Reconstruction of the severely atrophic maxilla: A retrospective study

Reconstruction of the severely atrophic maxilla: A retrospective study
August 2003
Peter Gioulos, BSc, DDS
C.M.L. Clokie
G.K.B. Sandor
Journal of Oral and Maxillofacial Surgery Online
Abstract
Purpose: The removal of maxillary posterior teeth may lead to insufficient bone in the posterior maxilla for endosseous dental implant placement. This is due in part to the pneumatization of the maxillary sinuses. Different strategies for bone augmentation in the posterior maxilla have been attempted including techniques involving alloplastic, allogenic, and autogenous bone grafts. The objective of this investigation was to evaluate the efficacy of autogenous bone harvested from the iliac crest for subantral augmentation of the maxillary sinus and subsequently the ability of this site development strategy to allow for osseointegration.
Materials and Methods: Fifty-four patients (90 sinuses) with posterior maxillary alveolar ridge Lekholm-Zarb bone quality classification of 4 were evaluated. Bone was harvested from the anterior iliac crest in 17 patients and from the posterior iliac crests in 37. Forty-two patients were additionally treated with platelet rich plasma (PRP) at the time of bone graft placement. Two hundred seven root form endosseous dental implants were placed 6 to 9 months after initial graft surgery. Pantomography was used to evaluate posterior maxillary alveolar ridge height preoperatively (T1), immediately postoperatively (T2), and at the time of dental implant insertion (T3).
Results: Alveolar height was seen to increase at T2 by 14 mm with subsequent bone height loss at T3 during graft consolidation prior to implant insertion of 1.2 mm. The overall rate of osseointegration of the endosseous implants was found to be 94.7%. Eighteen patients experienced postoperative complications including soft tissue infection of the grafted site, implant failure, dehiscence of the grafted site, soft tissue infection of the donor site, sinus infection with fistulae, and seroma of the posterior hip donor site. Nine patients treated with PRP had bone cores harvested at the time of implant insertion and histomorphometric analysis revealed an average of 46.4% vital bone per core. No statistically significant differences in implant success were found with respect to gender, application of PRP, the different implant systems used, or donor site used.
Conclusion: The 2 step approach to posterior maxillary reconstruction with bone graft harvest from the iliac crest followed by dental implant placement at 6 to 9 months allows for predictable maxillary reconstruction and osseointegration.
References
Pejrone G, Lorenzetti M, Mozzati M, et al: Sinus floor augmentation with autogenous iliac bone block grafts: A histological and histomorphometrical report on the two-step surgical technique. Int J Oral Maxillofac Surg 13:69, 1998
Lekholm U, Wannfors K, Isaksson S, et al: Oral implants in combination with bone grafts: A 3-year retrospective multicenter system. Int J Oral Maxillofac Surg 28:187, 1999
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doi:10.1016/S0278-2391(03)00619-0