Implants Healing Sequence in Grafted Bone: Clinical Evaluation

Objective: To understand the sequence of bone graft healing, the role of graft on implant-bone integration and the influence of early loading on both tissues.

Methods: 58 implants were placed in atrophic alveolar ridges; residual bone defects were corrected with particle bone graft stabilized by titanium mesh. After 2 months a second surgical access was made to evaluate bone graft incorporation and implant stability by using Resonance Frequency Analysis. Implants were loaded as soon as their stability reached 57ISQ.

Results: 3 of 58 implants were lost during 1,5 year follow-up. In 68,3% of the sample a complete filling of alveolar ridge defect was observed. Average primary stability was 53,46ISQ. Average stability values (ASV) increment was higher during the first 2 months (ASV 61,25ISQ) and raised until the fourth month (ASV 65,35ISQ), during the first prosthetic-loading period. 84.63% of the fixtures reached the 57ISQ threshold value after 2 months. When the graft was not full incorporated, implant stability increased more slowly and was more influenced by prosthesization.

Conclusions: 2 months seems to be enough time to guarantee bone graft incorporation; bone graft seems to increase implant stability especially in the first healing period, allowing early loading. Early prosthethic-loading does not appear to jeopardize bone grafts healing, but to slightly augment ISQ values.