Autogenous onlay bone grafts vs. alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: a 2-4-year prospective study on humans

OBJECTIVES: The purposes of this study were to compare: (a) autogenous bone grafts (ABG) and distraction osteogenesis (DO) for their ability in correcting vertically deficient mandibular ridges and their capability in maintaining over time the vertical bone gain obtained before and after implant placement; and (b) the survival and success rates of implants placed in the reconstructed or distracted areas. MATERIAL AND METHODS: In a 2-year period (2001-2002), 17 patients presenting with vertically atrophied partially edentulous mandibles requiring implant-supported prosthetic rehabilitation, were included in this study. Patients were randomly assigned to two groups. Eight patients (group 1) were treated with ABG harvested from the mandibular ramus, while nine patients (group 2) were treated by means of DO. In group 1, patients received implants 4-5 months after the reconstructive procedure, while in group 2 implants were placed at the time of distraction device removal (approximately 3 months after the completion of distraction). A total of 19 endosseous implants were placed in group 1, and 21 implants were placed in group 2 patients. For both groups, after an additional 3-5-month period, prosthetic rehabilitation was started. RESULTS: Bone resorption before implant placement was significantly higher in group 1 (P=0.01), while no statistically significant differences were found between the two groups as far as survival and success rates of implants and peri-implant bone resorption after the start of prosthetic loading were concerned. CONCLUSION: The results suggested that: (a) both techniques may effectively improve the deficit of vertically resorbed edentulous ridges; (b) survival and success rates of implants placed in the reconstructed/distracted areas are consistent with those of implants placed in native bone.     

Long‐term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo‐mandibular defects due to extreme atrophy

Purpose: The objectives of this study were to evaluate (a) the clinical outcome of revascularized fibula flaps used for the reconstruction of extremely atrophic jaws and (b) the survival rates of dental implants placed in the reconstructed areas. Materials and methods: Between 1999 and 2004, 12 patients presenting with extreme atrophy of the edentulous jaws were reconstructed with fibula free flaps. Five to 12 months after the reconstructive procedure, 75 titanium dental implants were placed in the reconstructed areas, while prosthetic rehabilitation was started 4–6 months afterward. The mean follow‐up of patients after the start of prosthetic loading was 77 months (range: 48–116). Results: An uneventful healing of the bone transplants occurred in all patients. One out of the 75 dental implants placed was not loaded due to prosthetic reasons. No dental implants failed to integrate before prosthetic loading, while three were removed during the follow‐up period. Despite the high survival rate of dental implants (95.8%), a relevant number of them presented relevant peri‐implant bone‐level loss, ranging from 1 to 7 mm for maxillary dental implants and from 1 to 4.5 mm for mandibular dental implants. Conclusion: Although no failures of the bone transplants occurred and a high long‐term survival rate of dental implants were observed, this study showed that fibula free flaps do not guarantee dimensional stability of peri‐implant bone, despite the immediate blood supply delivered by the vascular pedicle. The peri‐implant bone resorption was higher when compared with the one related to dental implants placed in native bone. To cite this article:
Chiapasco M, Romeo E, Coggiola A, Brusati R. Long‐term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo‐mandibular defects due to extreme atrophy.
Clin. Oral Impl. Res. 22 , 2011; 83–91.
doi: 10.1111/j.1600‐0501.2010.01999.x     

Clinical evaluation of endosseous implants in nonvascularized fibula bone grafts for reconstruction of the severely atrophied mandibular bone.

PURPOSE: The purpose of the present study was to assess changes in graft height after augmentation of the severely atrophied mandibula with the use of avascular fibula bone grafts, as well as evaluation of the clinical success of endosseous implants placed in the grafted mandibula. PATIENTS AND METHODS: This retrospective study included 10 patients with a mean observation period of 31 months (range, 3 to 76 months). A total of 40 implants were placed. Clinical criteria included implant success, graft success, and crestal bone resorption. RESULTS: The grafting procedure was successfully performed in all patients. All implants were integrated, 2 implants could not be used for prosthetic rehabilitation. One implant was lost 2 years after abutment connection. The maximum bone resorption of 7.21% (+/- 2.7%) was seen within the first year; no significant resorption was seen thereafter. CONCLUSION: In this clinical and radiographic evaluation, it was found that nonvascular fibula graft is a reliable material for augmentation procedures. The resorption takes place within the first year after augmentation. The possibility of improving the clinical results in bone grafting situations with avascular fibula grafts will be further evaluated in a prospective follow-up study providing long-term assessment of this procedure.     

