Effect of bone quality and quantity on the primary stability of dental implants in a simulated bicortical placement

Are implant-based treatments considered viable for patients with focal or florid cemento-osseous dysplasia? A systematic review

BACKGROUND

Focal and florid cemento-osseous dysplasia are benign fibro-osseous lesions affecting the quality and quantity of the jawbones. This study aimed to determine the viability of implant-based approaches in the affected patients.

MAIN TEXT

Different scientific databases, including PubMed/MEDLINE, Scopus, Web of Science, Embase, the Cochrane Library, and Google Scholar, were searched until October 8, 2023, using a pre-determined search strategy. Two reviewers screened the retrieved reports and extracted the required information from the included studies. The eligibility criteria included English-language case reports/series or clinical trials. The JBI critical appraisal checklist for case reports was used to assess the methodological quality of the included studies. Three studies were deemed eligible to be included in this study out of the initial 202 records found. Five implants were placed in three patients, positioned in the proximity of the lesion area, without any additional treatment to remove the pathology. The mandibular posterior area was the affected site in all patients. Only one implant failed in one patient after 16 years, which was attributed to peri-implantitis and not the lesion. Other implants demonstrated successful maintenance over follow-up periods.

CONCLUSIONS

Although the number of the included records was relatively low to draw firm conclusions, it seems that implant-based treatments in patients with focal/florid cemento-osseous dysplasia could be viable, considering a conservative and well-planned approach.

Primary Stability of Implants Inserted into Polyurethane Blocks: Micro-CT and Analysis In Vitro

The approach employed for the site preparation of the dental implant is a variable factor that affects the implant's primary stability and its ability to integrate with the surrounding bone. The main objective of this in vitro study is to evaluate the influence of different techniques used to prepare the implant site on the primary stability of the implant in two different densities of artificial bone.

MATERIALS AND METHODS

A total of 150 implant sites were prepared in rigid polyurethane blocks to simulate two distinct bone densities of 15 pounds per cubic foot (PCF) and 30 PCF, with a 1-mm-thick simulated cortex. The implant sites were equally distributed among piezoelectric surgery (PES), traditional drills (TD), and black ruby magnetic mallet inserts (MM). Two methods have been employed to evaluate the implant's primary stability, Osstell and micro-tomography.

RESULTS

In the present study, we observed significant variations in the implant stability quotient (ISQ) values. More precisely, our findings indicate that the ISQ values were generally higher for 30 PCF compared to 15 PCF. In terms of the preparation technique, PES exhibited the greatest ISQ values, followed by MM, and finally TD. These findings corresponded for both bone densities of 30 PCF (PES 75.6 ± 1.73, MM 69.8 ± 1.91, and TD 65.8 ± 1.91) and 15 PCF (PES 72.3 ± 1.63, MM 62.4 ± 1.77, and TD 60.6 ± 1.81). By utilizing Micro-CT scans, we were able to determine the ratio of the implant occupation to the preparation site. Furthermore, we could calculate the maximum distance between the implant and the wall of the preparation site. The findings demonstrated that PES had a higher ratio of implant to preparation site occupation, followed by TD, and then the MM, at a bone density of 30 PCF (PES 96 ± 1.95, TD 94 ± 1.88, and MM 90.3 ± 2.11). Nevertheless, there were no statistically significant differences in the occupation ratio among these three approaches in the bone density of 15 PCF (PES 89.6 ± 1.22, TD 90 ± 1.31, and MM 88.4 ± 1.17). Regarding the maximum gap between the implant and the site preparation, the smallest gaps were seen when TD were used, followed by MM, and finally by PES, either in a bone density 15 PCF (PES 318 ± 21, TD 238 ± 17, and MM 301 ± 20 μm) or in a bone density 30 PCF (PES 299 ± 20, TD 221 ± 16, and MM 281 ± 19 μm). A statistical analysis using ANOVA revealed these differences to be significant, with p-values of < 0.05.

CONCLUSION

The outcomes of this study indicate that employing the PES technique and osteo-densification with MM during implant insertion may enhance the primary stability and increase the possibility of early implant loading.

Biomechanical analysis of alveolar bones with compromised quality supporting a 4-unit implant bridge; a possible association with implant-related sequestration (IRS)

OBJECTIVES

This study aimed to investigate the strain in the bone surrounding dental implants supporting a 4-unit bridge and assess the role of excessive strain as a possible risk factor for implant related sequestration (IRS) or peri-implant medication-related osteonecrosis of the jaw (PI-MRONJ).

