Extraoral Donor Sites Research Articles

Maxillary Anterior Implant-supported Restorations with Allogeneic Block-bone Graft: A Report of Two Clinical Cases

Prosthetic rehabilitation of a severely atrophic anterior maxilla is challenging. To achieve aesthetic and functional outcomes with anterior implant-supported restorations, horizontal or vertical bone augmentation should be performed prior to implant placement. Autogenous block-bone grafting is the gold standard for onlay graft techniques; however, it is associated with problems, such as patient discomfort due to additional surgery at the intra- or extra-oral donor site. Therefore, the allogeneic block-bone graft, which is relatively less traumatic and safer, is used for convenience, and the high success rate in previous studies has proven the reliability of this technique. Herein, we report two cases in which allogeneic block-bone was successfully grafted in single and long-span defects in the maxillary anterior region, with satisfactory aesthetic and functional outcomes that were stable at regular follow-ups after surgery.

V-shaped Folded Nasolabial Flap in the Repair of the Anterior Buccal Mucosal Defect.

To investigate the efficacy of V-shaped folded nasolabial flap in the repair of small-sized and medium-sized defects of the anterior buccal mucosa. From March 2019 to December 2021, 9 cases of male patients with anterior buccal mucosal lesions were enrolled in this study. After the lesions were completely excised, the mucosa and part of the buccal mucosal defect were left. A transverse V-shaped folded nasolabial flap was created with the pedicle located at the corner of the mouth and the long axis along the nasolabial fold. The lower part was lifted from the end to the pedicle. Next, from the level of the superficial musculo-aponeurotic system, the upper and lower parts were lifted from the end to the pedicle, and the V-shaped flap was folded and turned over through the buccal tunnel to repair the mucosal defect. The extraoral donor site was directly pulled and sutured. The nasolabial flap survived in 9 patients, and the wounds inside and outside the mouth healed at stage I. The postoperative follow-up time was 4 to 32 months, and the patients had no recurrence, with symmetrical buccal shape, and no traction and deformation in the affected buccal organs. In addition, the linear scar had no obvious hyperplasia and was hidden in the affected nasolabial folds, without symptoms of buccal nerve injury, and the shape of the corner of the mouth was normal. The width and opening degree of oral fissure were not significantly reduced compared with those before operation. Meanwhile, the intraoral flap was thin and flat, and healed well with the surrounding mucosa, without obvious flap contracture, buccal bite, or incomplete closure. Overall, V-shaped folded nasolabial flap has the advantages of flexible design, simple preparation, reliable blood supply, and protection of the donor site, which may be one of the effective methods for repairing small-sized and medium-sized defects in the anterior buccal mucosa.

Survival Rates of Dental Implants in Autogenous and Allogeneic Bone Blocks: A Systematic Review.

Background and Objectives: Preliminary studies emphasize the similar performance of autogenous bone blocks (AUBBs) and allogeneic bone blocks (ALBBs) in pre-implant surgery; however, most of these studies include limited subjects or hold a low level of evidence. The purpose of this review is to test the hypothesis of indifferent implant survival rates (ISRs) in AUBB and ALBB and determine the impact of various material-, surgery- and patient-related confounders and predictors. Materials and Methods: The national library of medicine (MEDLINE), Excerpta Medica database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies reporting the ISRs of implants placed in AUBB and ALBB with ≥10 participants followed for ≥12 months from January 1995 to November 2021. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed via several scoring tools, dependent on the study design. Means of sub-entities were presented as violin plots. Results: An electronic data search resulted in the identification of 9233 articles, of which 100 were included in the quantitative analysis. No significant difference (p = 0.54) was found between the ISR of AUBB (96.23 ± 5.27%; range: 75% to 100%; 2195 subjects, 6861 implants) and that of ALBB (97.66 ± 2.68%; range: 90.1% to 100%; 1202 subjects, 3434 implants). The ISR in AUBB was increased in blocks from intraoral as compared to extraoral donor sites (p = 0.0003), partially edentulous as compared to totally edentulous (p = 0.0002), as well as in patients younger than 45 as compared to those older (p = 0.044), cortical as compared to cortico-cancellous blocks (p = 0.005) and in delayed implantations within three months as compared to immediate implantations (p = 0.018). The ISR of ALBB was significantly increased in processed as compared to fresh-frozen ALBB (p = 0.004), but also in horizontal as compared to vertical augmentations (p = 0.009). Conclusions: The present findings widely emphasize the feasibility of achieving similar ISRs with AUBB and ALBB applied for pre-implant bone grafting. ISRs were negatively affected in sub-entities linked to more extensive augmentation procedures such as bone donor site and dentition status. The inclusion and pooling of literature with a low level of evidence, the absence of randomized controlled clinical trials (RCTs) comparing AUBB and ALBB and the limited count of comparative studies with short follow-ups increases the risk of bias and complicates data interpretation. Consequently, further long-term comparative studies are needed.

