Calvarial Bone Graft Research Articles

Human cranial vault thickness in relation to age, sex and general body build in a South Indian population

Background & Objectives : During legal investigations, the forensic pathologist is often required to give an opinion regarding personal identification of the deceased. The bone that is among the most helpful for these investigations is the skull. As to my knowledge, this is the first study of its kind in this part of the world where an attempt is made to find any correlation between cranial vault thickness, age sex and general body build in a population group. Methods: Materials for the present study consists of eighty two South Indian origin victims autopsied at the mortuary of A. J. Institute of Medical Sciences, Mangaluru, Karnataka between November 2016 and October 2018. The victims comprised of both the genders in the age group of 18-80 years belonging to various parts of South India (Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, Telangana & Union territories of Lakshadweep & Pondicherry). Results : The victims in the age group of 18-80 years belonging to various parts of South India The average stature among males was 168.69 ± 10.98 and ranged from 148cm and 192cm. There was found to be a significant correlation between the occipital thickness and the sexes. There was found to be no significant correlation between different areas of cranial vault thickness with respect to each other and also between cranial vault thickness with height, weight or general body build. Interpretation & Conclusion: The present study emphasizes the utility of cranial vault thickness in identifying individuals. It also provides useful insights in the fields of calvarial bone grafting and neurosurgery

Management of Massive Iatrogenic Temporal Lobe Meningoencephalocele and Bacterial Meningitis Following Pediatric Cochlear Implant Surgery.

To review the management of meningitis, large lateral skull base defect, and meningoencephalocele following pediatric cochlear implant (CI) surgery. Case report. Patient demographics, medical and surgical history, computed tomography (CT). An 8-year-old male with congenital severe to profound sensorineural hearing loss underwent uncomplicated right CI surgery at 18 months of age. He returned to his home country and received a bilateral sequential left ear CI at age 2. Five years following his second CI surgery, he presented to his local emergency room with worsening fever, headache, back pain, and vomiting. Lumbar puncture confirmed bacterial meningitis, and he was managed with intravenous antibiotics. The hospital course was complicated by a right-sided facial nerve paresis, prompting a temporal bone CT. Imaging demonstrated a tegmen defect measuring 15 mm × 10 mm with soft tissue opacification involving the entire mastoid and CI harness. He was then referred by family back to our institution. Intraoperatively, we identified a massive temporal lobe meningoencephalocele involving the entire mastoid cavity and engulfing the entire proximal electrode harness. Following middle cranial fossa craniotomy and revision mastoidectomy, proximal and distal array were separated, encephalocele transected, and remaining temporal lobe reduced. The lateral skull base was reconstructed with calvarial bone, temporalis fascia, and bovine collagen graft. The remnant electrode array was removed, a new CI receiver stimulator was fixed postero-superiorly to the cranial defect, and a new multichannel array inserted. A titanium cranioplasty completed the repair. A lumbar drain was placed for 3 days. Recovery and CI activation occurred uneventfully. Risk of encephalocele and meningitis underscores the importance of early identification, adequate repair, and long-term radiologic follow-up of iatrogenic tegmen defects during pediatric CI surgery.

Temporoparietal Fascial Flap Combined With Vascularized Outer Table Calvarial Bone Graft and Entire Temporalis Muscle: A Stable Pedicled Flap for Orbital Floor Reconstruction After Total Maxillectomy.

Orbital reconstruction after total maxillectomy is essential to maintain ocular function and facial contour. Free flap transfer with simultaneous orbital bone reconstruction is a straightforward approach; however, it is challenging in medically unstable patients with multimorbidity. The authors developed an easily harvested temporoparietal fascial flap combined with vascularized outer table calvarial bone and entire temporalis muscle. The authors applied this technique in an 81-year-old patient with multiple comorbidities who required orbital floor reconstruction following total maxillectomy. Intraoperative indocyanine green fluorescence imaging confirmed excellent perfusion of the temporoparietal fascia, entire temporalis muscle, and calvarial bone. Although the patient developed postoperative local wound infection, the vascularized bone graft resisted infection and preserved the orbital structure without bone exposure. Our technique is minimally invasive and results in a well-vascularized flap for orbital reconstruction after total maxillectomy involving the orbital bone, and particularly beneficial in patients with multimorbidity or at high risk of local infection.