MATERIALS AND METHODS

A 3D-mandibular model was constructed using computed tomography and segmented it into cortical and cancellous bones. The 4-unit implant-supported bridges replacing the mandibular posteriors were constructed, and each featuring two, three, and four implants, respectively. The Young's modulus was assigned based on the quality of the bone. A maximum occlusal force of 200 N was applied to each implant in the axial and in a 30-degree oblique direction.

RESULTS

The maximum principal strain of the fatigue failure range (> 3000 µε) in the bone was analyzed. The volume fraction of fatigue failure was higher in poor-quality bone compared to normal bone and oblique load than in axial load. An increasing number of implants may dissipate excessive strain in poor-quality bones.

CONCLUSIONS

Occlusal force applied to poor-quality bone can result in microdamage. Given that unrepaired microdamage may initiate medication-related osteonecrosis of the jaw, long-term occlusal force on fragile bones might be a risk factor.

CLINICAL RELEVANCE

When planning implant treatment for patients with compromised bone status, clinical modifications such as strategic placement of implants and optimization of restoration morphology should be considered to reduce excessive strain which might be associated with IRS or PI-MRONJ.

Improving the accuracy of bone mineral density using a multisource CBCT

Multisource cone beam computed tomography CBCT (ms-CBCT) has been shown to overcome some of the inherent limitations of a conventional CBCT. The purpose of this study was to evaluate the accuracy of ms-CBCT for measuring the bone mineral density (BMD) of mandible and maxilla compared to the conventional CBCT. The values measured from a multi-detector CT (MDCT) were used as substitutes for the ground truth. An anthropomorphic adult skull and tissue equivalent head phantom and a homemade calibration phantom containing inserts with varying densities of calcium hydroxyapatite were imaged using the ms-CBCT, the ms-CBCT operating in the conventional single source CBCT mode, and two clinical CBCT scanners at similar imaging doses; and a clinical MDCT. The images of the anthropomorphic head phantom were reconstructed and registered, and the cortical and cancellous bones of the mandible and the maxilla were segmented. The measured CT Hounsfield Unit (HU) and Greyscale Value (GV) at multiple region-of-interests were converted to the BMD using scanner-specific calibration functions. The results from the various CBCT scanners were compared to that from the MDCT. Statistical analysis showed a significant improvement in the agreement between the ms-CBCT and MDCT compared to that between the CBCT and MDCT.

Influence of implant length and insertion depth on primary stability of short dental implants: An in vitro study of a novel mandibular artificial bone model

Background/purpose

Dental implants are a mainstream solution for missing teeth. For the improvement of dental implant surface treatment and design, short dental implants have become an alternative to various complex bone augmentation procedures, especially those performed at the posterior region of both the maxilla and mandible. The objective of this study was to evaluate the effect of various insertion methods on the primary stability of short dental implants.

Materials and methods

Commercial dental implants were inserted into artificial mandibular bone specimens using various insertion methods (equicrestal position, subcrestal position 1.5 mm, and lateral cortical anchorage) in accordance with an implant surgical guide. Insertion torque value (ITV) curves were recorded while implant procedures were performed. Both maximum ITVs (MITVs) and final ITVs (FITVs) were evaluated. Subsequently, Periotest values (PTVs) and implant stability quotients (ISQs) were measured for all specimens. A Kruskal-Wallis test was conducted to analyze the results for four primary stability parameters, and the Dunn test was used for a post hoc pairwise comparison when a difference was identified.

Results

For all groups, their mean MITVs ranged from 33.6 to 59.4 N cm, whereas their mean FITVs ranged from 17.5 to 43.5 N cm. Insertion torque value, ISQ, and PTV decreased significantly when implants were inserted into subcrestal positions. When implants were inserted in the lateral bicortical position, the four aforementioned parameters yielded greater values.

Conclusion

When 6-mm short implants were inserted in a lateral cortical anchorage position, high primary stability was yielded.

