The influence of initial alveolar ridge defect morphology on the outcome of implants in augmented atrophic posterior mandible: an exploratory retrospective study.
OBJECTIVE
Clinicians commonly consider atrophic site topography as an important determinant in deciding the augmentation technique to utilize, as well as forecasting the likelihood of success. The purpose of this retrospective study was to examine the influence of initial atrophic posterior mandible morphology on the outcome of implants placed following augmentation.


METHODS
A total of 52 patients contributed 71 edentulous sites, and 185 implants were placed with mean follow-up of 37.97 months. The initial defect morphology was classified according to ABC classification (Journal of Oral Implantology, 37, 2013a and 361). Ridge augmentation was performed by "cortical autogenous tenting" (CAT) followed by either simultaneous or delayed implant placement after 4-6 months of healing. The European Academy of Osseointegration success criteria were used to evaluate implant outcomes.


RESULTS
The overall survival and success rates of dental implants were 98.91% and 80%, respectively. Cumulative success and survival rates in CAT group were 95% and 100% after 2 years of follow-up. The highest marginal bone loss (MBL) was observed (1.26 mm ± 0.99) around implants placed in augmented edentulous sites with initially narrow and flat alveolar crest (defect class CII). Conversely, least MBL (0.48 mm ± 0.78) was detected around implants placed into edentulous sites with two sloped boney walls (defect class AII). Differences between MBL observed around implants placed into initial defect class C, initial defect type and class A (I, II), as well as class BII, were statistically significant (P < 0.05). Among all implants, 148 were considered as successful, 26 exhibited satisfactory survival, nine with compromised survival, and two implants failed.


CONCLUSIONS
The present data confirmed the effect of initial ridge morphology on the outcome of implants placed into augmented bone. Specifically, class A and class B atrophic ridge defects, with one and two vertical boney walls, respectively, may be considered as more favorable recipient sites than class C defects with flat morphology. This conclusion is based on least MBL around implants placed into initial defect class A and class B augmented sites, and higher MBL in implants placed into class C recipient sites. A randomized controlled trial is warranted to examine these exploratory observations.
Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arash
A
Khojasteh
Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Saeed Reza
SR
Motamedian
Laboratory for Immunoregulation and Tissue Engineering, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.
Navid
N
Sharifzadeh
Laboratory for Immunoregulation and Tissue Engineering, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.
Homayoun H
HH
Zadeh
D016301:Alveolar Bone Loss / Q000473:pathology* / Q000601:surgery*; D000539:Alveolar Process / Q000473:pathology / Q000601:surgery*; D000540:Alveolar Ridge Augmentation; D001284:Atrophy; D003758:Dental Implantation, Endosseous; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
alveolar bone atrophy; alveolar ridge augmentation; anorganic bovine bone mineral; bone graft; dental implants