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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
Rivista di Chirurgia Maxillo-Facciale
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2009 Dicembre;20(3):163-70
Autogenous onlay bone grafts for the rehabilitation of atrophied jaws with oral implants
Chiapasco M., Zaniboni M.
Unit of Oral Surgery Dental Clinic, Head and Neck Department, S. Paolo Hospital, University of Milan, Milan, Italy
Aim. The aim of this study was to present the long-term results of the rehabilitation of atrophic partially and totally edentulous jaws by means of autogenous onlay bone grafts and endosseous implants, evaluating the success rate of the reconstructive procedures and the survival and success rates of implants placed in reconstructed areas.
Methods. Between 1992 and 2007, 605 patients, aged between 18 and 76 years (mean: 44 years), presenting with partial or total edentulism associated with loss of bone volume due to atrophy or trauma were treated by means of autogenous onlay grafts harvested from intraoral (mental symphysis, mandibular ramus) and/or extraoral (ilium, calvarium) sites, to allow the placement of endosseous implants of adequate dimensions in a prosthetically-driven position. Three to six months after the reconstructive procedures, 2 429 implants were placed in the reconstructed areas, and the prosthetic rehabilitation was completed either with fixed or removable prostheses. Patients were then followed with clinical and radiographic periodical controls from a minimum of 2 to a maximum of 17 years.
Results. The overall complication rate of the reconstructive surgeries was 9.1% (605 patients, 55 complications). Complications were represented by 6 total failures of the graft (0.9%), 8 partial failures of the graft (1.3%), 23 relevant bone resorption before implant placement (3.8%), and finally 21 early exposures of the graft (3.5%), of which 15 associated to the total or partial failures of the grafts, and 6 with no significant sequelae. Out of 2 429 implants placed, 74 were removed due to chronic infection irresponsive to antibiotic and/or surgical treatment or to loss of osseointegration. Overall implant survival rate was 97.0%, ranging from 93.7% to 100% according to type of graft and type of reconstruction (horizontal, vertical, tridimensional). Despite being osseointegrated, 131 implants presented with bone resorption or peri-implant infection higher than those proposed by Albrektsson et al. for successful implants. The overall success rate of implants was 91.6%, ranging from 87.5% to 98.2%, according to type of graft and type of reconstruction (horizontal, vertical, tridimensional).
Conclusions. Results obtained in this study were very encouraging, and consistent with those reported in the international literature. In particular, as far as long-term implant survival and success rates are concerned, better results were obtained when autogenous bone harvested from intraoral sites or from the calvarium was used for the reconstrution, while reconstructions performed with iliac bone, especially in the mandible, presented lower implant survival and success rates.