Calvarial bone graft for craniovertebral junction fixation in children.

To evaluate the efficacy of calvarial graft (CG) in craniovertebral fusion procedures in children at a single single center. Paediatric patients in whom CG had been used as the sole construct, or to augment a semi-rigid construct were identified from a prospective operative database. Age, underlying diagnosis and clinical presentation were obtained from review of the electronic patient record. The primary outcome was bony fusion confirmed on CT. Additional outcome measures were donor site morbidity and need for further surgery. From 82 paediatric CVJ procedures, CG was used in 15 patients with a mean age of 4.1 (± 3.52) years. Aetiology comprised skeletal dysplasia (n = 12), congenital anomaly of segmentation (n = 1) and cervical trauma (n = 2). Myelopathy was the most common clinical finding (9/15), followed by cervical pain (3/15). The indications for surgery comprised atlanto-axial subluxation (8/15), basilar invagination with compression (2/15), and cervicomedullary compression without instability but deemed at risk of instability following decompression (4/15). CG was used in three scenarios: (i) CG + wire only (n = 10); (ii) CG + semirigid instrumentation (n = 3); (iii) CG to augment rigid instrumented fixation (n = 2). In 13 patients a Halo-body Jacket was used peri-operatively. At a mean time of 4.4months following surgery, 80% of cases had radiological evidence of fusion. Full thickness calvarial bone graft is readily available, has good structural integrity and is associated with minimal donor site morbidity. CG should be considered for use as a sole construct, or to augment semi-rigid constructs when instrumented fixation is precluded.

Reconstruction of atrophic maxilla with calvarial bone graft and concomitant implant placement: case report

The aim of this study was to report a case of atrophic maxillary reconstruction with calvarial bone graft and immediate installation of implants, and to present the benefits of reconstruction for rehabilitation with dental implants. A 66-year-old female patient came to the Oral and Maxillofacial Surgery service of the Hospital dos Fornecedores de Cana de Piracicaba complaining of non-retention of the total prosthesis. On clinical examination, there was no intraoral or extraoral pathological condition. After initial clinical and radiographic evaluation, we considered the need for maxillary reconstruction with calvarial bone graft, bilateral maxillary sinus lifting, and installation of implants in the maxilla concomitantly with the adaptation of the blocks. Moreover, the installation of implants in the mandibular region was performed. According to the results of this case report and according to the literature, the use of calvarial bone grafting has some advantages: effective in the correction of extensive maxillary bone deficiencies, restoring aesthetics and functionality to the patient, and high rates of success with implants. Thus, bone grafts from the calvaria are viable options for the rehabilitation of atrophic maxilla.

Maxillary bone augmentation with calvarial bone graft for immediate full-arch rehabilitation: Insights from a 10-year proof-of-concept retrospective analysis.

Evaluate the long-term outcomes of full-arch rehabilitation using immediate dental implant placement and continuous functional loading with full-fixed dental prostheses (FFDPs). Fifty-six patients received temporary implants (n = 327) at maxillary augmentation with calvarial bone. A provisional acrylic FFDP was immediately loaded onto these implants. After 6 months, the temporary implants were replaced with definitive implants (n = 326) and immediately loaded with a second provisional FFDP (N = 55). Subsequently, a baseline radiograph was taken following a 6-month healing period. The second bridge was then substituted with a definitive FFDP. Primary outcomes included peri-implant marginal bone level (MBL) and definitive implant survival. Secondary outcomes evaluated provisional implant and prostheses survival, complications, and patient satisfaction. The provisional implants had a survival rate of 97.9%. One patient was excluded from further analysis due to loss of temporary implants and first FFDP. The definitive implant survival rate after 10 years was 92.2%, with a moderate but significant decrease in MBL between baseline radiography and 10 years later (-0.08 ± 0.18 vs. -0.24 ± 0.44). However, large individual variations were observed, with 65.8% of implants showing no bone loss and 9.2% showing loss ≥0.5 mm. Sinusitis was experienced by 14.3% of patients upon surgery. Patient satisfaction was high or reported no issues after protocol completion (80%). One patient lost all six definitive implants and definitive FFDP 8.2 years after implant placement. The described protocol can be regarded as a long-term, highly successful method for full-arch rehabilitation of atrophied maxillae while enabling continuous masticatory and speaking functionality.

