The International Journal of Periodontics & Restorative Dentistry

COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO, INC.PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.NO PART OF THIS ARTICLE MAY BERE-
PRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
 109
PRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO, INC.PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.NO PART OF THIS ARTICLE MAY BERE-

Long-Term Stability of Osseointegrated

Implants in Augmented Bone:
A 5-Year Prospective Study in
Partially Edentulous Patients

Daniel Buser, DMD, Prof Dr Med Dent* Implant therapy based on the prin-
Sigurgísli Ingimarsson, DMD, Dr Med Dent** ciple of osseointegration has seen a
Karl Dula, DMD, Dr Med Dent*** remarkable expansion of its appli-
Adrian Lussi, DMD, Prof Dr Med Dent**** cation in dentistry in recent years.
Hans Peter Hirt, DMD, Dr Med Dent***** This development is due to several
Urs C. Belser, DMD, Prof Dr Med Dent******
factors, including a much better
acceptance for implant therapy by
This prospective clinical study evaluated the 5-year survival and success rates of
66 titanium implants placed in bone that had been previously augmented with patients, the increasing number of
autografts and nonresorbable barrier membranes. During the observation period, clinicians receiving education in the
three patients with five implants dropped out of the study. None of the remaining surgical and prosthetic aspects of
61 implants were lost during the follow-up period (implant survival rate of 100%). implant therapy during undergradu-
One implant exhibited a periimplant infection, whereas 60 implants were consid- ate and/or postgraduate training or
ered clinically successful at the 5-year examination, resulting in a 5-year success in continuing education courses, and
rate of 98.3%. It can be concluded that the clinical results of implants in regener- the significant progress made with
ated bone are comparable to those of implants in nonregenerated bone. bone augmentation procedures to
(Int J Periodontics Restorative Dent 2002;22:108–117.) successfully handle compromised
patients with localized bone defi-
******Professor and Chairman, Department of Oral Surgery and Stomatology,
ciencies in potential implant sites of
School of Dental Medicine, University of Berne, Switzerland.
******Postgraduate Student and ITI Scholar, Department of Oral Surgery and the alveolar process.
Stomatology, School of Dental Medicine, University of Berne, Switzerland. One of these surgical tech-
******Assistant Professor and Head, Service of Dental Radiology, Department niques is guided bone regeneration
of Oral Surgery and Stomatology, School of Dental Medicine, University
of Berne, Switzerland.
(GBR) using barrier membranes. The
******Associate Professor and Head, Division of Pediatric Dentistry, development of the GBR technique
Department of Operative Dentistry, School of Dental Medicine, University started in the late 1980s with a series
of Berne, Switzerland.
of experimental studies.1–4 Parallel to
******Instructor, Department of Oral Surgery and Stomatology, School of
Dental Medicine, University of Berne, Switzerland. experimental studies, clinicians
******Professor and Chairman, Department of Fixed Prosthodontics and around the world started to use bar-
Occlusion, School of Dental Medicine, University of Geneva, Switzerland. rier membranes in implant patients
for various clinical indications.5–8
******Reprint requests: Dr Daniel Buser, Department of Oral Surgery and
Stomatology, PO Box 56, Freiburgstrasse 7, CH-3010 Berne, One of the scientifically well-
Switzerland. e-mail: daniel.buser@zmk.unibe.ch documented surgical procedures of