Prevalence and Association between Primary Stability and Bone Quality in Implants Placed in Edentulous Dental Arches: A Retrospective Analysis

Immediate function has become an accepted treatment modality for fixed restorations in completely edentulous jaws. The dental implants have gained immense popularity. A secure implant primary stability is positively associated with a successful implant integration and long term successful clinical outcome. The main aim of this study was to find the association between primary stability and bone density in implants placed in maxilla and mandible. A total of 1263 patients who had undergone implant placement from March 2020-March 2021 in Saveetha Dental College and Hospitals, Chennai, India were chosen for the study. The primary stability and bone density of these patients were collected from the hospital records. The collected data was compiled, reviewed, tabulated in Microsoft Excel sheet and entered in SPSS software for statistical analysis. In the present study, the patient aged between 28 and 37 years had undergone more implant placement (31%) with male predilection (53%). The most commonly associated primary stability was found to be 30-40 Ncm (51.37%) predominantly with D2 type of bone density (52.69%). A Chi-squared statistical test was done for primary stability and bone density and the P was found to be 0.00 (Chi-squared P < 0.05, statistically significant). The most predominant bone density was D2 associated with primary stability of 30-40 Ncm. The association between bone density and primary stability was found to be statistically significant. The present study shows a strong relationship between bone density and primary implant stability.

Influence of the contact area of the sub-antral space with sinus bone and the Schneiderian membrane on osteogenesis in lateral window sinus elevation surgery: a prospective experiment

BACKGROUND

Osteogenesis of lateral window sinus elevation surgery is the key to placement of the subsequent implant, excessive collapse of the sub-antral space may adversely affect long-term stability of implants. At present, few studies focus on the influence of the contact area of the sub-antral space on osteogenesis. This study evaluated whether the change in the contact area of the sub-antral space with maxillary sinus bone and the Schneiderian membrane can affect osteogenesis.

METHODS

Cone beam computed tomography (CBCT) images were collected of patients requiring maxillary sinus floor elevation (residual bone height < 6 mm) for standard-length implant placement before surgery, after surgery, and at 6-month follow-up visits. The postoperative sub-antral space volume (V₁) and surface area (S₁), and the remaining volume after six months of healing (V₂) were measured. Then, the contact area of sub-antral space with maxillary sinus bone (S_bc) and the Schneiderian membrane (S_mc), the absorbed volume during healing (V_a), and the percentage of remaining volume (V₂%) and absorbed volume (V_a%) were calculated. The correlation between anatomical parameters was analyzed using multiple linear regression.

RESULTS

A total of 62 maxillary sinuses from 56 patients were augmented, of which 57 were considered for the final analysis (5 withdrew due to perforation). Multiple linear regression results demonstrated that S_bc was significantly positively correlated with V_a (β coefficient = 0.141, p < 0.01) without correlation between S_mc and V_a (β coefficient =  - 0.046, p = 0.470). There was a positive correlation between S_bc and V₂% (β coefficient = 2.269, p < 0.05).

CONCLUSIONS

This study confirmed that the size of the S_bc in lateral window sinus elevation surgery affected osteogenesis after six months of healing. Clinicians should assess the sinus contour type preoperatively, then consider whether it is necessary to expand the range of the Schneiderian membrane elevation to avoid excessive collapse of the sub-antral space.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR), ChiCTR2200057924. Registered 22 March 2022-Retrospectively registered.

Three-dimensional radiographic assessment of bone changes around posterior dental implants at native bone site in Gansu Province, Northwest of China: A retrospective cohort study

PURPOSE

The aim of this study was to assess bone density and thickness changed following dental implant placement in the maxillary and mandibular jaws. Also, observe the form of bone loss around the implant and the relationship between preoperative bone density and bone thickness with bone loss around dental implants.

METHODS

65 patients, including 102 dental implants, were assessed in this study. CBCT was utilized to determine the bone condition (bone thickness and density at three levels (sub-crestal bone at 3 mm (CB3), 6 mm (CB6), and 9 mm (CB9)) before implant placement, and 2 to 3 years after placement, also determine the bone loss pattern.