Changes in Volume and Bone Density of Calvarial Grafts After Two Years of Orbital Reconstruction.

One of the greatest challenges in orbital reconstruction is to obtain adequate orbital volume and globe projection after traumatic injury. Autologous bone graft has been considered the gold standard for orbital floor reconstruction, but the harvesting yields many possible complications, such as donor site morbidity. Bone resorption is a frequent problem that can lead to insufficient volume after graft placement. There is a theoretically lower resorption rate of skull bone grafts, even though the exact amount is not known yet. This study is the first to evaluate bone volume and density changes of calvarial split bone grafts after orbital floor reconstruction with a 2-year follow-up. Bone volume and density of calvarial split grafts were determined using computed tomography scans and the software program RadiAnt Dicom Viewer in a total of 10 patients with orbital floor fracture reconstruction. Computed tomography scans taken immediately after surgery (T0) and after a postoperative period of 2 years (T1) were evaluated. The authors found a mean bone volume reduction of 34.25% after 2 years. Bone density was still high after 2 years (over 850 HU), with a mean reduction of 8%. Based on these findings, calvarial split bone grafts represent the ideal reconstruction material for orbital floor fractures.

Effects of Pterional and Osteoplastic Craniotomy on Temporalis Muscle and Calvarial Bone Graft Atrophy.

This study aims to compare the effects of osteoplastic craniotomy on temporalis muscle and bone graft atrophy in patients operated on with a pterional approach to the standard technique. Patients operated on for an intracranial aneurysm with a pterional approach between 2014 and 2018 were studied. Following the exclusion criteria, 36 patients were included in this retrospective study. Temporalis muscle volume and bone graft volume were calculated. The volumes were compared from preoperative and postoperative computed tomography images for temporalis muscle and from early and late postoperative computed tomography images for the bone graft. The osteoplastic craniotomy group (group I) had 17 patients, and the standard craniotomy group had 19 patients (group II). Temporalis muscle volume and bone graft volume decreased statistically significantly in group II after surgery. However, no significant volume difference was found in group I measurements. When compared with the standard technique, osteoplastic craniotomy reduces the likelihood of postoperative temporalis muscle and bone graft atrophy in patients undergoing pterional craniotomy. As a result, the patients' cosmetic and functional well-being is improved.

Primary Cranio-Orbital Presentation of Multiple Myeloma.

A 49-year-old man presented with left upper eyelid ptosis noted after minor head trauma. Clinical examination revealed a soft, mildly tender mass of the superior orbit with left hypoglobus and relative proptosis. He had moderate limitation in supraduction, without visual or pupillary deficit. MRI imaging showed a superior extraconal cystic mass (Fig. 1C, D), and CT demonstrated erosion of the superior orbital roof and invasion of the frontal sinus (Fig. 1A, B).FIG. 1Excisional biopsy was performed via a bifrontal craniotomy with a frontal bone flap, exposing a well-encapsulated vascular lesion eroding through the orbital roof and frontal sinus (Fig. 2A). The mass was dissected from the surrounding dura, sinus mucosa, and periorbita, and removed in toto (Fig. 2B). The frontal sinus was obliterated and a split-thickness calvarial bone graft was used to reconstruct the orbital rim and roof, secured with mini plate fixation (Fig. 2C).FIG. 2Pathological analysis revealed plasma cell neoplasm (Fig. 2D) with clonal kappa-light proliferation (Fig. 2E), consistent with an extramedullary plasmacytoma. The full-body PET scan revealed multiple lytic lesions of the clavicle, rib, and vertebrae, conferring a diagnosis of multiple myeloma. He underwent an autologous stem cell transplant and started maintenance Bortezomib therapy with a good serologic response. Multiple myeloma accounts for 10% of hematologic malignancies and presents as a malignant plasma cell proliferation leading to bone marrow destruction. There are few reports of multiple myeloma initially presenting in the orbit. Solitary plasmacytoma without systemic disease may be treated with radiation therapy. Systemic disease mandates oncologic evaluation and consideration of chemotherapy or transplant.