Maxillary alveolar ridge reconstruction with nonvascularized autogenous block bone: clinical results.

PURPOSE: The purposes of this study were to evaluate the clinical success of bone reconstruction of the severely atrophic maxilla using autogenous bone harvested from the anterosuperior edge of iliac wing and to analyze the clinical success and the marginal bone level of dental implants placed 4 to 5 months after bone grafting and before prosthetic rehabilitation. PATIENTS AND METHODS: Fifty-six patients (18 men, 38 women) aged 27 to 63 years were included in the study and required treatment for maxillary atrophy. All patients selected were scheduled for onlay bone graft and titanium implants in a 2-stage procedure. The dental implants were inserted 4 to 5 months after grafting. RESULTS: No major complications were observed from the donor sites. A total of 129 onlay bone grafts were used to augment 56 severely resorbed maxillas. Three out of 129 bone grafts had to be removed because of early exposure occurring with bone grafts placed to increase the vertical dimension of the alveolar ridge. One hundred sixty-two implants were placed in the area of bone augmentation. Seven implants failed to integrate and were successfully re-placed without any need for additional bone grafting. The clinical measurements for bone resorption around implants revealed a mean bone loss of 0.05 mm (+/- 0.2); the marginal bone level evaluated with periapical radiographies was 0.3 mm (+/- 0.4) at implant placement and 0.1 mm (+/- 0.3) 6 months after placement. CONCLUSION: The success rate of the block grafts was very good. The clinical and radiographic bone observations showed a very low rate of resorption after bone graft and implant placement. Therefore, on the basis of this preliminary study, iliac bone grafts (from the anterosuperior edge of the iliac wing) can be considered a promising treatment for severe maxillary atrophy.     

Dental implants placed in expanded narrow edentulous ridges with the Extension Crest device. A 1-3-year multicenter follow-up study

OBJECTIVE: This study has been designed to evaluate the capability of a new surgical device (Extension Crest) to widen narrow edentulous alveolar ridges and to allow a correct placement of endosseous implants in horizontally atrophied sites. MATERIAL AND METHODS: Forty-five patients, 20 males and 25 females, aged 20-66 years, affected by edentulism associated to horizontal resorption of the ridges, were treated by means of a sagittal osteotomy and expansion of the ridge with a new surgical device (Extension Crest) to obtain a wider bony base for ideal implant placement. In the same procedure in 33 patients, and 1 week afterwards in 12 patients, 110 endosseous titanium implants (ITI TE) were placed. Three to four months later, the patients were rehabilitated with implant-supported prostheses. RESULTS: The success rate of the expansion technique was 97.8%. A total of 110 implants were inserted in the expanded ridges. The mean follow-up after the start of prosthetic loading was 20.4 months. Three implants were removed before the start of prosthetic loading, because of non-integration, while no other implants failed after the completion of the prosthetic rehabilitation. Three implants, although integrated and in function, did not fulfill success criteria: cumulative success and survival rates at the end of the observation period were 95.4% and 97.3%, respectively. CONCLUSION: Within the limits of this study, this technique appeared to be reliable and simple, with reduction of morbidity and times of dental rehabilitation as compared with other techniques such as autogenous bone grafts and guided bone regeneration. Survival and success rates of implants placed in the treated areas are consistent with those placed in native bone.     

Staged reconstruction of the severely atrophic mandible with autogenous bone graft and endosteal implants.