Volume 22, Number 2, 2002

110
the GBR technique is horizontal
ridge augmentation using a staged
approach.9 This surgical procedure
has been systematically examined
in patients in the past 12 years.10
During the development period
between 1988 and 1991, the surgi-
cal technique was optimized step by
step to achieve a successful treat-
ment outcome in patients with a nar-
row alveolar crest.8,11,12 This early
phase clearly demonstrated that the
combination of autogenous block
grafts and expanded polytetrafluo-
roethylene (e-PTFE) membranes
(GoreTex, 3i/WL Gore) could be suc-
cessfully used for horizontal ridge
augmentation in partially edentu-
lous patients. This initial phase was
followed by a validation period to
assess the efficacy and predictability
of this new surgical technique. A clin-
ical study with 40 consecutively
treated partially edentulous patients
achieved horizontal ridge augmen-
tation in all 66 potential implant sites
with a mean gain of 3.5 mm of crest
width, allowing the placement of 66
titanium implants with a titanium
plasma-sprayed (TPS) surface (ITI
Dental Implant System, Straumann)
6 to 9 months following ridge aug-
mentation.13 This technique offers
high efficacy and predictability for
horizontal ridge augmentation in
partially edentulous patients.
The last remaining questions in
the scientific documentation of this
new augmentation technique are (1)
whether augmented bone will sus-
tain the functional load through
prosthetically restored endosseous
implants, and (2) what long-term sur-
vival and success rates implants
The International Journal of Periodontics & Restorative Dentistry
would have in augmented bone. To
answer these two questions, it was
decided to prospectively follow
these 66 implants clinically and radi-
ographically to evaluate their 5-year
survival and success rates.
Method and materials
Between 1992 and 1999, a group of
40 partially edentulous patients (26
women and 14 men) were prospec-
tively followed up to 5 years. These
patients all underwent horizontal
ridge augmentation with autografts
and barrier membranes 6 to 9
months prior to implant placement,
as reported in a previous publica-
tion.13
After completion of implant
restoration with either single crowns
or fixed partial dentures, the pa-
tients were enrolled in a mainte-
nance care program. Over a 5-year
period, they were recalled and
examined at annual intervals using
a standard protocol. This protocol
has been routinely used for prospec-
tive long-term studies of nonsub-
merged ITI implants in nonregen-
erated bone. 14,15 The following
clinical and radiographic parame-
ters were assessed for each implant:
• Modified plaque index (mPLI) at
four aspects around the im-
plants.16 For each implant, one
mPLI value was calculated based
on the mean of the four obtained
values.
• Modified sulcus bleeding index
(mSBI) at four aspects around the
implants.16 For each implant, one
mSBI value was calculated based
on the mean of the four obtained
values.
• Probing depth (PD) at four as-
pects around the implants. For
each implant, one PD value was
calculated based on the mean
of the four obtained values.
• The distance between the im-
plant shoulder and the mucosal
margin (DIM) at four aspects
around the implants.14 A sub-
mucosal implant shoulder was
recorded with a negative DIM
value.
• Clinical attachment level (AL) at
four aspects around the implants
(AL = PD + DIM).14
• The distance between the im-
plant shoulder and the first visi-
ble bone-implant contact (DIB)
was measured at the mesial and
distal aspects of each implant
using periapical radiographs with
the long-cone technique.15,17 All
radiographs were examined by
the same examiner. For each
implant, one DIB value was cal-
culated based on the mean of
the mesial and distal values. The
5-year DIB values were com-
pared with the 1-year DIB values
to evaluate the crestal bone
changes around the implants
over the 4-year period between
both examinations (
DIB5y – 1y).
The data were analyzed using
the paired t test. The significance
level chosen in all statistical tests was
.05. Based on clinical and radi-
ographic findings, each implant was
classified as either successful or non-
successful using the same success