Considerations in Eyelid Reconstruction in Treacher Collins Syndrome: A Scoping Review

Objective: Treacher Collins syndrome (TCS) is a rare congenital craniofacial disorder with extensive associated eyelid deformities. Given its rarity and the breadth of manifestations, many treatment options have been previously described, but never summarized. Design: A literature review adherent to PRISMA guidelines and pertaining to surgical outcomes of TCS eyelid repair was performed. Successful surgical outcomes were defined as improvement or satisfaction as described by the authors. Results: A total of 144 patients and 212 procedures from 24 articles were included in this review. The mean age of first eyelid reconstruction was 13 years (range 1-36 years). Previous craniofacial surgery for malar insufficiency was performed in 57% of patients using a calvarial bone graft (n = 56), temporal osteomuscular flap (n = 21), split-rib graft (n = 3), and malar implant (n = 2). Patients underwent between 1 and 3 eyelid procedures (median 2). Most common eyelid defects included pseudocolobomas (54%), lateral canthal dystopia (38%), and true colobomas (8%). Coloboma repairs had the highest success rate (92%), followed by pseudocoloboma (80%), and lateral canthal dystopia repair (79%). Coloboma repair had the highest revision rate (13%), followed by pseudocoloboma repair (2%). Conclusion: TCS eyelid abnormalities most commonly present as pseudocolobomas, true colobomas, and lateral canthal dystopia. Given this diversity of presentations in TCS, surgical management must ultimately be tailored to the collective defects present with consideration of previous craniofacial reconstruction and current midface development.

Sternal cleft reconstruction with acellular dermal matrix and full-thickness calvarial graft.

We describe reconstruction of a sternal cleft in a neonate using acellular dermal matrix, full-thickness calvarial bone graft and myocutaneous pectoralis flaps.

Rehabilitation of severe dentofacial deformity after early radiotherapy of retinoblastoma: a case report

BackgroundRetinoblastoma is an intraocular cancer of infancy and childhood, which has been treated with radiation therapy and chemotherapy. Radiation on growing patients can cause deterioration in maxillofacial growth and development that leads to severe skeletal discrepancies between the maxilla and mandible, and dental problems such as crossbite, openbite, and hypodontia.Case presentationWe present the case of a 19-year-old Korean man with chewing disability and dentofacial deformities. He had undergone enucleation of the right eye and radiation therapy of the left eye due to retinoblastoma 100 days after birth. Subsequently, he received cancer therapy for the secondary nasopharyngeal cancer at the age of 11 years. He was diagnosed with severe skeletal deformity including sagittal, transverse, and vertical growth deficiency of the maxilla and midface, and with class III malocclusion, severe anterior and posterior crossbite, posterior openbite, multiple missing upper incisors, right premolars, and second molars, and impaction of the lower right second molars. To restore impaired functions and esthetics of the jaw and dentition, the orthodontic treatment combined with two jaw surgery was performed. At the end of surgical orthodontics, dental implants were placed for prosthetic treatment of missing teeth. Additional plastic surgery for zygoma elevation was done with calvarial bone graft followed by fat graft. Facial esthetics and occlusal functions of patient were favorably enhanced with the improvement of skeletal discrepancy and the rehabilitation of maxillary dentition by prosthetic work. At the 2-year follow-up, the skeletal and dental relationships and implant prosthetics were well maintained.ConclusionIn an adult patient with dentofacial deformities caused by early cancer therapy in the head and neck area, interdisciplinary interventions including additional plastic surgery of zygoma depression and prosthetic work of missing teeth as well as surgical–orthodontic treatment could establish favorable facial esthetics and oral rehabilitation.

