Implantological indications for the use of bone replacement materials (german guideline, dental)

The atrophy of the jaws can have several causes. These include tooth loss, periodontitis and natural resorption due to the aging of the patient. The consequence of the atrophy is a reduced supply of hard and soft tissue. The number, dimension and position of the implants must be selected in such a way that that from a static point of view the load transfer from the planned implant-retained restoration in the relevant section of the jaw is secured and overloading of the implants is avoided. For this purpose, a sufficient bone and soft tissue supply must be available as the basis for high long-term success rate of implants. In cases where the existing tissue is not sufficient, the volume must be increased by augmentation measures. The emergence of shortened and diameter-reduced implants and their scientific establishment can reduce the need for augmentation in many cases. However, even for these implants, there must be sufficient bone available and the special indications of these implants must be observed. The bone volume required in the individual case lies in the responsibility of the practitioner.

Due to the effort to avoid the second operation for obtaining autologous bone grafts for implantological purposes, the interest in bone replacement materials in the past few years has risen steadily.

There are a large number of products on the market, but for many of these products clinical studies and preclinical studies in clinically representative large animal models with adequate histological characterization of the tissue reaction are missing.

Ridge preservation
As far as can be seen, all materials show a better alveolar ridge preservation compared to untreated alveoli. A large part of the literature focuses on xenogenic and allogenic material. In case of defects of the alveolar walls, a barrier membrane should be used to further reduce the resorption of the alveolar ridge.Dehiscence defects on implants
According to current knowledge, all available synthetic, xenogenic and allogenic materials are suitable as replacement materials. When using particulate material, the use of a barrier membrane is indicated.

Sinus floor augmentation
According to the current state of knowledge, all available xenogenic, synthetic and allogenic bone replacement materials are suitable for augmentation of the maxillary sinus in addition to autogenous bone respectively bone compositions. The additional harvesting of autologous bone in the surgical site can be recommended.

Horizontal and vertical defects of the alveolar ridge – complex deficits and defects
1. a combination of particulate material and membrane can be used for complex defects up to 3 mm
2. for complex defects, implantation should be secondary (two-stage procedure).

Bone replacement with particulate material
Bone replacement with autologous blocks
Alveolar ridge augmentation with allogenic, xenogenic and alloplastic blocks

1. xenogenic and alloplastic block grafts are inferior to autogenous bone block
2. the long-term prognosis of allogeneic block grafts is not documented in the literature.

Statements to special surgical techniques:
– shell methods
– sandwich osteotomy
– vertical distraction
– revascularized transplants

Deutsche Gesellschaft für Implantologie im Zahn-, Mund- und Kieferbereich (DGI)
Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK)
AWMF register number: 083-009, Valid until: June 2025 (German original)
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