Cross-sectional analysis of spatial distribution and total amount of harvestable calvarian split bone

BackgroundBone resorption of the jaw leads to challenging implant placement. Frequently, augmentation of the jaw is necessary. Is calvarian split bone an alternative to other extraoral donor sites and what volume of bone is harvestable? The aim was to evaluate the spatial distribution and the total amount of harvestable calvarian split bone. Material and MethodsComputerized tomographies of 600 patients were divided into four groups (male and female: ≤45 years and >45 years). The skull was segmented and cut into the harvestable compartments (Os frontale, Ossa parietalia). The volume and thickness of the harvestable bone were calculated. ResultsThe overall harvestable bone was 110.644 ± 25.429 cm³. The bone from the Os frontale was significantly less than harvestable bone from the Os parietale (p < 0.001). More bone could be harvested from the right Os parietale. In younger males, significantly more bone could be harvested than in females (females ≤45 years: p = 0.001; females >45 years: p = 0.003). A weak negative correlation existed between the participants’ age and the harvestable bone volume of the left Os parietale (r = −0.087; p = 0.033). The thickness of the harvestable bone from the Ossa parietalia is greater in females than in males. ConclusionA great amount of calvarian bone can be harvested to augment the jaw. Surgeons must acknowledge that more bone is harvestable from males than females while the female bone is thicker. Calculating the volume leads to accurate results of the available bone.

Calvarial bone grafts to augment the alveolar process in partially dentate patients: a prospective case series

BackgroundCalvarial bone grafts as a pre-implant augmentation procedure are mostly used to reconstruct the edentulous maxilla, although calvarial grafts could also be used in the partially dentate patients needing extensive bone grafting.MethodsIn 7 consecutive partially dentate patients needing bone grafting because of a large bony defect as a result of trauma (n = 1), oligodontia (n = 1), failed previous bone augmentation (n = 1), or atrophy (n = 4), the alveolar process was reconstructed with calvarial bone as a pre-implant procedure.ResultsA total of 30 implants was placed either immediate at the time of bone grafting (13 implants) or after a healing time of 4 months when immediate placement was not possible (17 implants). One wound dehiscence occurred that needed secondary intervention. During follow-up (40 ± 14 months), one implant was lost due to peri-implantitis with an infected osteosynthesis screw. Marginal peri-implant bone loss was 0.65 ± 0.47 mm during this period.ConclusionCalvarial bone is a sound extra-oral donor site when aiming for reconstruction of a large bony defect of the alveolar process of partially dentate patients.

Multicenter study of patients' preferences and concerns regarding the origin of bone grafts utilized in dentistry.

