and distal sides, whereas the resorption around implants placed into horizontally grafted bone of anterior maxilla seemed to be limited just to buccal and distal aspects. Comparisons with the pristine horizontal procedure revealed that just the buccal sides were involved. The analysis of time comparisons attested to a continuous alveolar bone remodeling during the entire time of the survey for the pristine group. Given the extremely unfavorable resorption at the buccal aspect of the augmented areas, clinicians should reserve dental implant positioning into horizontal bone graft to selected patients, in whom it may represent one of the last opportunities of rehabilitation with a fixed prosthesis.