RESULTS

The difference in bone thickness was 0.32 ± 0.50 mm at CB3, 0.18 ± 0.40 mm at CB6, and 0.14 ± 0.07 mm at CB9. The change buccal bone density at CB3, CB6, and CB9 were 344.5 ± 278.9, 260.5 ± 276, and 138.9 ± 313.9 HU, respectively, and the change in lingual bone density was 252.7 ± 247, 179.9 ± 244.1, and 281 ± 4063 HU, respectively. Only the CB3 level showed a significant decrease in bone thickness (p < 0.001), and a change in bone density was observed at the three levels (p < 0.001). The means of vertical and horizontal bone loss were 0.19 ± 0.23 mm and 0.18 ± 0.22 mm, respectively. Splinted or adjacent dental implants have more horizontal bone loss, with statistically significant (p < 0.001). Age, gender, and implant position were not statistically related to the outcome variables. There was a negative correlation between the preoperative status of the bone condition and pattern bone loss, as indicated by Pearson's correlation coefficient.

CONCLUSION

CBCT detected a significant bone thickness decrease was found only at the crestal third. A significant bone density increase was found at three levels around dental implants. Implant areas with higher bone thickness and density had less bone loss.

Dental Implant Placement in Focal Osteoporotic Bone Marrow Defect: a Case Report and Treatment Recommendations

BACKGROUND

Focal osteoporotic bone marrow defect is asymptomatic radiolucent area usually discovered incidentally during radiographic examination of the jaws. This bone condition can lead to clinical complications during dental implant placement or during osseointegration process.

METHODS

A 54-year-old woman was referred to private dental implant centre for a dental implant rehabilitation treatment in May 17, 2016. Oral examination revealed a healthy mucosa with no visible pathology. Adentia of tooth #46 and moderate atrophy of the edentulous alveolar process were found. Panoramic radiography of the jaws showed 2 cm x 2 cm radiolucency with irregular borders located in tooth #46 region. The margins of the bone defect were uneven, single trabeculae were visible, and the cortical layer was not deformed. In the absence of signs of pathology, it was decided to perform a dental implant surgery in the edentulous jaw segment #46.

RESULTS

The osteoporotic focus was filled with natural bovine bone substitute Cerabone^®. The granules were gently condensed to the sides - to the buccal and lingual walls until they filled the entire cavity. A 10 mm long, 4.1 mm diameter Straumann^® Tissue Level implant was surgically placed with the shoulder of the implant resting on the margins of the osteotomy. It was proposed six steps protocol for surgical dental implant installation in focal osteoporotic bone marrow defect in mandible.

CONCLUSIONS

A six-step protocol for surgical placement of dental implants in focal osteoporotic bone marrow defects may be a useful tool for clinicians in implant dentistry.

Effects of assessing the bone remodeling process in biomechanical finite element stability evaluations of dental implants

BACKGROUND AND OBJECTIVE

While an accurate assessment of the biomechanical stability of implants is essential in dental prosthesis planning and associated treatment assurance, the bone remodeling process is often ignored in biomechanical studies using finite element (FE) analysis. In this study, we aimed to analyze the significance of assessing the bone remodeling process in FE analysis for evaluating the biomechanical stability of dental implants. We compared the FE results considering the bone remodeling process with FE results simulated using commonly used conditions, with no considerations of the bone remodeling process.

METHODS

The mathematical model proposed by Komarova et al. was used to calculate cell population dynamics and changes in bone density at a discrete site. The model was implemented in the FE software ABAQUS, using the UMAT subroutine. Three-dimensional FE models were constructed for two types of bone (III and IV) and three values of implant diameter (4.0, 4.5, and 5.0 mm). An average biting force of 50 N in the vertical direction was applied during the bone remodeling process for 150 days. Afterwards, the maximum biting force of 200 N in the 30° oblique direction was applied to evaluate the stability of the implant systems.

RESULTS

To understand the impact of bone remodeling on the resultant mechanical responses, we focused on peri-implant cancellous bone based on two parameters: apparent density change and microstrain distribution. The bone density decreased by an average of 5.3 % after implantation, and it was the lowest on the 6^th day. The average density increases of the peri-implant cancellous bone were 264.4 kgm³ (bone type III) and 220.0 kgm³ (bone type IV) over 150 days. For the bone stability analysis, the maximum principal strain in the peri-implant bone was used to evaluate the bone stability. If the bone remodeling process is ignored, then the bone volume within the fatigue failure range of the microstrain differs significantly from that if the bone remodeling process is considered, i.e., 60 % higher for bone type III and 33.4 % lower for bone type IV than when the bone remodeling process is considered.

CONCLUSIONS

The FE result without considering the bone remodeling process could be considered a conservative criterion for bone type III. However, in bone type IV, the FE result without considering the bone remodeling process tends to underestimate the risks. The bone remodeling process is more affected by the initial bone quality than the implant diameter.

