Minimal invasiveness in lateral bone augmentation with simultaneous implant placement: A systematic review

The presence of a peri-implant bone dehiscence (BD) or fenestration (BF) is a common finding after implant placement in a crest with a reduced bucco-lingual bone dimension. The presence of a residual BD is associated with a relevant incidence of peri-implant biological complications over time. Guided bone regeneration (GBR), performed at implant placement, is the most validated treatment to correct a BD. In the present systematic review, the evidence evaluating factors which could reduce the invasiveness of a GBR procedure with respect to patient-reported outcomes, intra- and post- surgical complications, was summarized. Factors included were: technical aspects, regenerative materials for GBR, and peri- and post-operative pharmacological regimens. The available evidence seems to indicate that the use of membrane fixation and flap passivation by means of a double flap incision technique may reduce the incidence of post-surgical complications. When feasible, the coronal advancement of the lingual flap is suggested. The use of a non-cross linked resorbable membrane positively impacts on patient discomfort. The adjunctive use of autogenous bone to a xenograft seems not to improve BD correction, but could increase patient discomfort. Systemic antibiotic administration after a GBR procedure does not seem to be justified in systemically healthy patients.