Table 1 Clinical parameters (mean ± standard deviation) of 61 examined implants
Exam mPLI
1y 0.27 ± 0.38
5y 0.25 ± 0.29
mPLI = modified Plaque Index; mSBI = modified sulcus bleeding index; PD = probing depth; DIM = distance from implant shoulder to mucosal margin; AL =
clinical attachment level.
Bars = significant difference between values at P ≤ .05.
criteria as in previous prospective
studies of implants in nonregener-
ated bone14:
1. Absence of persistent subjective
complaints, such as pain, foreign
body sensation, and/or dyses-
thesia
2. Absence of periimplant infection
with suppuration
3. Absence of mobility
4. Absence of continuous radiolu-
cency around the implant
Results
During the 5-year observation
period, three patients with five
implants dropped out of the study,
resulting in a dropout rate of 7.6%.
At the 5-year examination, one
implant demonstrated a periimplant
infection with suppuration and did
not meet the success criteria. This
implant, which was ankylotically sta-
ble during the 5-year study period,
also showed extensive bone loss in
the crestal region radiographically.
The remaining 60 implants exhib-
ited clinically healthy periimplant soft
tissues without signs of periimplant
infection with exudation. All implants
maintained their ankylotic stability
throughout the study period. The
mSBI PD (mm)
0.42 ± 0.44 3.64 ± 1.04
0.25 ± 0.43 4.43 ± 1.24
Table 2 DIB values (mm) of 61 examined implants
Exam Minimum
1y 1.47
5y 1.78

DIB5y – 1y
DIB = distance from implant shoulder to first bone-implant contact.
clinical parameters at the 1- and 5-
year examinations are summarized in
Table 1. The mean values for the
mPLI and mSBI were below 0.5 and
did not differ significantly between
both examinations. The mean PD at
the 5-year examination was 4.43 mm
and demonstrated a significant
increase when compared with the
1-year examination (3.64 mm). The
DIM values were stable, exhibiting a
mean value around –1 mm that cor-
responded with a slightly subgingi-
val location of the implant shoulder.
The AL values ranged mainly
between 2 and 6 mm, resulting in a
mean AL of 3.29 mm at the 5-year
examination. As already mentioned,
all implants, including the implant
with a periimplant infection, main-
tained their ankylotic stability dur-
ing the study period.
During the 5-year period, none
of the 61 implants developed a
111
DIM (mm) AL (mm)
–1.14 ± 1.34 2.49 ± 0.99
–1.11 ± 1.27 3.29 ± 0.37
Standard
Maximum Mean deviation
4.25 2.83 0.61
6.00 2.95 0.87
+0.12 0.57
continuous periimplant radiolucency.
Mean DIB values at the 1- and 5-
year examinations were 2.83 mm
and 2.95 mm, respectively (Table 2).
Direct comparison of the 1- and 5-
year DIB values showed a mean
bone loss of 0.12 mm between both
examinations. To further evaluate the
changes at the bone crest level, a
frequency analysis of the
DIB5y – 1y
of 61 implants was performed (Fig
1). This analysis revealed that 55 of
the 61 implants had stable bone
crest levels (Figs 2 and 3), since the

DIB5y – 1y ranged between –0.8 mm
and +0.8 mm, which corresponds
with less than +0.2 mm bone loss or
gain per year. One implant showed
a bone gain exceeding 0.8 mm
between the two examinations,
whereas five implants lost more than
0.8 mm of bone. This group of five
implants included the implant with
the periimplant infection, as well as
Volume 22, Number 2, 2002
112

Fig 1 For 55 of 61 implants, the frequency analysis of
DIB5y – 1y

demonstrates stable bone crest levels. One implant showed some
bone gain, whereas five implants had lost some crestal bone dur-
0.81 5 ing the observation period. Clinically, 60 of 61 implants fulfilled the

Bone loss
success criteria at the 5-year examination.
DIB 5y – 1y (mm)

0.41/0.80 5

0.00/0.40 21

–0.01/–0.40 24

Bone gain
–0.8/–0.41 5

–0.81 1
0 20 40
No. of implants

Fig 2a Edentulous space in the premolar
region of the left maxilla. The buccal atro-
phy and an intraalveolar bone defect do
not allow the placement of implants.
Fig 2b To augment the ridge, a rather
small block graft is harvested in the chin and
applied with a fixation screw in an appropri-
ate position. The surrounding spaces are
filled with autogenous bone chips.
Fig 2c An e-PTFE membrane is then
applied to act as a barrier during the heal-
ing period of 6 months. Tension-free pri-
mary soft tissue closure is obtained.