Evaluation of crestal sinus floor elevations using versah burs with simultaneous implant placement, at residual bone height ≥ 2.0 _ < 6.0 mm. A prospective clinical study

PURPOSE

To evaluate the efficacy of Versah drills in breaching the maxillary sinus floor while keeping the membrane intact, as well as measure the implant stability (primary stability at the time of implant placement by the osseous densification of the residual bone height (RBH) of ≥ 2.0 _ < 6.0 mm, and secondary stability after 6 months of osseous healing period).

METHODS

This prospective clinical study, which included twenty crestal sinus floor elevations, was conducted on 17 patients (10 males and 7 females, ages 29 to 70 years). The sinus membrane integrity was clinically checked at the time of osseodensification sinus lifting and confirmed by CBCT after sinus augmentation and implant insertion. Time of operation has been recorded from the first drill to implant installation. Primary implant stability was measured using an Osstell beacon at the time of implant placement, and secondary stability was measured after 6 months of osseous healing.

RESULTS

The mean of secondary stability in the current study is significantly higher than the mean of primary stability (P ≤ 0.011), which was 74.22 ± 8.11 and 69.85 ± 9.74, respectively, in RBH 3.81 mm as a mean. There was no clinical evidence of membrane perforation or complication reports, and the average operation time was 11.2 ± 1.85 min.

CONCLUSION

The current study found that at highly atrophic posterior maxilla with a residual bone height of ≥ 2.0 _ < 6.0 mm, osseodensification using Versah drills was effective in crestal sinus elevation with no membrane perforation, which was confirmed by cone-beam CT scan postoperatively, and showed higher primary and secondary implant stability.

Non-destructive, spectrophotometric analysis of the thickness of the cell-multilayered periosteal sheet

Background

Autologous tissue-engineered periosteal sheets, which have been clinically applied for periodontal regeneration, sinus lift, and alveolar ridge augmentation, are enriched with osteoblast precursor cells and the abundant deposition of collagen type I in the extracellular spaces. Their quality is inspected prior to clinical use; however, most criteria cannot be evaluated without sacrificing samples. To reduce such losses, we developed a non-destructive optical method that can quantitatively evaluate the thickness of the periosteal sheet.

Methods

Dispersed periosteal cells were inoculated into small pieces of collagen sponge (Terudermis®) and plated into 60-mm dishes for further explant culture using a conventional medium and a stem-cell culture medium. The thickness of periosteal sheets was evaluated using inverted microscopic, histological, labeling (CellVue®)-based imaging and spectrophotometric (Spectro-1®) methods.

Results

The three-dimensional growth of periosteal sheets did not necessarily correlate with two-dimensional growth. The periosteal sheet prepared with the stem-cell medium formed cell multilayers, a phenomenon that could be observed qualitatively by inverted microscopy. The spectrophotometric analysis enabled the quantitative evaluation of the thickness of the cell multilayer without sacrificing the samples processed for scheduled cell therapy.

Conclusions

The growth of periosteal sheets is influenced by several major factors, including the basic quality of the individual original periosteal tissue segments, the technical expertise of doctors and operators involved in tissue harvesting and processing, and culture conditions. This newly developed spectrophotometric analysis can quantify the thickness of cell-multilayered periosteal sheets for quality assurance in a non-destructive manner, thereby contributing to better bone augmentation prior to implant therapy.

An experimental study on the effects of the cortical thickness and bone density on initial mechanical anchorage of different Straumann® implant designs

Background

The aim of the current study was to comparatively assess the primary stability of different Straumann® implant designs (BLX, Straumann Tapered Effect, Bone Level Tapered, and Standard Plus) via resonance frequency analysis by using an implant insertion model in freshly slaughtered bovine ribs with and without cortical bone. Tapered Effect (4.1 × 10 mm), Bone Level Tapered (4.1 × 10 mm), Standard Plus (4.1 × 10 mm), and BLX (4.0 × 10 mm) implants were inserted into the distal epiphysis on the longitudinal axis of the freshly slaughtered bovine ribs. As a control, implants with the same sizes were inserted into the proximal diaphysis. The stability of the implants was examined with resonance frequency analysis.