PURPOSE: Vastly different surgical techniques have been advocated for osseous reconstruction of the severely atrophic mandible. Endosseous implants placed in autologous bone grafts have been proposed to minimize graft resorption and restore function; however, sufficient bone must exist to support the implants and prevent pathologic fracture. The purpose of this retrospective analysis was to assess the efficacy of autologous bone grafting and the subsequent placement of endosteal implants as a staged procedure in patients with severely atrophic mandibles. MATERIALS AND METHODS: The records of all patients presenting to The University of North Carolina for treatment from 1997 to 1999 with atrophic mandibles (vertical mandibular height <7 mm as measured on panoramic radiographs in at least 1 site at the mandibular midline and at the thinnest portion of the mandibular body) were reviewed. Bone height was assessed preoperatively, immediately postoperatively, at the time of implant placement (4 to 6 months), and again at 12 and 24 months after bone grafting from posterior iliac crest to the mandible via an extraoral approach. Five endosteal implants were subsequently placed in each patient as a delayed procedure 4 to 6 months after bone grafting, and prosthetic rehabilitation was completed with implant supported prostheses. RESULTS: Fourteen consecutive patients were identified with a median preoperative bone height of 9 mm (interquartile range, 25th to 75th percentile [IQ], 7 to 10 mm) in the mandibular midline and 5 mm (IQ, 2 to 5 mm) in the body region. There were no perioperative complications. Median estimated blood loss during the bone graft procedure, as estimated by the surgeon and the anesthesiologist, was 300 mL (IQ, 150 to 1,100 mL), and 1 patient required blood transfusion secondary to symptomatic anemia. The mean loss of vertical bone height after grafting and during the 4 to 6 months before implant placement was 33%. After implant placement and at 12 months, the vertical bone loss was negligible in the implant-supported region and less than 11% in the body region. CONCLUSION: Reconstruction of the severely atrophic mandible using autogenous corticocancellous bone grafts followed by placement of osseointegrated implants in 4 to 6 months can restore and maintain mandibular bone sufficient to support implants and facilitate successful restoration of occlusion. A prospective study is planned to identify predictors of successful outcomes compared with other surgical/prosthetic treatment.     

Use of titanium mesh for staged localized alveolar ridge augmentation: clinical and histologic-histomorphometric evaluation

The use of titanium mesh for localized alveolar ridge augmentation was evaluated by clinical, radiographic, laboratory, and histologic-histomorphometric evaluation. Seventeen patients participated in this study. All patients required localized alveolar ridge augmentation before placement of dental implants. An equal mixture of autogenous bone graft and inorganic bovine mineral (Bio-Oss) was used as a bone graft material. Autogenous bone graft was harvested intraorally. Titanium mesh was submerged for 8.47 months (SD 2.83). Impressions were taken intraorally before bone grafting, 6 months after bone grafting, and 6 months after implant placement. Impressions were used to measure the volume of alveolar ridge augmentation and provide linear laboratory measurements regarding the results of bone augmentation. Bone quality (type II-IV) was recorded during implant surgery. Standardized linear tomographs were taken before bone grafting and before implant placement. A biopsy was harvested with a trephine bur from the grafted area during implant surgery for histologic-histomorphometric evaluation. In all cases the grafted area had adequate bone volume and consistency for placement of dental implants. Early mesh exposure (2 weeks) was observed in 2 patients, and late exposure (>3 months) was observed in 4 patients. Volumetric laboratory measurements indicated 0.86 cc (SD 0.69) alveolar augmentation 1 month after bone grafting, 0.73 cc (SD 0.60) 6 months after bone grafting, and 0.71 cc (SD 0.57) 6 months after implant placement. This indicated 15.11% resorption 6 months after bone grafting, and no further resorption occurred after implant placement. Linear laboratory measurements indicated vertical augmentation of 2.94 mm (SD 0.86) 1 month after bone grafting, 2.59 mm (SD 0.91) 6 months after bone grafting, and 2.65 mm (SD 1.14) 6 months after implant placement. The corresponding measurements for labial-buccal augmentation were 4.47 mm (SD 1.55), 3.88 mm (SD 1.43), and 3.82 mm (SD 1.47). Radiographic evaluation indicated 2.56 mm (SD 1.32) vertical augmentation and 3.75 mm (SD 1.33) labial-buccal augmentation. Histomorphometric evaluation indicated 36.47% (SD 10.05) new bone formation, 49.18% (SD 6.92) connective tissue, and 14.35% (SD 5.85) residual Bio-Oss particles; 44.65% (SD 22.58) of the Bio-Oss surface was in tight contact with newly formed bone. The use of titanium mesh for localized alveolar ridge augmentation with a mixture of autogenous intraorally harvested bone graft and Bio-Oss offered adequate bone volume for placement of dental implants. Intraorally harvested autogenous bone graft mixed with Bio-Oss under a titanium mesh offered 36.47% new bone formation, and 15.11% resorption occurred 6 months after bone grafting.     