PurposeBone graft materials can be obtained from the patient’s own body (autologous graft), animals (xenograft), human cadavers (allograft) and synthetic materials (alloplastic bone graft). Patients may have ethical, religious or medical concerns about the origin of bone grafts, which could lead them to reject the use of certain types of bone graft in their treatments. The aim of this multicenter study, which surveyed patients from five university clinics in Portugal, France, Italy, Spain and Chile, was to analyze patients’ opinions regarding the source of bone grafts.Patients and methodsA survey composed of ten questions was translated into local languages and validated. Patients were asked about the degree of acceptance/rejection of each graft and the reasons for rejection. A chi-squared test was used to analyze statistically significant differences.ResultsThree hundred thirty patients were surveyed. The grafts that elicited the highest percentage of refusal were allograft (40.4%), autologous bone graft from an extraoral donor site (34%) and xenograft (32.7%). The grafts with the lowest rate of refusal were alloplastic (6.3%) and autologous bone grafts from an intraoral donor site (24.5%). The main reason for autologous bone rejection was the fear of pain and discomfort, for xenograft it was the fear of disease transmission and the rejection of use of animals for human benefit, and for allograft it was ethical/moral motivations and the fear of disease transmission. Religious affiliation influenced patient’s preferences.ConclusionThe origin of bone grafts is still conflictive for a high percentage of patients.

Assignment of autogenous bone grafts for reconstruction of the alveolar ridge before implant placement

Introduction:Autologous bone is considered to be the “gold standard” for the reconstruction of the reabsorbed alveolar ridges. For small defects, autologous bone samples can be harvested from intraoral donor sites. However, extraoral donor sites are the first choice for any extensive augmentation of the alveolar ridges. The resorption of the bone grafts depends on several factors, including the recipient sites, the donor sites, volume of the bone grafts and whether or not the patient smokes. The aim of this study was to investigate the rate of autologous bone graft resorption, 4 months after the surgical reconstruction, according to their sites of origin, parietal or ramus, according to the grafted site, mandible or maxilla and according to the surgical indications.Patients and methods:22 patients had 51 reconstructions of alveolar ridges with ramic or parietal onlay bone grafts. The increase of bone volume was assessed with computed tomography, immediately after augmentation (V0) and 4 months after the procedure (V1), before the placement of dental implants.Results:The mean rate of bone resorption was 26% for the parietal bone grafts and 27% for the ramus bone grafts after 4 months (p: ns). This rate was 26% for maxillary grafts and 25% for mandibular grafts (p: ns). This rate varies from 22% to 33% according to the etiology of the bone defect but these variations are not significant and ultimately, this rate of bone resorption was unaffected by the gender of patients.Conclusion:Based on these findings, the resorption of onlay grafts doesnʼt seems to be affected by the recipient and donor sites nor by the etiology of the bone defects. Parietal and ramic bone grafts showed limited resorption rates for the pre-implant reconstruction of alveolar ridges.

Clinical Outcome of Implants Placed in Staged Maxillary Sinus Augmentation Using Bovine Bone Mineral Mixed with Autogenous Bone at Three Different Ratios: A 5-Year Prospective Follow-up Study.

