title: A randomized controlled clinical trial comparing small buccal dehiscence defects around dental implants treated with guided bone regeneration or left for spontaneous healing.
abstract: OBJECTIVE
  The aim of the present randomized controlled clinical study was to test whether small bony dehiscence defects (≤5 mm) left to heal spontaneously result in the same clinical and radiological outcome as defects treated with guided bone regeneration (GBR).
  
  
  METHODS
  Twenty-two patients who received at least one implant with a small bony dehiscence defect were enrolled in the study. If the defect height was ≤5 mm, the site was randomly assigned to either the spontaneous healing (SH) group or the GBR group. In the SH group, the defect was left without any treatment. In the GBR group, the defects around the implants were grafted with deproteinized bovine bone mineral (DBBM) and covered with a native collagen membrane. Clinical and radiographic measurements were performed 6 months after implant placement with a reentry surgery and at the time of crown insertion and the subsequent follow-up appointments at 3, 6, 12 and 18 months after loading. For statistical analyses, the mixed linear model was applied for the clinical and radiographic measurements observed around the implants. Simple comparisons of the location of the measurements in the two independent groups are performed with the Mann-Whitney U-test. In addition, the mixed model assumptions were checked.
  
  
  RESULTS
  The implant and crown survival rate 18 months after loading was 100%, revealing no serious biologic or prosthetic complication. The mean changes of the buccal vertical bone height between implant placement and reentry surgery after 6 months revealed a small bone loss of -0.17 ± 1.79 mm (minimum -4 mm and maximum 2.5 mm) for the SH group and a bone gain of 1.79 ± 2.24 mm (minimum of -2.5 mm and maximum of 5 mm) for the GBR group, respectively (P = 0.017). Radiographic measurements demonstrated a slight bone loss of -0.39 ± 0.49 mm for the SH group and a stable bone level of 0.02 ± 0.48 mm for GBR group after 18 months. All peri-implant soft tissue parameters revealed healthy tissues with no difference between the two groups.
  
  
  CONCLUSIONS
  Small bony dehiscence defects left for spontaneous healing demonstrated high implant survival rates with healthy and stable soft tissues. However, they revealed more vertical bone loss at the buccal aspect 6 months after implant insertion and also more marginal bone loss between crown insertion and 18 months after loading compared to sites treated with GBR.
authors.affiliation: Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Jung
authors.affiliation: Private Practice, Affoltern a.A., Switzerland.
authors.forename: Milan
authors.initials: M
authors.lastname: Herzog
authors.affiliation: Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Wolleb
authors.affiliation: Private Practice, Zürich, Switzerland.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Ramel
authors.affiliation: Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Thoma
authors.affiliation: Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
authors.forename: Christoph H F
authors.initials: CH
authors.lastname: Hämmerle
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss; D000818:Animals; D001861:Bone Regeneration / Q000502:physiology*; D018786:Bone Substitutes / Q000627:therapeutic use; D002417:Cattle; D015921:Dental Implants; D005260:Female; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D008297:Male; D008875:Middle Aged; D013529:Surgical Wound Dehiscence / Q000503:physiopathology*; D014945:Wound Healing / Q000502:physiology*
chemical_list: D018786:Bone Substitutes; D015921:Dental Implants
keywords: 
  RCT
  ; bone substitute; dental implant; graft material; guided bone regeneration; healing; membranes