Following alveolar ridge grafting procedures for ridge preservation, for example, the immediate filling of extraction sockets, and ridge augmentation, for example, the building up of the atrophic jawbone, punch biopsies were obtained at various times postextraction prior to the placement of endosseous root-form implants. These histological sections provided an opportunity to study the bony regenerative response to an osteoconductive synthetic graft material and longer term interactions over a period from 8 months to 12 years. The formation and remodeling of healthy dense lamina of bone in areas where bone voids previously existed either from healed or immediate extraction sockets or where there was jawbone atrophy resulting from multiple tooth loss was observed. The grafting procedures enabled dentists to place implants into sites that would have been impossible if not for these preimplant grafting procedures. The jawbone areas studied involved grafted single sites and quadrants as well as full arch augmentation with a calcified microporous copolymer (Bioplant HTR Synthetic Bone, Bioplant Inc, South Norwalk, Conn) graft material. Retrospective case reports of 24 patients were followed radiographically and clinically to 12 years post–alveolar-ridge grafting and subsequently to 5 years after implants were placed into these augmented ridges. Implant and grafting histories from 4.7 months to 17 years are reported for three of these patients. General applications of synthetic bone grafting before implant placement are recommended.

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