To evaluate the 5-year clinical outcomes for implants placed in a staged sinus floor elevation (SFE) procedure and to compare three patient groups with sinus grafts with three different ratios of bovine bone mineral (BBM) and autogenous bone (AB) mixture. A 5-year prospective cohort study was conducted on 81 patients with 119 staged SFEs non-randomly distributed to three groups based on the origin of the AB and the mixture ratio with BBM: group 1 (locally harvested AB [LHB] from osteotomy sites + BBM, ratio: 1:10), 31 patients, 37 SFEs; group 2: (LHB + intraorally harvested peripheral AB [IHPB] from retromolar/chin region + BBM, ratio: 1:4), 22 patients, 29 SFEs; and group 3 (LHB + extraorally harvested peripheral AB [EHPB] from iliac crest/tibia + BBM, ratio 1:1), 28 patients, 53 SFEs. After graft healing (5 to 7 months), 284 dental implants (group 1: 76, group 2: 61, group 3: 147 [overall: 2.3 implants/sinus]) were placed. After an additional healing period (5 to 7 months), all implants placed were functionally loaded and prospectively followed by clinical and radiographic evaluations assessing implant survival/success rate as well as peri-implant marginal bone level (MBL) alteration at 1, 3, and 5 years postloading. A total of 76/81 patients with 267/284 implants were followed for up to 5 years (dropouts: 5 patients/15 implants; implant loss = 2). The 5-year implant survival and implant success rate (group 1: 100%/98.6%; group 2: 98.3%/96.6%; group 3: 99.3%/95.7%) did not differ between the three graft mixture groups. The peri-implant marginal bone alteration (reduction) averaged over all 5 years was 1.40 ± 0.29 mm for group 1, 1.41 ± 0.22 mm for group 2, and 1.46 ± 0.46 mm for group 3 (P = .187). However, over time, a continual and significant MBL reduction (P = .045) was noted for all groups presenting peri-implant MBL changes between 1 year and 5 years of -0.17 mm (group 1), -0.12 mm (group 2), and -0.24 mm (group 3), respectively. According to the clinical results obtained, dental implants inserted in grafted (staged) SFE using a mixture of BBM with a minimal amount of AB harvested from local sites provide for similarly high 5-year implant/augmentation success rates as graft mixtures with AB harvested from peripheral intraoral or extraoral donor sites, confirming no need for additional bone harvesting.

Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants

ObjectivesThe reconstruction of extended and complex defects of the alveolar bone is a frequent requirement prior to implant placement. The aim of this study was to assess and compare location, intensity, and experience of pain after bone graft harvesting for dental implants with respect to the donor site. MethodsIn this prospective non-randomized intervention study, a consecutive sample of 23 patients who received autologous bone grafts from intra-oral (IO; N = 8) or extra-oral (EO; N = 15) donor sites prior to insertion of dental implants for fixed dental prostheses were recruited. All patients completed a self-administered questionnaire regarding pain location, intensity, and experience at baseline (B; before surgery), at the first follow-up (F1; 3 days after surgery), and at the second follow-up (F2; 4 weeks after surgery). Relative Risk Ratios (RRR) were determined for pain locations. For pain intensity and pain experience, 95% confidence intervals were evaluated using percentiles of a bootstrap with 1000 replications to assess statistical significance. ResultsBoth patient groups did perceive pain in the mouth/face after the intervention, but patients in the EO donor site group had additional pain at the hip, felt their pain longer and of higher intensity, and had more negative pain experiences than patients with IO donor sites (all p < 0.05). ConclusionsWhile both IO and EO bone graft harvesting are procedures that are associated with pain in a large proportion of patients, an EO donor site is expected to lead to more pain-related burdens than an IO donor site. Clinical significancePrior to bone graft harvesting, surgeons can now provide patients with tailored information regarding pain perceptions to be expected. This will help the patients with making an informed decision, and on whether or not to agree with surgery.

The Use of Cortical Bone Wedges from the Mandibular Ramus “Wedge Technique”: For 3-Dimensional Bone Augmentation of the Atrophic Ridges. Technique Presentation and Report of Case Series

