Bone Augmentation in Implant Dentistry: A Systematic Exploration of Techniques and Outcomes

OBJECTIVE: To evaluate the outcomes of bone augmentation techniques prior to implant placement in atrophic ridges using only moderate-to-high quality evidence, and to provide a provisional decision-making aid. METHODS: A systematic search of PubMed, Scopus, and Web of Science was conducted. Randomized controlled trials (RCTs), prospective cohort studies, and retrospective cohorts with ≥ 10 patients reporting implant survival and complications were included. Case reports, small case series, and studies without essential data were excluded. Study quality was assessed using the Cochrane Risk of Bias 2.0, ROBINS-I, and GRADE. RESULTS: Of 471 identified records, 12 studies met inclusion criteria: 5 RCTs, 4 prospective, and 3 retrospective cohorts. Implant survival rates ranged from 88% to 100% depending on graft type and defect morphology. Autogenous grafts showed the highest predictability for extensive defects but had the highest donor site morbidity. GBR with xenograft-autogenous mixtures provided stable horizontal augmentation with fewer complications. Growth factor-enhanced xenografts and Ti-reinforced d-PTFE membranes offered promising results in selected cases. CONCLUSIONS: Graft selection can be guided by defect size, patient comorbidity, and morbidity tolerance. The clinical decision-making table serves as a provisional, evidence-informed reference to assist clinicians in thinking through graft choices.