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Issue No. 132
Summarised from Journal of Clinical Periodontology, Volume 51, Issue 12, December 2024, 1656-1664

Editor: Andreas Stavropoulos, chair, EFP scientific affairs committee

What are the 10-year outcomes of dental implants in narrow alveolar ridges?

Authors: M. Alami, N. Ntovas, G. Penne, W. Teughels, M. Quirynen, A. Castro, A. Temmerman

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Background

In terms of bone resorption after dental extraction, the buccal plate tends to experience greater loss compared to the lingual/palatal plate, with horizontal dimensional changes being more prominent.

It is recommended that a minimum buccal bone thickness of 1–2mm should be maintained to safeguard the buccal plate and provide adequate soft-tissue support around dental implants. When the alveolar ridge dimensions are insufficient, bone-augmentation procedures are often needed to achieve successful implant-supported rehabilitation. However, these procedures require advanced surgical expertise and are linked to higher morbidity, extended treatment duration, and increased costs.

Avoiding augmentation procedures may help in minimizing post-operative complications, lowering treatment expenses, and facilitating patient recovery. Moreover, patients generally tend to favour minimally invasive approaches. Provided there is long-term dimensional stability of thin buccal plates, the need for augmentation may be superfluous, thereby simplifying the overall treatment process.

Aim

This study aimed to evaluate 10-year outcomes of implants placed in ridges with limited bucco-oral width (≤4.5mm) without bone augmentation. Radiological interproximal bone changes, cumulative survival rates, and clinical parameters were assessed to determine the long-term stability and success of this simplified treatment approach.

Materials and methods

This prospective case series was carried out at KU Leuven, Belgium, involving 28 patients who received a total of 100 implants between 2009 and 2010.

Inclusion criteria for eligibility consisted of:
- Patients 18 years old or older.
- Implant sites with a bucco-oral width of ≤4.5mm, confirmed by using CBCT.
- Patients who prioritize function over aesthetics.
Exclusion criteria were the absolute contraindications for implant therapy.
Prior to placement, alveolar ridge width was assessed by using CBCT or multi-slice CT cross-sectional images.
Measurements were taken at the crest and at 2mm sections up to 12mm below the crest.
All implant sites presented with buccal bone thickness of <1mm after implant placement.
Intra-oral radiographs were taken at the time of implant placement, functional loading, and follow-up intervals of one, two, three, five, and 10 years.
Marginal bone-level changes were measured by assessing the distance between the implant shoulder and the first visible bone-to-implant contact both mesially and distally.
Thread pitch distance and total implant lengths were also recorded.
Full-mouth periodontal charting was performed, which included: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), bleeding on probing (BoP), suppuration on probing (SoP), probing pocket depth (PPD), keratinized tissue width (KTW), mucosal attachment type, presence of peri-mucositis and peri-implantitis.
Radiographic data were analysed in terms of mean, standard deviation, median, and range.
Measurements were compared across different time points for mesial, distal, and combined sites.

Table with figures — TABLE: Analysis of annual marginal bone-level changes.

Results

The study included 28 patients (three males, 25 females) with an average age of 63.4 years (range: 42–76 years).
A total of 100 implants were placed in 13 males and 87 females. One patient acquired diabetes, and two patients had a history of radiotherapy outside the head-and-neck region.
Eighty-eight implants were in the upper jaw, while 12 implants were placed in the lower jaw, mostly localized at the second incisor and second premolar area.
All the implants were 3.5mm in diameter, with the majority of 13mm (45%) or 11mm in length (33%) (Range: 8-15mm).
At the final 10-year follow-up, 21 patients with 75 implants without any failures, were evaluated.
FMPS below 20% was found in 6% of the patients. In 22% of the patients, FMPS was between 20% and 50%, while 7% had FMPS exceeding 50%.
Regarding FMBS, 11% of the patients had scores below 20%, 22% between 20% and 50%, and 72% above 50%.
Implant sites with keratinized but non-attached tissues were more prone to higher BoP values and peri-mucositis presence compared to sites with attached keratinized tissues.
The overall mean marginal bone loss during the first year of functional loading was found to be 0.2mm ± 0.36. Bone loss measured as 0.18mm, 0.23mm, 0.33mm, and 1.04mm at two, three, five, and 10 years after functional loading, respectively.

Bar chart — FIGURE: Bleeding on probing and peri-mucositis by tissue type.

Limitations

These successful long-term outcomes, obtained after 10 years of implant placement in narrow bone ridges, may somehow be attributed to the meticulous surgical care, skills, and experience of the surgeon.
A specific set of burs and a single implant system were used, which does not allow generalization of the results.
Information on the fate of the buccal bone in these cases is missing.
Understanding patient perception is essential for the evaluation of the treatment outcomes and therefore, patient-reported outcomes would have been supporting to the long-term follow-up results.

Conclusions & impact

This 10-year follow-up study demonstrates that oral implants placed in alveolar ridges with limited bucco-oral dimensions (≤4.5mm) achieve successful long-term results with minimal marginal bone loss, revealing a 100% implant survival rate. The findings suggest that meticulous surgical implant placement in narrow ridges without augmentation can be a viable treatment option, particularly in non-aesthetic areas, offering a simplified and cost-effective approach.

This study is valuable as it presents successful 10-year results of implants placed in narrow ridges without augmentation and introduces a classification of peri-implant soft tissues based on keratinization and attachment type. It challenges traditional augmentation needs through a simplified treatment, with reduced costs and patient morbidity.

Rapporteurs: Serra Özdenak and Berfin Sarı, supervised by Professor Bahar Kuru and Associate Professor Ebru Özkan Karaca.

Affiliation: Postgraduate programme in periodontology, Yeditepe University, Istanbul, Turkey.