Alveolar distraction osteogenesis vs. vertical guided bone regeneration for the correction of vertically deficient edentulous ridges: a 1-3-year prospective study on humans

The purpose of this prospective study was to compare vertical guided bone regeneration (GBR) and vertical distraction osteogenesis (DO) for their ability in correcting vertically deficient alveolar ridges and their ability in maintaining over time the vertical bone gain obtained before and after implant placement. Eleven patients (group 1) were treated by means of vertical GBR with autogenous bone and e-PTFE membranes, while 10 patients (group 2) were treated by means of DO. In group 1, six patients received implants at the time of GBR (subgroup 1A), while five patients had implants placed at the time of membrane removal (subgroup 1B). In group 2, implants were placed at the time of distraction device removal. A total of 25 implants were placed in group 1 and 34 implants were placed in group 2 patients. Three to 5 months after implant placement, patients were rehabilitated with implant-borne dental prostheses. The following parameters were evaluated: (a) bone resorption of the regenerated ridges before and after implant placement; (b) peri-implant clinical parameters 1, 2, and 3 years after prosthetic loading of implants; (c) survival and success rates of implants. Bone resorption values before and after implant placement were significantly higher in group 1. The results suggested that both techniques may improve the deficit of vertically resorbed edentulous ridges, although distraction osteogenesis seems to be more predictable as far as the long-term prognosis of vertical bone gain is concerned. Implant survival rates as well as peri-implant clinical parameters do not differ significantly between the two groups, whereas the success rate of implants placed in group 2 patients was higher than that obtained in group 1 patients.     

Immediate loading of dental implants placed in revascularized fibula free flaps: a clinical report on 2 consecutive patients

PURPOSE: The objective of this study was to report the clinical outcome of dental implants placed in revascularized fibula flaps for the reconstruction of severely atrophied edentulous maxillae and immediately loaded with full-arch implant-supported prostheses. MATERIALS AND METHODS: Two patients, a 55-year-old woman and a 59-year-old woman, who presented with severely atrophied edentulous maxillae and local anatomy incompatible with rehabilitation with conventional complete removable dentures and insufficient bone volume for placement of implants of adequate dimensions were selected for reconstruction with revascularized fibula free flaps. Three months after the reconstructive procedure, Br?nemark System dental implants (8 in the 55-year-old patient, 7 in the 59-year-old patient) were placed in the reconstructed areas and immediately loaded with implant-supported full-arch prostheses. The mean follow-up period of implants after the start of prosthetic loading was 24 months. Radiographic peri-implant bone level changes and peri-implant clinical parameters (Plaque Index, Bleeding Index, and probing depth) were evaluated. RESULTS: No implants were lost during the follow-up period. Implant survival and success rates were 100% and 93.3%, respectively. Peri-implant clinical parameters presented values consistent with those obtained for implants placed in native nonreconstructed bone and allowed to heal before loading. DISCUSSION: To the authors' knowledge, this is the first time that the successful immediate loading of implants placed in fibula free flaps for the rehabilitation of totally edentulous patients with severely resorbed maxillae or mandibles has been described. CONCLUSION: Despite the limited number of patients and the short follow-up period, immediate loading of implants placed in revascularized fibula free flaps appears to be a reliable method for the dental rehabilitation of these patients.     

Vertical alveolar ridge augmentation by means of a titanium mesh and autogenous bone grafts

The aim of this study is to evaluate a surgical protocol for vertical ridge augmentation in the maxilla and mandible using autogenous onlay bone graft associated with a titanium mesh. A group of 18 partially edentulous patients, presenting the need for vertical bone augmentation of at least 4 mm, were treated before implant placement. During the first surgery, an autogenous bone graft was harvested from either the mandibular ramus or the mental symphysis and secured by means of titanium screws. Particulate bone was added and a titanium micro-mesh was used to stabilize and protect the graft. After a mean interval of 4.6 months, meshes and screws were removed and 37 endosseous implants were successfully placed. The desired bone gain was reached in all patients. Mean vertical bone augmentation obtained was 4.8 mm (range 4-7 mm). No major complications were recorded at recipient or donor sites. Abutment connection was carried out 2-3 months after implant placement. No implant was lost. Clinical parameters and probing depth, after prosthetic reconstruction, demonstrated the presence of a healthy peri-implant mucosa. The preliminary results suggest that, by using the presented technique, patients can be successfully rehabilitated by means of implant-supported prosthesis 6-7 months after the first surgery, even in case of severely atrophied maxilla.     

