A retrospective analysis of grafting and adjunctive procedures performed to facilitate dental implant therapy in private practice
AffiliationMelbourne Dental School
Document TypeMasters Research thesis
Access StatusOpen Access
© 2016 Mehrnoosh Dastaran
Purpose: To retrospectively describe and analyse, with reference to the published literature, the augmentation profiles and any associated complications of grafting for dental implants that were placed and/or restored in private practice in the state of Victoria, Australia. Materials and Methods: Specialist and general dentists, and oral and maxillofacial surgeons who were placing and/or restoring implants during the period January 2005 to December 2009 were invited to participate in the study. Data were extracted by trained and calibrated research assistants from anonymised patient histories. Information was collected on augmentation techniques of onlay and particulate grafting, open and closed sinus lifting, socket preservation and soft tissue procedures. Complications were categorised as surgical (technical): neuro-sensory disturbance, pain, bleeding, swelling, bone perforation, insufficient bone quantity or quality or inadequate primary stability; and biological: Infection, bone loss, failure to osseointegrate, loss of integration, and peri-implantitis. Cross tabulation was carried out in IBM SPSSTM to provide statistics on frequency, timing of procedures, materials and complications. Uni- and multi-variate analysis was performed to assess independent risk factors of augmentation complications using GenStat®. Complications at implants sites that were augmented were compared to the sites that were not augmented. Results: During the period January 2005 to December 2009, 8486 implants were placed in 4116 patients. Nearly one third (26.9%) underwent at least one augmentation procedure either before or at the same time as placement. Particulate grafting was the most common hard-tissue procedure (21.4% of implants) and 63.1% of these were simultaneous, single-stage implants. In 35.9% of grafts, barrier membranes were used. 5.5% of implants had a soft tissue procedure recorded. The most popular materials overall were Bio-Oss® (Geistlich Biomaterials: Pharma North America Inc.) and autogenous bone. 92.9% of onlay grafts and 83.7% of open sinus lifts had a healing period before implant placement (mean overall healing period 6.7 months). The anterior maxilla was the most common site for all augmentation procedures. There was a significant difference in the overall complication rate between the augmented implant sites and the sites that were not augmented (17.3% versus 12.6%; p=<0.001). The hard tissue augmented group had significantly more cases of insufficient bone and/or more dehiscences (2.10% v 0.58%; p<0.001) and bone loss (0.61% v 0.19%; p=0.0014) at implant placement than the non-augmented group. In these cases, implants were placed and grafted simultaneously (p<0.05) with particulate autogenous bone and/or Bio-Oss (p<0.05) in combination with resorbable xenograft membrane (p<0.001). There was significantly more bone loss in open sinus lifted cases than in cases where implants were placed in native bone (1.90% v 0.30%; p=-0.009). Other factors such as augmentation technique or material used, healing period length or timing of implant placement, were not found to significantly contribute to the complications, on multi-variate analysis. Conclusions: Augmentation procedures were required for nearly one third of implants placed, highlighting their importance in routine dental implant treatment and potential for complications to influence implant outcomes. The study demonstrated no relationship between graft complication and any specific augmentation technique or material. This suggested that routine grafting procedures used in private practice were safe and appropriate despite a recent drive to avoid augmentation by using angulated, narrow or wide implants, in addition to zygomatic implants, as alternatives, when native bone might be lacking. A small (5%) but statistically significant increase in complication rate in the augmentation group did not preclude implant placement or aberrantly affect implant outcome in the short-term. Whilst there are no guidelines with respect to the best materials to use for augmentation, the use of membrane, healing periods, and timing of procedures, this study demonstrated practices and complication rates largely in keeping with the published literature.
KeywordsImplantology; bone graft; augmentation; complications
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