Soft tissue profile changes after autogenous iliac crest onlay grafting for the extremely atrophic maxilla

Abstract

Purpose: The aim of this study was to evaluate profile changes in the hard and soft tissues after onlay grafting in the extremely atrophic maxilla. Patients and Methods: Onlay grafting using autogenous iliac crest bone grafts was performed in 49 patients (42 females and 7 males) with extreme atrophy of the edentulous maxilla (vertical amount of bone: <6 mm, transverse amount of bone: <5 mm). For the assessment of the changes to the hard and soft tissues, the preoperative and postoperative cephalograms were traced and the cephalometric measuring points (44 skeletal and 25 soft tissue points) were digitalized with the aid of the Dentofacial Planner System. Evaluation of a relationship between soft tissue and hard tissue profile changes was performed by comparing the movement of the skeletal points Sub-ANS and A-point with the shift of the soft tissue point SLS. To determine significant hard tissue and soft tissue changes, the measured values were evaluated using the SPSS program system and examined for statistical significance by use of the Wilcoxon test. Results: An advancement of the bony maxilla profile in the sagittal direction by an average of 2.4 mm (P <.01) was found. The soft tissue profile of the upper lip was moved forward on average by 2.3 mm (P =.0039) at the superior labial sulcus point and by 2.7 mm (P =.0018) at the labrale superius point. The ratio of the soft tissue change to hard tissue change was 0.7:1 (superior labial sulcus: skeletal point sub-ANS) or 0.9:1 (superior labial sulcus: A point). Conclusions: When planning onlay graft operations, consideration should be given to the functional and aesthetic effects of the profile changes on the upper lip. © 2000 American Association of Oral and Maxillofacial Surgeons