Implants in Reconstructed Bone: A Comparative Study on the Outcome of Straumann® Tissue Level and Bone Level Implants Placed in Vertically Deficient Alveolar Ridges Treated by Means of Autogenous Onlay Bone Grafts

Purpose: To evaluate: (1) the survival rate of Straumann® Tissue Level and Bone Level implants placed in atrophic edentulous jaws previously reconstructed by means of autogenous onlay bone grafts; (2) to compare peri‐implant bone resorption values over time. Materials and Methods: From 2005 to 2010, 50 patients presenting with vertical or tridimensional defects of the edentulous ridges were treated with autogenous bone grafts. Three to 7 months afterward, 192 implants were placed (Group A: 97 Tissue Level implants; Group B: 95 Bone Level implants) in the reconstructed areas. After a further waiting period of 2 to 3 months, patients were rehabilitated with implant‐supported fixed prostheses. The follow‐up ranged from 12 to 68 months after the start of prosthetic loading (mean: 33 months). Results: No implants were removed (survival rate: 100%), but in Group B 13 implants (8 placed in iliac grafts, 2 placed in ramus grafts, and 3 placed in calvarial grafts) presented peri‐implant bone resorption values higher than those proposed by Albrektsson and colleagues. for successful implants: the overall implant success rate was then 100% for Group A and 86.8% for Group B. No prosthetic failures were recorded, thus leading to a 100% prostheses success rate. Conclusion: No significant differences were found between the two types of implants as far as implant survival rate is concerned, but results from this study seem to demonstrate that Tissue Level implants may present better long‐term results in terms of peri‐implant bone maintenance, as compared with Bone Level implants, when placed in reconstructed areas.     

Sinus floor augmentation with autogenous iliac bone block grafts: a histological and histomorphometrical report on the two-step surgical technique

In thirteen patients, screw-type endosseous implants were inserted 6 months after sinus floor elevation and augmentation with autogenous iliac bone block grafts. Bone biopsies were harvested at graft positioning (baseline), at implant placement (6 month) and at abutment connection (1 year). Histological evaluation suggested a decrease in the volume of mineralized tissue and in the vitality of the grafts 6 months after graft insertion, followed by an increase at abutment connection. Histomorphometric analysis of the bone specimens showed that, at implant placement, bone content was reduced by 5.2% on average, while 12 months after grafting it had increased by 4.8% compared to the amount of mineralized tissue contained in the graft at baseline. The results suggest that in sinus floor augmentation procedures with autogenous iliac bone blocks, a two-step surgical technique allows implant insertion when graft healing is entering a phase of greater density and vitality.     

Localized ridge augmentation using a micro titanium mesh: a report on 27 implants followed from 1 to 3 vears after functional loading

The present paper describes the clinical and radiographic healing results of 27 implants followed from 1 to 3 years after functional implant loading. Prior to implant placement, alveolar ridges with insufficient bone volume were augmented using autogenous bone grafts and a micro titanium mesh for graft stabilization. After a mean interval of 5.2 months implants were installed. Following an osseointegration period of on average 7.2 months, implants were supplied with suprastructures. The mean loading period for the 27 implants was 21 months. All implants exhibited ankylotic stability and healthy peri‐implant soft tissues. The detailed analysis of clinical parameters (probing depth, level of mucosal margin, attachment level, modified plaque and sulcus bleeding indices) and radiographic measurements (crestal bone level), revealed findings similar to those at implants placed into non‐augmented bone. Peri‐implant bone resorption was calculated to be 1.0 mm for the 1st year after implant loading and 0.1 mm for the following year. Pain, suppuration or semilunar bone defects were absent at all implants. It was concluded that loaded dental implants which have been inserted into an augmented alveolar ridge using autogenous bone grafts and a micro titanium mesh for graft stabilization, demonstrate clinical and radiographic findings similar to those of implants placed into a pristine ridge.     

Maxillary antral-nasal inlay autogenous bone graft reconstruction of compromised maxilla: a 12-year retrospective study.