Fig 2d At reopening an excellent treat-
ment outcome is found, allowing the
placement of two ITI implants with good
stability in appropriate positions from a
prosthetic point of view.
Fig 2e One-year radiograph demon- Fig 2f Five-year radiograph shows stable
strates normal periimplant bone structures bone crest levels for both implants.
around both implants and no signs of peri-
implant radiolucencies.

The International Journal of Periodontics & Restorative Dentistry

 113

two implants in one patient for

whom a revision was necessary after
3 years of function. These two im-
plants showed an increased bone
loss, although no periimplant infec-
tion was noted during the follow-up
period (Figs 4a and 4b). The open-
flap revision demonstrated that the
buccal block graft was insufficiently
remodeled and revascularized (Fig
4c). Therefore, the avascular coro-
nal remnant of the autograft was
shortened (Fig 4d) to achieve an
even and bleeding bone surface
around the implant, and the flap was
closed in a more apical position. The
5-year examination showed clinically
healthy periimplant soft tissues for Fig 3a Distal extension situation in the Fig 3b Clinical situation 6 months follow-
both implants and a stable crest level left mandible. The narrow alveolar crest of ing horizontal ridge augmentation with two
less than 4 mm does not allow the place- block grafts, bone chips, and coverage
at a clearly reduced bone height ment of dental implants. with an e-PTFE membrane. The new crest
(Figs 4e and 4f). measures more than 8 mm, allowing the
placement of three ITI implants.

Discussion

This prospective clinical study pre-

sents detailed clinical and radi-
ographic 5-year data of 61 implants
in bone that had been previously
augmented with autogenous block
grafts and nonresorbable barrier
membranes. Overall, the clinical and
radiographic 5-year results obtained
compare well with published 5-
year data from various studies with
Fig 3c One-year radiograph demon- Fig 3d Five-year radiograph shows sta-
nonsubmerged ITI implants with a
strates normal periimplant bone structures ble bone crest levels for all implants and
TPS surface in nonregenerated around all three implants. no apparent bone loss.
bone.18–20 The mean mPLI and mSBI
values were remarkably low, indicat-
ing excellent home care by the
patients and healthy periimplant soft
tissues. The mean PD and AL values
at 5 years—4.43 mm and 3.29 mm,
respectively—compare well with

Volume 22, Number 2, 2002

114
Fig 4a Two implants 1 year following
placement into augmented bone. The radi-
ograph shows the first signs of an osteolytic
process around and between both implants.
Fig 4d Surgical revision includes shorten-
ing of the buccal remnant of the block graft
until a bleeding bone surface is achieved,
smoothing of the TPS implant surface, and
apical repositioning of the flap.
those reported in the already men-
tioned 5-year studies. In any case, a
direct comparison of different stud-
ies has to be done with caution,
since differences in periodontal
probe selection and probe pressure
certainly influence the results of
probing around implants. In the pre-
sent study, some implants showed
increased probing depths exceeding
5 mm. These were primarily found at
approximal aspects of implants in
esthetic sites, where the implants
were intentionally placed deeper
The International Journal of Periodontics & Restorative Dentistry
Fig 4b At 3 years, prior to surgical revi-
sion, the bone loss has progressed,
although both implants never showed any
signs of a periimplant infection.
Fig 4e At the 5-year examination, the
clinical status demonstrates a healthy peri-
implant mucosa, although the distal
implant has a significant recession of the
soft tissues.
into the hard and soft tissues of the
alveolar crest than in standard sites,
mainly for esthetic reasons. This
technique of submerged implant
placement has become routine for
ITI implants in esthetic sites in the
past 7 years. 21 However, these
implants demonstrated clinically
healthy periimplant soft tissues with-
out signs of periimplant pathology.
All implants exhibited clinical stabil-
ity reflecting functional ankylosis.
The radiographic 5-year exami-
nation showed stable bone crest
Fig 4c After flap elevation, an avascular
remnant of the block graft is present on the
buccal aspect. In addition, approximately 3
mm of bone loss is noted around both
implants.
Fig 4f Five-year radiograph shows a sta-
bilization of the bone crest at a clearly
reduced level.
levels for the majority of implants.
The mean DIB of 2.93 mm at the 5-
year examination is comparable with
previously published radiographic
data on nonsubmerged implants in
nonregenerated bone.19,20 Of 61
implants, only five implants lost more
than 0.8 mm between the two exam-
inations, among them one implant
with a periimplant infection and two
implants for which a surgical revision
was necessary to remove an avascu-
lar remnant of the buccal block graft.
The pattern of the frequency distri-
 115

