Abstract
PurposeThe purpose of this study was to evaluate the clinical course of bone reconstruction of the alveolar crest using homologous fresh-frozen bone harvested from deceased donors.MethodsA retrospective survey was based on the Castelfranco Veneto Hospital database, in which 3264 clinical records with a primary or secondary diagnosis of alveolar atrophy were collected over a 10-year period. A random sample of 483 patients with at least 5 years’ follow-up was included in the survey. Patients were contacted by telephone and administered a questionnaire with specific questions to build a significant sample.ResultsOf the patients, 449 (93% of the sample) had an uneventful follow-up after surgery and 93.2% received at least one implant, with a mean of 3.4 implants per patient. At the time of the survey, 93% of the patients were wearing a dental prosthesis, 86.9% had not lost any implants, and 6.7% had lost at least one implant, while 6.4% still had implants but presented some clinical problems. Finally, patients were asked to provide an index score (1–10 points) on the therapy as a whole, i.e., bone graft, implants, and prostheses. A score of insufficient (up to 5 points) was given by 5.3% of patients, of sufficient (6 to 7 points) by 6.1%, and of good/very good (over 7) by 88.6%.ConclusionsHomologous bone for alveolar crest reconstruction can be a valid alternative to autologous grafting if specific tissue limitations are considered when planning therapy. Creeping substitution is partial and slower than in autologous grafts, especially in cases where cortical bone is thick or volume graft is very large. The quality of soft tissue coverage and mucosa lining is also important, possibly due to slower tissue revascularization, so future implants should predictably be positioned primarily within the original host bone.
Highlights
The need to increase the alveolar ridge for the purposes of implantology requires different techniques, and bone grafting is a cornerstone
The aim of this study was to present the experience of the Maxillofacial Surgery Unit of Castelfranco Veneto Hospital, Italy, where alveolar crest reconstruction with autologous bone has been substituted with homologous corticocancellous FFB grafting since 2003, initially in a few cases, and subsequently as the new standard in almost every patient
Several papers have been published in recent years to establish the final evolution of FFB grafts in jaw reconstruction, in terms of infectious disease transmission, histology, volume changes, and short- and long-term results of osseointegrated implants
Summary
The need to increase the alveolar ridge for the purposes of implantology requires different techniques, and bone grafting is a cornerstone. Experience in bone allografts dates back more than 100 years in orthopedics and about 25 years in the maxillofacial field. The first bone allograft was performed in 1880 by a Scottish surgeon who grafted a tibia to reconstruct the infected humerus of a 4-year-old boy [1]. In order to use these materials appropriately, the surgeon must be familiar with the properties of each and must feel confident that the bone bank is supplying a safe, sterile graft [3,4,5]. The first report of FFB in maxillofacial surgery is dated 1992, when ten patients were treated with FFB, alone or mixed with autologous bone, for the augmentation of six atrophic mandibles and the reconstruction of four jaws with defects secondary to trauma or tumor. After a median follow-up of 26.3 months, the
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