Single implants and buccal bone grafts in the anterior maxilla: Measurements of buccal crestal contours in a 6-year prospective clinical study

Background: Patients provided with buccal bone grafts seem to lose a substantial part of the graft in the short term. Purpose: To measure long-term changes in buccal and proximal tissue volumes after local bone grafting and single implant treatment. Materials and Methods: Eight of 10 originally treated male patients were followed up for 6 years after treatment with buccal bone grafts in the central incisor region. After a healing time of 6 months, a two-stage implant surgery procedure was performed followed by single crown placement. Clinical photographs and impressions were taken prior to the surgical interventions and after crown placement and at first and fifth annual checkups. The photographs were analyzed with regard to papilla regeneration by means of a clinical papilla index. The models were used to measure the clinical length of teeth and tooth movements adjacent to the implants. Changes in buccal crest volume during the study period were measured by means of optical scanning of obtained study models. Results: Papillae volume increased significantly (p <.05) during the first year, thereafter showing a slow further increase during the 4 following years. Three of the patients (38%) presented small movements of their adjacent central incisor in a vertical or palatal direction of less than I mm during the follow-up period. All patients showed resorption during the first year after grafting (p <.01), in which three patients (38%) had lost basically all of increased volume at second surgery. After abutment or crown placement, all patients showed an increased volume (p <.01), followed by an average reduction during the first year, reaching a significant level in the apical part of the crest (p <.05). Thereafter, a relatively stable average situation was observed during the following 4 years, with individual variations, however. Conclusion: Local bone grafting seems to create sufficient bone volume for implant placement after 6 months, but individual variations in resorption pattern make the grafting procedure unpredictable for long-term prognosis. Instead, the abutment and the crown seem to play a more important role for building up and maintaining the buccal contour in the coronal part of the crest long term.