Table 3 Clinical studies of implants in bone regenerated with GBR

Observation Membrane Bone Surgical Indication, Survival Success
Study Year n period type filler approach localization rate (%) rate (%)
Buser et al28 1996 12 5y Gore-Tex None Staged 100.0 100.0
Fugazotto25 1997 626 6–51 mo Gore-Tex Allograft/ Simultaneous/ 98.6
TCP staged
Nevins et al26 1998 526 6–74 mo Gore-Tex Autograft/ Simultaneous/ 97.5
allograft staged
Becker et al29 1999 49 5y Gore-Tex None Simultaneous Extr max 93.9
Extr mand 93.8
55 5y Gore-Tex None Simultaneous Dehisc max 76.8
Dehisc mand 83.8
Simion et al27 2001 123 1–5 y Gore-Tex None/allo- Simultaneous 99.2
or autograft
Zitzmann 2001 112 5y Gore-Tex Bio-Oss* Simultaneous 95.4
et al30 41 5y Bio-Gide* Bio-Oss Simultaneous 92.6
Present study 61 5y Gore-Tex Autograft Staged 100.0 98.3
*Manufactured by Osteohealth.
TCP = tricalcium phosphate; extr = extraction socket defect sites; max = maxilla; mand = mandible; dehisc = dehiscence defect sites.

bution (Fig 1) was practically identi-
cal with radiographic 8-year data on
97 ITI implants in nonregenerated
bone.22
Summarizing the clinical and
radiographic results, 60 implants
were considered successfully inte-
grated at the 5-year examination,
whereas one implant with a periim-
plant infection did not meet the suc-
cess criteria. This results in a 5-year
survival rate of 100%, whereas the 5-
year success rate was 98.3%. These
favorable results compare well with
the already mentioned 5-year stud-
ies on ITI implants in nonregener-
ated bone.18–20 It can be concluded
that augmented bone regenerated
in combination with autogenous
bone grafts and barrier membranes
responds to implant placement in a
similar manner as nonregenerated
pristine bone. This clinical observa-
tion confirms the histologic results of
two experimental studies in the
canine mandible.23,24 In both stud-
ies, all implants achieved osseoin-
tegration in regenerated bone.
Whereas one study24 did not include
loaded implants, the other23 pre-
sented histologic data of implants
with functional loading of 6 months.
The histologic analysis clearly con-
firmed that osseointegration was
achieved and maintained for all
loaded implants during the study
period.
The present study also confirms
favorable results of various clinical
long-term studies on osseointe-
grated implants in regenerated bone
using the GBR technique (Table 3).

