Maxilla augmentation with calvarial bone: immediate or delayed dental implant placement?

In the severely atrophic maxilla, an augmentation is required to allow placement of dental implants to support the denture. Since 2010 calvarial bone blocks were used to augment the maxilla. Dental implants are placed after 4 months healing time, or immediate at the time of augmentation. A retrospective study was done to measure peri-implant bone loss, implant loss and influencing factors. A retrospective cohort study was set up including patients that were treated from 2010 to 2020. Patient factors (age, sex, smoking, medication use), surgery factors (delayed or immediate implantation, location of implant) and radiological follow-up (peri implant bone loss, implant loss) were scored. A GEE (Generalized Estimated Equations) statistical analysis was performed to find factors influencing outcome. A total of 111 patients (47 male; 64 female) received 508 implants. Follow-up was 4.6 ± 2.3 years. Mean peri-implant bone loss in 26 patients with a delayed approach was 0,34 ± 0,73 mm and in 85 patients with combined augmentation and immediate implantation 0,57 ± 0,88 mm (p < 0,001). Implant success was 99 % in the delayed group, and 92 % in the immediate group. Age, smoking, status of mandible (edentate/(partially) dentate) and implant location did not influence peri-implant bone loss. When a severely athrophic maxilla is augmented with calvarial bone, immediate implant placement seems a viable option with low long-term peri-implant bone loss, and the advantage to reduce total treatment time and the need for an extra surgical procedure.