For which clinical indications in dental implantology is the use of bone substitute materials scientifically substantiated?

Purpose: The objective of this systematic review was to provide a basis for an expert consensus group to evaluate the influence of different particulate bone substitute materials in local bone augmentation procedures in conjunction with dental implant placement on implant survival and histology. Materials and methods: The following indications were analysed with either simultaneous or delayed dental implant placement: external or internal maxillary sinus floor elevation and vertical and/or lateral alveolar ridge augmentation. Retro- and prospective studies written in English or German including 20 or more patients (for randomised, controlled trials and prospective, split-mouth trials with 5 or more patients) were eligible for this review. The review focused on (1) performance of the augmentation procedures (total augmentation loss, gain of vertical and horizontal alveolar ridge dimensions, histomorphometric data of the augmented areas) and (2) dental implant success criteria (survival rates of the inserted dental implants, peri-implant bone levels under functional loading). Results: From over 3800 abstracts identified, 72 full-text articles fulfilled the inclusion criteria and were further evaluated (52 studies on maxillary sinus floor elevation procedures and 21 studies on vertical and/or lateral alveolar ridge augmentation). The majority of the included studies were prospective studies including a rather limited number of patients and short observation periods. Conclusions: There is a high level of evidence that survival rates of dental implants placed into augmented areas are comparable with survival rates of implants placed into pristine bone. For maxillary sinus floor elevation, all investigated bone substitute materials performed equally well compared with bone, with high dental implant survival rates and adequate histomorphometric data. For the alveolar ridge augmentation procedures, the heterogeneity of the available data did not allow identification of a superior grafting technique. Parole chiave: alveolar ridge augmentation, bone grafting, bone substitute material, dental implants, sinus floor elevation