Volume 22, Number 2, 2002

116
True 5-year results of implants in
regenerated bone have been pre-
sented so far by three clinical stud-
ies.28–30 The first 5-year data were
published by Buser et al28 on the
very first 12 implants that were
placed following successful ridge
augmentation with e-PTFE mem-
branes without the use of autografts.
At 5 years, all 12 implants were still
successfully integrated, although
two demonstrated an increased
bone loss and had a questionable
prognosis. Becker et al29 presented
clinical outcomes for implants
placed either immediately into ex-
traction sockets or in sites with dehis-
cence or fenestration defects. The
periimplant bone defects were cov-
ered with e-PTFE membranes with-
out the use of a bone filler. The
analysis showed acceptable 5-year
survival rates for extraction sites of
93.8% and 93.9% for maxillary and
mandibular implants, respectively,
whereas the results in dehiscence
and fenestration sites were less
favorable, with 5-year survival rates
of 76.8% for maxillary and 83.8% for
mandibular implants. Clearly better
5-year results were recently reported
by Zitzmann et al30 using the same
implant type in similar clinical situa-
tions, but with barrier membranes
in combination with a xenogeneic
deproteinized bone filler. Overall,
the 5-year survival rate varied
between 93% and 97% for implants
treated with or without GBR.
There is increasing evidence
that bone regenerated underneath
nonresorbable barrier membranes
has a similar load-bearing capacity as
pristine nonregenerated bone and
The International Journal of Periodontics & Restorative Dentistry
that good long-term results can be
expected with osseointegrated
implants placed in augmented bone
using a staged approach.
References
1. Dahlin C, Linde A, Gottlow J, Nyman S.
Healing of bone defects by guided tissue
regeneration. Plast Reconstr Surg 1988;81:
672–676.
2. Dahlin C, Gottlow J, Linde A, Nyman S.
Healing of maxillary and mandibular bone
defects using a membrane technique.
Scand J Plast Reconstr Hand Surg 1990;
24:13–19.
3. Seibert J, Nyman S. Localized ridged aug-
mentation in dogs: A pilot study using
membranes and hydroxyapatite. J
Periodontol 1990;61:157–165.
4. Schenk RK, Buser D, Hardwick WR, Dahlin
C. Healing pattern of bone regeneration
in membrane-protected defects. A histo-
logic study in the canine mandible. Int J
Oral Maxillofac Implants 1994;9:13–29.
5. Lazzara RJ. Immediate implant placement
into extraction sites: Surgical and restora-
tive advantages. Int J Periodontics
Restorative Dent 1989;9:332–343.
6. Nyman S, Lang NP, Buser D, Brägger U.
Bone regeneration adjacent to titanium
dental implants using guided tissue regen-
eration: A report of two cases. Int J Oral
Maxillofac Implants 1990;5:9–14.
7. Becker W, Becker BE. Guided tissue
regeneration for implants placed into
extraction sockets and for implant dehis-
cences: Surgical techniques and case
report. Int J Periodontics Restorative Dent
1990;10:376–391.
8. Buser D, Brägger U, Lang NP, Nyman S.
Regeneration and enlargement of jaw
bone using guided tissue regeneration.
Clin Oral Implants Res 1990;1:22–32.
9. Buser D, Dula K, Hess D, Hirt HP, Belser
UC. Localized ridge augmentation with
autografts and barrier membranes.
Periodontol 2000 1999;19:151–163.