Purpose: Autogenous bone was still considered as the gold standard in bone augmentations prior to implants insertion at the atrophic ridges. However if large bone grafts are needed to augment multiple edentulous atrophic segments, extraoral donor sites may be mandatory. The aim of this report is to introduce the Fares Wedge Technique, as a new bone augmentation method that can augment multiple edentulous ridges with intraoral cortical bone grafts. Methods: This report includes patients with moderate to severe ridge atrophy in different regions of the both jaws who were treated over 6-years period (2009-215) with wedge Technique (WT). Patients received panorex immediately after the surgery, and they were examined clinically and radiographically (periapical) every 2 weeks. At 4 months, computed tomography was performed to evaluate the bone gain. Reentry was performed after 4 to 5 months to evaluate the new bone volume and quality and to insert implants. At this stage specimens for histologic examination were also obtained. Results: 39 augmentation sites in 22 patients (15 women, 7 men: mean age 47 years) were followed 12 to 52 months. The healing process was uneventful, with minimal morbidity. The success rate was 95%, and the bone gain average was 3 - 6 mm vertically and 3 - 9 mm horizontally. In two patients the graft was partially exposed and treated with shaving and rounding the exposed wedges, but the augmentations were saved. In one case the majority of the bone graft was lost. At 38 sites the patients had successfully received 114 implants. Conclusions: wedge technique can augment multiple segments of atrophic ridges with small amount of autogenic graft. The bone volume that achieved was satisfying, especially that the majority of the augmented areas were at posterior mandibular defects.

Risk factors for post-operative complications after procedures for autologous bone augmentation from different donor sites

AimThe aim of this study has been to identify risk factors for post-operative complications after grafting bone from different donor sites prior to implant placement. Material and methodsThe study encompassed 279 patients who underwent autologous bone augmentations in a 2-stage procedure, harvested from three intraoral and one extraoral donor sites, as well as sinus floor elevations prior to implant placement. The following complications were recorded: soft tissue dehiscence; wound infection; bone graft exposure; sensory disturbance; sinusitis symptoms; haemorrhage; graft failure; implant failure. Complications were correlated with: patient age; smoking status; history of gingivitis/periodontitis; cause of tooth loss; jaw area; dental situation; sinus membrane perforation; surgeons' experience. Results279 patients underwent 456 augmentation procedures, involving 546 sites. 436 grafts were successful. 525 implants were inserted into 436 augmented sites in 273 patients. 20 grafts were lost due to complications. 2 implants were removed before prosthetic restoration. 2 implants were lost within 2 years after placement. Age (p = 0.0009, Odds Ratio = 2.44), smoking (p < 0.0001, Odds Ratio = 2.47), Approximal Plaque Index (p < 0.0001, Odds Ratio = 6.64), Sulcus Bleeding Index (p < 0.0001, Odds Ratio = 39.06) and dental situation (p < 0.0001) were significantly correlated with higher post-operative morbidity. Cause of tooth loss (p = 0.7399), jaw area (p = 0.6725), sinus membrane perforation (p = 0.0762) and surgeons' experience (p = 0.0939) did not influence complication rates. ConclusionsPatients over 40 years old, smokers, a history of periodontitis, and augmentation in tooth gaps involving more than one tooth represent a significantly increased risk of there being post-operative complications compared with patients younger than 40 years old, non-smokers, no history of periodontitis, only a single-tooth gap, or free-end arch situations.

Autogenous bone grafts in oral implantology\u2014is it still a \u201cgold standard\u201d? A consecutive review of 279 patients with 456 clinical procedures