During a 12-year period (1984-1996), 118 maxillary inlay autogenous bone grafts and 248 commercially pure titanium threaded root-form endosseous implants were placed in 54 consecutively treated patients with compromised maxillary bone. In this retrospective clinical study, 3 groups of patients were reviewed, group selection being based on anatomic location and surgical access to the recipient site. Group 1 included patients with bone grafts placed in the antrum floor via an intraoral antrostomy exposure, group 2 included patients with bone grafts placed in the nasal floor via an anterior intraoral nasotomy exposure, and group 3 included patients with bone grafts placed in the antral and nasal floor via an intraoral Le Fort I osteotomy downfracture exposure. Each patient received an implant-supported dental prosthesis. For the combined 3 groups, survival rates were 87% for endosseous implants and 100% for autogenous bone grafts. The success rate for the dental prostheses in the 3 groups was 95%. Sixty-nine dental prostheses functioned a mean of 57.1 months, whereas 3 prostheses required remaking because of implant loss. Of the medical and mechanical risk factors tabulated in this study, current use of nicotine, history of sinusitis, molar site implant placement, and shorter implant lengths had the most influence on implant failure.     

A Retrospective Study on 287 Implants Installed in Resorbed Maxillae Grafted with Fresh Frozen Allogenous Bone

Background: Several studies have been performed to evaluate the clinical outcome of implants inserted into maxillae grafted with autogenous bone but few reports have focused on maxillae grafted with fresh‐frozen allogenous bone (FFAB). Purpose: The purpose of this study is to retrospectively evaluate the clinical outcome of implants installed in resorbed maxillae augmented with FFAB. Materials and Methods: A total of 69 patients whom had been treated with FFAB grafts to their maxillae and implant placement 4 to 6 months later were retrospectively evaluated. Edentulism was total and partial in 22 and 47 cases, respectively. A total of 287 implants of various systems had been used. A life table analysis was performed. Marginal bone loss was calculated in radiographs. Results: Five of the 287 implants were lost, giving a survival rate (SVR) of 98.3% over a mean follow‐up time of 26 months. The marginal bone resorption at the implants was 1.68 mm (SD = 0.44) after 1 year and 1.85 mm (SD = 0.98) after 4 years. The cumulative success rate based on defined criteria was 96% in the first year but decreased to 40% at 4 years because of marginal bone loss. The Kaplan–Meier algorithm demonstrated a better outcome for female patients, removable dentures, and total edentulism. No differences were detected among diameters, lengths, and implant site. Conclusion: Implants placed in FFAB showed a high SVR similar to that reported in previous studies on maxillae grafted with autogenous iliac crest bone. Although our data point to more marginal bone loss in partially edentulous patients and for fixed prosthetic restorations, the use of FFAB for reconstruction of the atrophic jaw prior to implant placement can be considered as a reliable alternative to autogenous bone.     

The use of autogenous block graft for augmentation of the atrophic alveolar ridge

The use of osseointegrated implants has become a standard treatment option in modern dental rehabilitation. Adequate bone quantity and quality is a prerequisite for good esthetic and biomechanical result. Alveolar ridge defects can be the result of trauma, periodontal diseases or other pathologic conditions. In these cases, alveolar ridge augmentation is needed if endosseous implants are to be used. While xenografts, alloplastic bone grafts and allografts have been proposed for alveolar ridge augmentation, the use of autogenous bone grafts represents the "gold standard" for bone augmentation procedures. Either intraoral or extraoral sites may be considered for donor sites. Although the iliac crest is the most common donor site in maxillofacial reconstruction, the mandibular symphysis or ramus offer important advantages like avoidance of general anesthesia, convenience due to the proximity between the donor site and the augmentation site and avoidance of cutaneous scar. Bone harvested from intraoral donor site is less associated with resorption when compared with iliac bone because membranous grafts revascularize more quickly than endocondral bone grafts. The main disadvantage of the intraoral donor sites is the limited amount of available bone. Alveolar ridge augmentation using autologous bone block, can be done during implant placement or staged with implant placement, after bone graft healing. In the staged technique, a better implant positioning and the use of wide diameter implants are possible. The overall implant success is higher in the staged technique. Alveolar ridge augmentation using autogenous block graft is a predictable way of treatment, for the atrophic alveolar ridge before implant placement.     