10. Buser D, Tonetti M. Clinical trials on
implants in regenerated bone. Ann
Periodontol 1997;2:329–342.
11. Buser D, Dula K, Belser U, Hirt HP,
Berthold H. Localized ridge augmenta-
tion using guided bone regeneration. I.
Surgical procedure in the maxilla. Int J
Periodontics Restorative Dent 1993;13:
29–42.
12. Buser D, Dula K, Belser UC, Hirt HP,
Berthold H. Localized ridge augmenta-
tion using guided bone regeneration. II.
Surgical procedure in the mandible. Int J
Periodontics Restorative Dent 1995;15:
13–29.
13. Buser D, Dula K, Hirt HP, Schenk RK.
Lateral ridge augmentation using auto-
grafts and barrier membranes. A clinical
study in 40 partially edentulous patients.
J Oral Maxillofac Surg 1996;54:420–432.
14. Buser D, Weber HP, Lang NP. Tissue inte-
gration of non-submerged implants. 1-
year results of a prospective study with
100 ITI hollow-cylinder and hollow-screw
implants. Clin Oral Implants Res 1990;1:
33–40.
15. Buser D, Weber HP, Brägger U, Balsiger
C. Tissue integration of one-stage ITI
implants. 3-year results of a longitudinal
study with hollow-cylinder and hollow-
screw implants. Int J Oral Maxillofac
Implants 1991;6:405–412.
16. Mombelli A, van Osten MAC, Schurch E,
Lang NP. The microbiota associated with
successful and failing osseointegrated
titanium implants. Oral Microbiol
Immunol 1987;2:145–151.
17. Weber HP, Buser D, Fiorellini JP, Williams
RC. Radiographic evaluation of crestal
bone levels adjacent to non-submerged
titanium implants. Clin Oral Implants Res
1992;3:181–188.
18. Mericske-Stern R, Steinlin Schaffner G,
Marti P, Geering AH. Peri-implant mucos-
al aspects of ITI implants supporting
overdentures. A five-year longitudinal
study. Clin Oral Implants Res 1994;5:9–18.
117
19. Behneke A, Behneke N, d’Hoedt B. The 28. Buser D, Dula K, Lang NP, Nyman S.
longitudinal clinical effectiveness of ITI Long-term stability of osseointegrated
solid screw implants in partially edentu- implants in bone regenerated with the
lous patients: A 5-year follow-up report. membrane technique. 5-year results of a
Int J Oral Maxillofac Implants 2000;15: prospective study with 12 implants. Clin
633–645. Oral Implants Res 1996;7:175–183.
20. Weber HP, Crohin CC, Fiorellini JP. A 5- 29. Becker W, Dahlin C, Lekholm U, et al.
year prospective clinical and radiograph- Five-year evaluation of implants placed at
ic study of non-submerged dental extraction and with dehiscences and fen-
implants. Clin Oral Implants Res 2000;11: estration defects augmented with ePTFE
144–153. membranes: Results from a prospective
21. Buser D, von Arx T. Surgical procedures study. Clin Implant Dent Rel Res 1999;1:
in partially edentulous patients with ITI 27–32.
implants. Clin Oral Implants Res 2000;11 30. Zitzmann NU, Schärer P, Marinello CP.
(suppl I):83–100. Long-term results of implants treated with
22. Buser D, Mericske-Stern R, Dula K, Lang guided bone regeneration: A 5-year
NP. Clinical experience with one-stage, prospective study. Int J Oral Maxillofac
non-submerged titanium dental implants. Implants 2001;16:355–366.
Adv Dent Res 1999;13:153–161.
23. Buser D, Ruskin J, Higginbottom F,
Hardwick WR, Dahlin C, Schenk RK.
Osseointegration of titanium implants in
bone regenerated in membrane-pro-
tected defects. A histologic study in the
canine mandible. Int J Oral Maxillofac
Implants 1995;10:666–681.
24. von Arx T, Cochran DL, Hermann J,
Schenk RK, Higginbottom F, Buser D.
Lateral ridge augmentation and implant
placement: An experimental study eval-
uating implant osseointegration in differ-
ent augmentation materials in the canine
mandible. Int J Oral Maxillofac Implants
2001;16:343–354.
25. Fugazotto PA. Success and failure rates of
osseointegrated implants in function in
regenerated bone for 6 to 51 months: A
preliminary report. Int J Oral Maxillofac
Implants 1997;12:17–26.
26. Nevins M, Mellonig JT, Clem DS, Reiser
GM, Buser D. Implants in regenerated
bone: Long-term survival. Int J
Periodontics Restorative Dent 1998;18:
34–45.
27. Simion M, Jovanovic SA, Tinti C, Parma
Benfenati S. Long-term evaluation of
osseointegrated implants inserted at the
time of or after vertical ridge augmenta-
tion. A retrospective study on 123
implants with 1-5 year follow-up. Clin Oral
Implants Res 2001;12:35–45.
Volume 22, Number 2, 2002