Results

BLX and Tapered Effect implants showed higher implant stability quotient values in both study and control groups. All implant systems showed a significant decrease of mechanical anchorage in the study group. BLX and Bone Level Tapered designs had a significantly lower loss of mechanical anchorage in the lack of cortical bone.

Conclusion

Both Tapered Effect and BLX designs could ensure sufficient initial stability; however, BLX implants could be an appropriate option in the lack of cortical bone and poor bone quality at the implant recipient site.

Clinical relevance

BLX is a novel implant system, which could be especially beneficial in the presence of spongious bone type at posterior maxillae.

QCBCT-NET for direct measurement of bone mineral density from quantitative cone-beam CT: a human skull phantom study

The purpose of this study was to directly and quantitatively measure BMD from Cone-beam CT (CBCT) images by enhancing the linearity and uniformity of the bone intensities based on a hybrid deep-learning model (QCBCT-NET) of combining the generative adversarial network (Cycle-GAN) and U-Net, and to compare the bone images enhanced by the QCBCT-NET with those by Cycle-GAN and U-Net. We used two phantoms of human skulls encased in acrylic, one for the training and validation datasets, and the other for the test dataset. We proposed the QCBCT-NET consisting of Cycle-GAN with residual blocks and a multi-channel U-Net using paired training data of quantitative CT (QCT) and CBCT images. The BMD images produced by QCBCT-NET significantly outperformed the images produced by the Cycle-GAN or the U-Net in mean absolute difference (MAD), peak signal to noise ratio (PSNR), normalized cross-correlation (NCC), structural similarity (SSIM), and linearity when compared to the original QCT image. The QCBCT-NET improved the contrast of the bone images by reflecting the original BMD distribution of the QCT image locally using the Cycle-GAN, and also spatial uniformity of the bone images by globally suppressing image artifacts and noise using the two-channel U-Net. The QCBCT-NET substantially enhanced the linearity, uniformity, and contrast as well as the anatomical and quantitative accuracy of the bone images, and demonstrated more accuracy than the Cycle-GAN and the U-Net for quantitatively measuring BMD in CBCT.

Osteoconductivity of Porous Titanium Structure on Implants in Osteoporosis

In compromised bone conditions such as osteoporosis, developments of the implant surface are necessary to secure the stability of implants. This study investigated the effect of the surface porous titanium structure (PS) on the osseointegration of implants in osteoporotic bone. Bilateral ovariectomy (OVX) was performed in 4 female beagle dogs to induce osteoporosis for 32 wk. Success of induction was based on the evaluation of bone mineral density by Hounsfield units (HU) in computed tomography images. Posterior teeth in both mandibles were extracted 1 wk after OVX, and a total of 30 implants (15 implants in each group) were placed after 32 wk of osteoporosis induction. The control group implant underwent resorbable blast media (RBM) surface treatment, whereas the test group underwent RBM surface treatment in the coronal two-thirds and a PS added to the apical 3-mm portion. HU values in the mandibular trabecular bone, lumbar, and femoral head significantly decreased 32 wk after OVX, confirming osteoporotic condition after induction. Resonance frequency analysis and removal torque test showed comparable values between the 2 groups at 4 wk after implant placement. The surface topography of the implant after removal showed hard tissue integration at the PS in the test group. Bone-to-implant contact length was greater in the apical portion of the test group, although statistical significance was not found between the groups. Interthread bone area in the apical portion of the test group showed a significant increase compared to the control group (control: 0.059 ± 0.041 mm², test: 0.121 ± 0.060 mm², P = 0.028) with the histological feature of bone ingrowth at the PS. The findings of the study demonstrated that the surface PS could improve osteoconductivity in the osteoporotic trabecular bone by bone ingrowth at the pore space, thereby enhancing the osseointegration and stability of the implants.

Frequency of Bone Augmentation Materials Use in a General Dental Practice

This retrospective study aimed to evaluate the frequency of bone augmentation materials used for implant or periodontal surgical treatment depending on the age and sex of the patients from a dental practice in Essen, Germany, but also the implants dimensions and respectively the stage and progression grade of the periodontitis. The analysis of the data showed that bone augmentation materials are used much more frequently in the implant surgical cases (43,33%) compared to periodontal surgical cases (13,33%). While the correlations with sex and age were less obvious, the use of bone augmentation materials in the implant surgical cases was correlated with the use of shorter implants, while their use in the periodontal surgical cases was correlated with the stage 3 periodontitis.