BackgroundThis study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts.MethodsA consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the years of 2009 until 2011 with autologous bone transplantation prior to secondary implant insertion. Intraoral donor sites (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, and anterior sinus wall) and extraoral donor site (iliac crest) were used. A total of 279 patients underwent after a healing period of 3–5 months routinely computer tomography scans followed by virtual implant planning. The implants were inserted using guided oral implantation as described by Naziri et al. All records of all the consecutive patients were reviewed according to patient age, history of periodontitis, smoking status, jaw area and dental situation, augmentation method, intra- and postoperative surgical complications, and surgeon’s qualifications. Evaluated was the augmentation surgical outcome regarding bone graft loss and early implant loss postoperatively at the time of prosthodontic restauration as well a follow-up period of 2 years after loading.ResultsA total of 279 patients underwent 456 autologous augmentation procedures in 546 edentulous areas. One hundred thirteen crista zygomatico-alveolaris grafts, 104 ramus mandible grafts, 11 symphysis grafts, 116 grafts from the anterior superior iliac crest, and 112 sinus lift augmentations with bone scrapes from the anterior facial wall had been performed. There was no drop out or loss of follow-up of any case that had been treated in our clinical center in this 3-year period. Four hundred thirty-six (95.6%) of the bone grafts healed successfully, and 20 grafts (4.4%) in 20 patients had been lost. Fourteen out of 20 patients with total graft failure were secondarily re-augmented, and six patients wished no further harvesting procedure. In the six patients, a partial graft resorption was detected at the time of implantation and additional simultaneous augmentation during implant insertion was necessary. No long-term nerve injury occurred. Five hundred twenty-five out of 546 initially planned implants in 259 patients could be inserted into successfully augmented areas, whereas 21 implants in 20 patients due to graft loss could not be inserted. A final rehabilitation as preplanned with dental implants was possible in 273 of the 279 patients. The early implant failure rate was 0.38% concerning two out of the 525 inserted implants which had to be removed before the prosthodontic restoration. Two implants after iliac crest augmentation were lost within a period of 2 years after loading, concerning a total implant survival rate after 2 years of occlusal loading rate of 99.6% after autologous bone augmentation prior to implant insertion.ConclusionsThis review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the “gold standard” in alveolar ridge augmentation prior to oral implantation.

Clinical efficacy of grafting materials in alveolar ridge augmentation: Asystematic review.

To evaluate the efficacy of grafting materials in lateral and vertical ridge augmentations. A systematic review of the literature on the clinical use of grafting materials of the years 1995 to April 2015 was conducted using electronic search of PubMed and Cochrane libraries and hand search of eight print journals. A total of 184 papers were included, comprising 6182 patients. Parameters evaluated were observation period [months], bone formation [histologic area%], defect fill [%], horizontal and vertical gain [mm], loss of augmented volume [mm], complication rate [%], and implant survival rate [%]. Results are expressed as weighted means±SD. Results were obtained after a weighted mean observation period of 27.4 months (range 3-168 months). Bone formation in the augmented areas varied from 33.2±14.9% for allogeneic grafts to 56.0±25.6% for mixtures of autogenous and other grafting materials. Defect fill in dehiscence defects ranged from 51.0±13.6% (synthetic) to 85.8±13.4% (xenogeneic) for the different materials, with an overall weighted mean of 79.8±18.7%. Weighted mean horizontal gain for all particulate grafting materials was 3.7±1.2mm, with variation between 2.2±1.2mm (synthetic) and 4.5±1.0mm (mixtures of autogenous bone with allogeneic/xenogeneic grafting material) without statistical significance. Weighted overall mean vertical gain was 3.7±1.4mm. Vertical gain was substantially higher when space-making barrier materials such as titanium meshes were used; however this was also associated with strong increase in complication rate. Block grafts achieved higher horizontal gain by approximately 1mm. The use of block grafts achieved significantly increased vertical gain compared to particulate material only when autogenous block grafts from extraoral donor sites were used. Horizontal and vertical gain by 3.7mm on average can be achieved using particulate materials. This can be increased by using titanium meshes. Substantial vertical gains beyond this dimension require the use of extraoral bone block grafts.

Histological and clinical analysis of fresh-frozen allogeneic vs autogenic bone grafts for 3D alveolar bone reconstruction