Cranial Base Reconstruction and Secondary Frontal Advancement for Meningoencephalocele Following LeFort III Osteotomy in a Patient with Crouzon Syndrome: Case Report.

Patients with Crouzon syndrome have increased risks of cerebrospinal fluid rhinorrhea and meningoencephalocele after LeFort III osteotomy. We report a rare case of meningoencephalocele following LeFort III midface advancement in a patient with Crouzon syndrome. Over 10 years since it was incidentally found during transnasal endoscopic orbital decompression, the untreated meningoencephalocele eventually led to intermittent clear nasal discharge, frontal headache, and seizure. Computed tomography and magnetic resonance imaging demonstrated meningoencephalocele in the left frontal-ethmoid-maxillary sinus through a focal defect of the anterior cranial base. Through bifrontal craniotomy, the meningoencephalocele was removed and the anterior cranial base was reconstructed with a pericranial flap and split calvarial bone graft. Secondary frontal advancement was concurrently performed to relieve suspicious increased intracranial pressure, limit visual deterioration, and improve the forehead shape. Surgeons should be aware that patients with Crouzon syndrome have the potential for an unrecognized dural injury during LeFort III osteotomy due to anatomical differences such as inferior displacement and thinning of the anterior cranial base.

Three-dimensional Assessment of Autologous Calvarial Bone Grafting for Alveolar Clefts Reconstruction in Pediatric Population: A Retrospective Study.

Reconstruction of alveolar clefts using cancellous bone graft is associated with a high rate of resorption. The aim of this study was to evaluate the osseointegration capacity of cortical calvarial bone grafting using 3-dimensional imaging assessment for alveolar cleft reconstruction in pediatric population.All alveolar bone grafting procedures performed between January 2015 and October 2017 in the maxillofacial surgery department of Lille University Hospital were included. All patients were evaluated clinically and by 3-dimensional imaging before bone grafting and at 3 months after surgery. Cleft and bone graft volumes were assessed using Horos software, v. 3.3.5, through a segmentation process. The bone filled ratio at 3 months after surgery was calculated. A total of 48 alveolar bone grafting procedures were performed in 37 patients: 3 unilateral cleft lip and alveolar, 20 unilateral cleft lip and palate, and 25 bilateral full cleft lip and palate (3 patients had only unilateral surgery). The mean bone filled ratio was 72.27%±23.65%, 81% for unilateral cleft lip and alveolus, 75.4%±20.6 for unilateral cleft lip and palate, and 65.5%±30 for bilateral complete cleft lip and palate ( P =0.1981). Calvarial bone grafting seems to be a relevant alternative to other donor sites for alveolar cleft reconstruction.

Reconstructive Approaches Following Sphenoorbital Meningioma Resection.

Sphenoorbital meningiomas are a challenge to access and reconstruct. Although there is much neurosurgical literature on resection of such tumors, there is little discussion on the best methods for the reconstruction of consequent defects, which are often extensive due to large areas of hyperostosis requiring resection. We performed a retrospective analysis of patients who underwent resection and reconstruction of a sphenoorbital meningioma by the senior authors (C.S. and D.A.S.) between 2010 and 2020. Surgical access in all cases included an orbitozygomatic osteotomy. The study cohort consisted of 23 patients (20 female, 3 male) with an average age of 50 (range: 37-72) years at the time of surgery. Most patients had progressive proptosis before the ablative operation. Orbital reconstruction was with a combined titanium-Medpor implant in 18 patients, split calvarial bone graft in 3 patients, and a Medpor implant in 2 patients. Calvarial reconstruction was performed with titanium mesh in 21 patients, split calvarial bone graft and titanium mesh in 1 patient, and craniotomy bone and titanium plate in 1 patient. Reoperation was required in 7 patients due to hypoglobus or enophthalmos (N=2), orbital implant malposition (N=1), abscess (N=1), pain (N=1), intracranial fat graft modification (N=1), and soft tissue deformities (N=2). Our experience demonstrates that sphenoorbital meningiomas can require broad areas of resection of the skull base and calvarium and necessitate comprehensive reconstruction of the anterior cranial fossa, orbital walls, and cranium. Collaboration between craniofacial surgeons and neurosurgeons can achieve optimal results.

