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

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.