Reconstruction of atrophic alveolar bone can be made with many grafting materi- als. Autogenous bone, from intra- or extraoral donor sites, represents the best doc- umented material in terms of number of patients and follow-up; allogeneic freshfrozen bone (FFB), from dead bodies has been suggested as an alternative to overcome problems related to autogenous bone collection (1, 2). The aim of this work is to histologically and histomorphometrically compare bone biopsies obtained during dental implant placement in reconstructed jaws with either FFB or autologous iliac crest bone blocks using the same surgical grafting procedure. All samples were processed for ground sections and then underwent a histomorphometrical evaluation using a stereologic method. Twenty edentulous patients were treated with either FFB (14 patients, group A) or with autografts (6 patients, group B) iliac crest grafts. Five to 9 months later, dental implants were placed in the reconstructed jaws and bone biopsies were harvested. Reconstructive procedure was uneventful in 9 patients of group A and in all patients of group B. In 5 patients of group A, bone sequestra were obtained and processed for ground sections. These specimens showed the typical findings of a bone necrosis. All other samples from both groups presented the same values in terms of proportion of lamellar, newly formed bone and bone marrow. In group A, the decreasing proportion of blood vessels from apical to coronal, the larger amount of osteocytic lacunae in the apical portion and the fewer vessels in the coro- nal portion compared to group B, evoke an effort of the host bone to “integrate” the graft from the apical portion. FFB cannot be considered as successful and safe in alve olar bone reconstruction as autogenous bone grafting.

Vertical ridge augmentation using the modified shell technique – a case series

Vertical defects of the alveolar crest often restrict the placement of implants. The outcome of vertical augmentation is unpredictable so we aimed to develop a technique that has predictable results. We used autogenous grafts trimmed to shells less than 1mm thick to rebuild the vertical dimensions of the alveolar ridge. The shells were fixed with microscrews and the vertical space between the shell and the residual bone was filled with autogenous particulate bone. Vertical dimensions before and after augmentation were measured and descriptive statistics calculated. A total of 17 patients (10 female, 7 male, mean (SD) age 46 (17) years) had 18 sites augmented (2 sites in one patient). In 2 cases the wound dehisced and healing was by secondary intention. The rest healed uneventfully. The mean (SD) vertical defect was 4.7 (1.4) mm and mean (SD) resorption during consolidation was 0.5 (0.7) mm. All 30 previously planned implants were placed, and none failed during the first year. Loading was monitored for a mean (SD) period of 14.6 (10.5) months. The technique showed promising results and could be an alternative to procedures that use extraoral donor sites.

Surgical techniques for maxillary bone grafting - literature review.

For oral rehabilitation with implant-supported prostheses, there are required procedures to create the bone volume needed for installation of the implants. Thus, bone grafts from intraoral or extraoral donor sites represent a very favorable opportunity. This study aimed to review the literature on the subject, seeking to discuss parameters for the indications, advantages and complications of techniques for autogenous bone grafts.

Impact of donor site for bone graft harvesting for dental implants on health‐related and oral health‐related quality of life

To assess and compare changes in health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) after bone graft harvesting for dental implants with respect to the donor site. Autologous bone grafts were harvested in a consecutive sample of 23 patients (mean age: 46.1years; 52% female) either from an intra-oral (IO; N=8; chin, ascending ramus, buttress region) or an extra-oral (EO; N=15; anterior iliac crest) donor site, followed by implant placements. HRQoL was self-administered by the patients using the Short-Form 36 (SF-36) and OHRQoL was assessed using the Oral Health Impact Profile (OHIP-49) preoperatively, 3days and 4weeks after surgery. Impact of donor site on changes in both concepts of QoL was determined in multiple linear regression analyses. Patients with extra-oral donor sites reported a substantial deterioration in the physical component (PC) of HRQoL indicated by an increase in the PC score of the SF-36 (P<0.001), whereas this score did not significantly change in patients with intra-oral donor sites. The mental health component (MC) of HRQoL (MC score of the SF-36) remained virtually identical in both groups. OHRQoL deteriorated from baseline (67.7 OHIP points) to first follow-up (76.6 OHIP points) in both groups, however, changes were not statistically significant. In clinical decision-making regarding donor site for bone graft harvesting, patients and clinicians should be aware of the expected decrease in HRQoL if deciding to use extra-oral donor sites. Whenever possible, intra-oral donor sites should be preferred.