Computer guided calvarial bone grafting for reconstruction of orbital floor blow out fracture.

Calvarial grafts represents a superior option for orbital floor reconstruction, however the difficulty of intraoperative moulding and placement remains as a major limitation. We used patient specific guides and sterolithographic models to facilitate this procedure. The study was conducted on 10 patients with orbital floor blow out fracture. A graft harvesting guide was virtually constructed based on the defect using mirroring of the normal side. The virtual guide and the defective orbital floor were then printed. The graft was harvested using the guide and adjusted to the defect using the model, finally seated in place. All patients showed no enophthalmos or diplopia. Orbital volume was comparable for both traumatised and normal orbits with no statistical significance difference (p value 0.28), and orbital volume ratio was 101.76±4.7%. The use of graft harvesting guide and orbital floor models for intraoperative graft moulding showed promising results.

Treatment of tegmen dehiscence using a middle fossa approach and autologous temporalis fascia graft: Outcomes from a single center

IntroductionAlthough bony defects of the tegmen surface are relatively common, the majority of dehiscences are asymptomatic. For those who experience symptoms, there is a wide spectrum of relatively benign manifestations such as hearing loss and otorrhea to potentially more serious but rare sequelae such as epilepsy and meningitis. Surgical management of tegmen dehiscences (TDs) can help prevent these symptoms. In this manuscript, we present one of the largest reported single team experiences of using a temporal craniotomy with middle cranial fossa approach and temporalis fascia graft in the treatment of tegmen defects. MethodsWe retrospectively reviewed every case of a TD surgically repaired by the same neurosurgeon/otolaryngologist team at Loyola University Medical Center from May 2015 to January 2022. In our chart review, we identified 44 patients with 48 cases of tegmen defect repair. We analyzed patient characteristics, operative details, and postoperative outcomes. Results44 patients met inclusion criteria for the presence of TD (mean age 55 years, 55% male, and average body mass index 35.6). 89% of these patients had no clear etiology for the dehiscence. Commonly reported symptoms were hearing loss (89%) and CSF otorrhea (82%). The least reported presenting signs and symptoms were seizures (5%) and meningitis (2%). Most defects were repaired with both temporalis fascial and calvarial bone grafts (63%), while a minority were treated with temporalis fascia only (33%), temporalis fascia with muscle (2%), or fascia lata (2%). Every patient in our sample experienced resolution of CSF otorrhea after tegmen repair and 81% of the sample reported subjective hearing improvements after surgery. 6% of our sample had post-operative infections and 8% of patients underwent repeat unilateral surgery for a surgical complication. ConclusionCraniotomy for middle fossa approach using autologous temporalis fascial grafts is a safe and effective method for the treatment of TD. These procedures should be performed by experienced and multidisciplinary teams.

