Comparing the present results to the aforementioned study with the same implant system on immediately placed implants, it seems that the GBR augmentation procedure has no influence on the long-term stability of the implants. In both studies with different placement modalities and protocols, comparable clinical and radiological results were achieved. This leads to the assumption that the investigated C-Tech bone level implant system is able to achieve long-term stable function and to render esthetically satisfying results for replacing missing teeth in cases of atrophy of the alveolar crest, as well as in cases of immediate implant placement.

However, the biomaterial-related tissue reaction is still not clarified in detail and more studies need to be performed to investigate the interaction of biomaterials, such as bone substitute materials and dental implants.

In the present study, the implant and peri-implant hard- and soft-tissue stability was analyzed in a bone level implant system placed simultaneously with a GBR procedure 3 years after prosthetic loading. Peri-implant hard- and soft-tissue parameters such as width and thickness of peri-implant keratinized gingiva, probing depth, BOP, PES, peri-implant bone loss, and the presence of peri-implant osteolysis were analyzed. The 3-year follow-up investigation revealed a survival rate of 100% and comparably low values for probing depth (2.7 mm) and BOP (30%). Furthermore, analysis of PES showed a favorable esthetic appearance of the implants and prosthetics. The synthetic HA and HA + β-tricalcium phosphate-based bone substitute materials used for the GBR seem to have had no negative influence on the peri-implant health, as all investigated parameters were in accordance with or better than the results presented in the international literature. In conclusion, the investigated bone level implant system seems to be suitable to achieve functionally and esthetically satisfying results in indications that require simultaneous augmentation procedures 3 years after loading.