Comparison of postoperative complications following bone harvesting from two different donor sites for autologous bone replacement (hipbone and proximal epiphysis of the tibia)

Whereas autologous bone replacement was earlier applied in maxillofacial surgery virtually only for the restoration of mandibular defects and for the osteoplasty of patients with cleft alveolar process, the free transplantation of autologous bone (spongiosa or cortical bone or both) is nowadays primarily used for implantation purposes. Autologous bone is still the gold standard for bone replacement. This is the case even though a wide selection of bone substitutes is currently available, with which new bone equivalent to autologous bone can be produced in certain cases. Autologous bone is often obtained from intraoral sources, but if a larger quantity of spongiosa is required, these sites (the chin, the retromolar area of the mandible, the muscular process, etc.) are not suitable. Of the extraoral donor sites, the most frequently used site is the iliac crest, but the proximal epiphysis of the tibia is also appropriate for this purpose since we have recently performed bone transplantations on appreciable numbers of patients, we decided to compare the morbidity data relating to the two donor sites. In the 9 months between March and November 2007, sinus elevations were carried out on 14 patients with bone taken from the tibia, while in 38 patients bone was taken from the iliac crest for osteoplasty on clefted alveolar process. The comparison was based on postoperative clinical examinations, the complaints of the patients and objective study of the morbidity relating to the two donor sites. Clinically the patients tolerated both interventions well. Mobilization took place on the day of intervention. There were no major complications; one minor haematoma was observed after each type of surgery. The postoperative complaints of the patients did not reveal any essential difference. Following bone harvesting from the iliac crest, the gait of the patients slightly hampered for up to 10 to 14 days. In the tibia cases, the patients experienced no pain on walking by the second day. As regards donor site morbidity, protracted (1-2 weeks) oedema was observed after hip surgery, with paraesthesia of the area of innervation of the n. cutaneous femoris lateralis in 1 case, while there was a minor seroma following tibia surgery in 1 case. Our clinical experience suggests that, if 10-15 cm(3) spongiosa is required for augmentation purposes and there is no need for cortical bone, the patient is exposed to less stress when bone is taken from the proximal epiphysis of the tibia.

Alveolar Ridge Augmentation With Titanium Mesh and a Combination of Autogenous Bone and Anorganic Bovine Bone: A 2‐Year Prospective Study

Recently, the use of bovine bone mineral (BBM) in combination with autogenous bone for alveolar ridge augmentation before implant placement has increased in favor because of concerns over morbidity associated with extraoral donor sites. The aim of this prospective study was to evaluate the clinical and radiographic parameters of implants placed in augmented ridges using a 70:30 mixture of autogenous bone and BBM in association with micro-mesh over a 2-year period. Sixteen partially edentulous patients requiring bone augmentation were consecutively treated for 19 reconstructive procedures and delayed implant placement (44 implants) after 8 to 9 months of submerged mesh healing. Clinical examinations were performed and radiographs of the implants were taken 6 months after prosthetic loading and once a year during a 2-year follow-up. Only one (5.3%) of the 19 micro-meshes became exposed after 2 months and was removed. Computed tomography scans of the alveolar ridge pre- and postreconstruction demonstrated mean vertical augmentation of 3.71 +/- 1.24 mm and mean horizontal augmentation of 4.16 +/- 0.59 mm. All of the implants were retained after 2 years, yielding a 100% survival rate. The mean bone resorption around the implants was 1.37 +/- 0.32 mm during the observation period. Only three implants demonstrated bone resorption >2 mm, whereas 41 implants were considered clinically successful, resulting in a success rate of 93.1%. This 2-year prospective study demonstrated that implants placed into augmented bone using this technique exhibited peri-implant stability with high survival (100%) and success (93.1%) rates.

Use of BMP Alone and With Composites for Maxillary Reconstruction

Sinus bone grafting in preparation for endosseous implant reconstruction has been an established procedure for over 25 years. Initially described utilizing autogenous cancellous bone, potential morbidity from intra and extraoral donor sites as well as limited quantities available restrict patient acceptance of these procedures.