Long-term results of mandibular reconstruction with autogenous bone grafts and oral implants after tumor resection

Objectives: (a) To evaluate retrospectively the clinical outcome of non‐vascularized bone grafts used for the reconstruction of mandibular defects following tumor resection; (b) to evaluate the clinical outcome of implants and implant‐supported prostheses placed in the reconstructed areas; and (c) to evaluate patients' satisfaction regarding function and esthetics after oral rehabilitation. Material and methods: In a 9‐year period (1995–2003), 29 patients affected by mandibular tumors involving to tooth bearing areas were treated by means of tumor resection and immediate or delayed reconstruction with autogenous non‐revascularized calvarial or iliac bone grafts. Among these patients, 16 patients were selected for dental rehabilitation of the lost dentition with implant‐supported 3fixed prosthese333s. For to 7 months later, the patients received 60 oral implants for the prosthetic rehabilitation of the reconstructed edentulous areas. Results: No total failure of the graft was observed, while partial loss of the graft was observed in one patient. The mean follow‐up of patients after the start of prosthetic loading of implants treated was 94 months (range: 36–132 months). Two patients dropped out of the follow‐up after 3 and 4 years of observation, respectively. Two implants were removed due to loss of osseointegration, while two implants, although still integrated, presented peri‐implant bone resorption values higher than those proposed by Albrektsson et al. for successful implants. Cumulative survival and success rates of implants were 96.7% and 93.3%, respectively. Conclusion: Results from this study demonstrated that bone defects following resection of mandibular tumors can be predictably reconstructed with autogenous bone grafts taken from the calvarium or the anterior iliac crest. It has also been shown that the long‐term survival and success rates of implants placed in the reconstructed areas (96.7% and 93.3%, respectively) may guarantee an excellent prognosis of implant‐supported prostheses.     

Dental implant treatment with different techniques for sinus floor elevation--a case report

A 60-year-old man with missing maxillary molar teeth received dental implant therapy for reconstruction of occlusion. Sinus floor elevation with autogenous bone graft consisting of iliac bone block and particulate cancellous bone and marrow (PCBM) was performed in the bilateral maxillary sinuses for implant placement. On the right side, bone height in the molar region was less than 2mm. Therefore, a delayed protocol was applied, and 2 implants were placed 4 months after bone grafting. Bone graft resorption occurred during the healing period of 4 months. On the left side, 3 implants were placed simultaneously with sinus floor elevation, as bone height in the molar region was more than 4-5mm. The bone graft was carried out at the same time as implant placement. After implant placement, resorption of the bone graft stopped, and the superstructures were delivered on both sides. The tissues around the implants were clinically healthy at one year after examination. Sinus floor elevation with autogenous bone graft is an acceptable option for implant treatment in the maxillary molar region where there is adequate height of existing bone. In postoperative care, it is important to undertake adequate follow-up to ascertain occurrence of bone graft resorption.     

种植床自体骨移植在上颌窦闭合式提升中的临床应用

目的评价种植床自体骨植骨行上颌窦闭合式提升后同期植入种植体的临床效果。方法对上颌后牙缺失后剩余牙槽骨高度在6-10mm患者,用中空圆柱钻制备种植床,收集种植床自体骨,行上颌窦闭合式挤压提升后,植入自体骨和ITI种植体,6-9个月后行上部结构修复。结果17例患者共植入25颗种植体,平均提升上颌窦底高度为3.4mm(2-4mm),修复后追踪观察6-36个月,l颗种植体修复6个月后松动拔除。其余24颗种植体平均负载21个月,种植体稳定,未见明显骨吸收,所有病例均无上颌窦并发症。结论严格掌握适应证,种植床自体骨植骨上颌窦闭合式提升同期植入种植体,创伤小、操作较简单,无须开辟第2手术区。     

Bone grafting of cleft lip and palate patients for placement of endosseous implants.

OBJECTIVE: Fixation of a prosthesis or single tooth replacement using osseointegrated implants has the potential to overcome functional and psychological inconveniences that many patients experience from such appliances. However, the dimensions of the recipient site are relatively often inadequate for implant placement. This study assessed grafting of this site with autogenous bone as a solution for the latter problem. METHODS: Ten cleft lip and palate patients had bone grafts; six had iliac crest grafts to the maxillary sinus floor (31 implants), and four had chin bone grafts to the local defect in the anterior maxilla (six implants). Implants were inserted during the grafting procedure (one patient) or after 3 months (nine patients). RESULTS: No inflammation of the bone grafts or the maxillary sinus occurred. One implant was lost during the healing phase. Four single tooth restorations, one fixed bridge, and five implant-supported overdentures were made. During the follow-up, which was 47 months (range, 28 to 65 months) in the anterior maxilla group and 56 months (range, 28 to 68 months) in the posterior maxilla group, no loss of implants was observed, and all prosthetic appliances functioned well. CONCLUSIONS: It is concluded that bone grafting followed by placement of dental implants can serve as a reliable alternative for conventional prosthetic rehabilitation of cleft patients.