Orbital Roof and Lateral Wall Reconstruction Using Split-Thickness Calvarial Bone Graft with Titanium Mesh Complex for a Spheno-Orbital Meningioma

ABSTRACT Objective: To describe our reconstruction of an orbital roof and lateral wall defect using a split- thickness calvarial bone graft with titanium mesh complex after resection of a meningioma of the left greater wing of the sphenoid with extension to the left frontotemporal bone and left orbital roof and lateral wall. Methods: Study Design: Surgical Innovation Setting: Tertiary Private University Hospital Patient: One Results: A 44-year-old woman with a left frontotemporal mass associated with left eye proptosis and epiphora underwent reconstruction of the left orbital roof and lateral wall defect using split-thickness calvarial bone graft with titanium mesh and screws after a left frontotemporal craniectomy, superior and lateral orbital wall resection of a mass of the sphenoid wing with orbital and frontotemporal extension. Final histopathology was consistent with meningioma. Surveillance of the mass and orbital reconstruction showed evidence of bone growth and osteointegration of the titanium mesh into the bone grafts. Conclusion: The initial good outcome of orbital roof and lateral wall reconstruction using split-thickness calvarial bone graft with titanium mesh is evidenced by osteointegration of the titanium mesh and revascularization leading to new bone growth. This autogenous-alloplastic complex may provide a more stable option for orbital reconstruction, but long term follow-up is needed for surveillance of recurrence and monitoring the status of orbital reconstruction.

Multiprofessional approach for class III malocclusion rehabilitation with autogenous calvarial bone graft followed by Le Fort 1 osteotomy and implant-supported prostheses – case report

Extensive treatments can eventually be challenging. Even more so when the patient has limitations such as extensive tooth loss and skeletal changes, including overgrowth of the lower jaw. When indicated, these treatments tend to discourage patients due to the history of previous failures. Therefore, in addition to an interdisciplinary dental team composed of oral and maxillofacial surgeons, and prosthodontists, a nutrologist, a speech therapist, and a psychotherapist were involved in the treatment of this case. A 52-year-old female patient, Angle Class III malocclusion, with few teeth and extensive maxillary bone loss, attended the dental clinic of the Brazilian Association of Dentistry in Uberlândia. The treatment involved reverse planning, extraction of the dental remnants, calvarial bone grafting, placement of 6 titanium implants (Neodent) in the maxilla (upper jaw) and 5 in the mandible (lower jaw), orthognathic surgery, and installation of implant-supported fixed complete dentures in both jaws. Furthermore, psychotherapeutic and nutrologist’s interventions were necessary during the dental treatment, concluding the treatment with speech therapy. Within the limitations of this case, the multidisciplinary approach proved to be efficient. It promoted the reestablishment of the stomatognathic system functions without compromising nutrition during the periods when it was impossible to wear prostheses for better healing of the tissues.

Incorporation of anterior iliac crest or calvarial bone grafts in reconstructed atrophied maxillae: A randomized clinical trial with histomorphometric and micro‐CT analyses

BackgroundAutologous bone grafts have been applied successfully to severely atrophied maxilla via a preimplant procedure. Differences in graft incorporation at the microscopic level can be the decisive factor in the choice between anterior iliac crest and calvarial bone.PurposeTo compare conversion of anterior iliac crest bone and calvarial bone 4 months after grafting of the edentulous maxilla.Materials and methodsTwenty consecutive patients were randomly assigned to either anterior iliac crest (n = 10) or calvarial (n = 10) bone harvesting to reconstruct their atrophied maxillae. Biopsies were taken from both fresh bone grafts and reconstructed maxillae after 4 months healing, at time of implant placement. Micro‐CT, histomorphometric and histological analyses were performed.ResultsMicro‐CT analysis revealed that both the anterior iliac crest and calvarial bone grafts retained their volume and bone mass after being incorporated in the maxilla, but with a favor for calvarial bone grafts: calvarial bone grafts had a higher mineral density before and after incorporation. Both bone grafts types were well incorporated after 4 months of healing with preservation of bone volume and mineral density. Although the fresh bone biopsies were similar histomorphometrically, after 4 months of graft incorporation, the osteoid percentage and osteocyte count remained higher in the anterior iliac crest bone whereas the percentage of bone was higher in the calvarial bone grafts compared to the anterior iliac crest bone grafts.ConclusionsBoth donor sites, that is, anterior iliac crest and calvarial bone, are well suited to provide a reliable and stable basis for implant placement 4 months after grafting with mineral density, porosity, and resorption rate in favor of calvarial bone grafts.