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

Abstract

Background Calvarial 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. Methods In 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. Results A 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. Conclusion Calvarial 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.

Reconstruction of Severely Atrophied Mandible and Simultaneous Implant Insertion with an Inverted Sandwich Technique

“…In our study, successful reconstruction of a severely atrophied mandible with simultaneous implant insertion was done. Literature suggests that vertical reconstruction of severely atrophied crests (height < 5 mm) be done with block grafts; thus, using an extraoral donor site was inevitable [ 1 , 6 ]. Also, the inverted sandwich technique (introduced in 2008, very few studies have chosen this method) allowed for a better graft volume distribution [ 5 , 7 ].…”

“…Simultaneous implant placement is indeed challenging, as it is hard to position the implants properly, especially with a submental approach; but it offers the advantages of concurrent implant osseointegration and graft consolidation, reduced healing period, and reduced number of procedures [ 5 , 7 ]. Most similar studies until 2011 preferred delayed implant insertion, but recent studies have chosen to place implants simultaneously [ 1 , 12 , 13 , 19 ]. In a study by Sakka and Krenkel, simultaneous implant insertion following calvarial grafts in the maxilla resulted in a 94.8% success rate for the implants [ 13 ].…”

“…In a study by Yousif and co-authors, delayed insertion was only preferred when immediate placement was not possible. They did not report any significant difference in implant success or survival rates related to the time of implant placement [ 1 ].…”

“…In severely atrophied jaws, bone augmentation is needed to achieve sufficient bone volume for implant stability and success [ 1 ]. Autologous grafts are the gold standard approach, and an extraoral donor site will provide sufficient bone volume for severely atrophied jaws.…”

A Prosthetic and Surgical Approach for Full-Arch Rehabilitation in Atrophic Maxilla Previously Affected by Peri-Implantitis

“…The use of autogenous bone graft is still the gold standard to rehabilitate atrophic jaws due to its osteogenic, osteoinductive, and osteoconductive properties [ 19 ]. However, in cases of severe atrophy of the maxilla, the amount of bone graft necessary to fully reconstruct the area is quite high, which requires an extra oral donor area such as the iliac crest region [ 20 ] or calvarial bone graft [ 21 , 22 ]. Autogenous bone graft has some drawbacks, for instance, limited amount of bone graft that can be harvested (intraoral approach), increased surgical time and rehabilitation, high costs, intensive postsurgical care, and excessive morbidity to the patient especially when extraoral graft is harvested.…”