Altogether, 47 implants were placed in the upper and lower jaws of a total of 20 patients. In all implants, lateral augmentation in a GBR process was performed simultaneously with implant placement due to reduced horizontal or vertical height of the alveolar crest. A total of 23 implants were placed in the upper jaw and 24 implants in the lower jaw. The implant diameter varied between 3.5 mm (32 implants) and 4.3 mm (15 implants). The implant length varied between 11 mm (37 implants) and 13 mm (10 implants). Prosthetic restoration consisted of fixed prosthetics (43 implants) and removable prosthetics (r.p.) (4 implants) (Table 1).

The bone substitute materials applied for the horizontal and vertical GBR procedures were of synthetic (HA and β-TCP) origin.

At the follow-up investigation 3 years after implant loading, all of the 47 placed implants were in situ, leading to a survival rate of 100%. No prosthetic complications, major infections, or incompatibility reactions were observed.

Clinical analysis of the probing depths and the presence of BOP was performed to uncover an inflammatory reaction in the peri-implant soft tissue. The mean probing depth calculated from the probing depths at four sites per implant was 2.4 mm, varying from 1 to 4 mm. BOP was observed during probing in 14 of the 47 implants (30%). A distinct correlation between an accumulation of increased probing depth and BOP was obvious, as most implants with BOP presented increased probing depths.

The amount of peri-implant attached keratinized gingiva in the implants of the present study was analyzed to determine a potential correlation between keratinized peri-implant gingiva, a potential inflammatory response, and peri-implant bone loss and peri-implant osteolysis. All implants had a band of keratinized gingiva of at least 1 mm width and thickness. The mean width was 3.2 mm, ranging from 2 to 6 mm, and the mean thickness was 2.4 mm, ranging from 1 to 4 mm. No distinct and statistically significant correlation of the amount of keratinized gingiva and the evaluated soft-tissue parameters (probing depth and BOP) was observed.

Investigation of the esthetic appearance via PES revealed a mean point score of 10.1 (ranging from 7 to 13) from a maximum of 14. The highest values and therefore acceptance were found in the alveolar process deficiency and the soft-tissue level, which can be interpreted as a benefit of the augmentation procedure around the implant shoulder.

Peri-implant bone loss calculated using the average bone loss mesially and distally of each implant was 0.55 mm (ranging from 0 to 3 mm) without any signs of acute infection or peri-implant osteolysis. Furthermore, the radiological analysis revealed a stable bone level in all implants 3 years after loading.

Table 2 gives an overview of the results of the clinical and radiological 3-year follow-up investigation. Figure 2a–d shows clinical images of the placed implant in patient 4.