Morbidity of harvesting of chin grafts: a prospective study

Abstract

In a prospective study, 20 patients who underwent harvesting of chin grafts as outpatients, were followed up for 12 months (3 further patients with incomplete follow-up data were excluded from the study). Preoperatively and 7 days, 1, 3, 6 and 12 months postoperatively, follow-up data were assessed. Evaluation of the superficial sensory function of the inferior alveolar nerve was determined by the Pointed-Blunt Test and the Two-Point-Discrimination Test. Sensory disturbances were objectively assessed by testing thermal sensitivity with the "Pain and Thermal Sensitivity" Test (PATH Test). In addition, evaluation of the pulp sensitivity of teeth 35-45 was carried out by cold vitality testing. One week postoperatively, 8 patients were affected by superficial sensory impairment. 8 nerve territories showed hypoaesthetic reactions and 5 showed hyperaesthetic reactions. After 12 months, two patients still suffered from hypoaesthesia of one side of the chin. There was a statistically significant sensitivity impairment of the chin for all patients comparing the preoperative data of the Two-Point-Discrimination Test (left/right median: 8.17/8.17 mm, interquartile range (IQR) 1.00/2.00 mm) with the first postoperative measurement (left/right median 9.00/8.33 mm, IQR 1.67/2.66 mm). Comparing the latter to the last postoperative measurement there was significant tendency for regeneration of a nerve function (left/right median 8.00/7.84 mm, IQR 0.66/2.00 mm). In the PATH Test all hypoaesthetic areas could be identified by a reduction of thermal sensitivity. After the first postoperative examination 21.6% (n=38/176) of the examined teeth had lost their pulp sensitivity. After 12 postoperative months 11.4% (n=20/176) still did not react sensitively. Many of these were canines (n=8/20). Comparing the preoperative to the first postoperative examination, there was a significant reduction of pulp sensitivity. However, statistically significant recovery until the last postoperative follow-up could not be detected. The assessed data show that patients have to be informed extensively about disturbances of the inferior alveolar nerve function lasting longer than 12 months. Moreover, the loss of pulp sensitivity is a very frequent event which has always to be taken into account. Considering the high rate of complications with harvesting of chin grafts, more prospective trials should be done to find out whether there are other donor sites for autogenous bone which put less strain on patients.

An investigation of post-operative morbidity following chin graft surgery

“…Apart from one study by Nkenke et al, 8 previous studies have been of a retrospective nature and objective assess- Table 4 Publications on chin grafts tivity in their lower anterior incisor teeth. This is in contrast with Nkenke et al where canines were affected preferentially.…”

“…This is in contrast with Nkenke et al where canines were affected preferentially. 8 Normally, during graft harvest, there is at least a 5 mm safety margin from the apices of lower anterior teeth. Perhaps the safety margin should be increased to avoid loss of sensitivity of lower anterior teeth.…”

Transcrestal guided sinus lift without grafting materials: a 36 months clinical prospective study

“…Subsequently, various modifications to the original technique have been performed in order to improve the reliability and safety, such as: the introduction of the osteotome for the sinus lift (17), the osteotome for positioning of bone (37) and the use of a balloon catheter for the membrane lifting (38)(39)(40)(41). Fractures or perforation of the sinus floor are the main complications related to the transcrestal approach with technique of osteotomes (14,16,17) and drills with (18,19) or without (15) depth stop; the limitations of this surgical approach are represented by: impossibility of a direct visualization of the sinus cavity and of the Schneider membrane, limited amount of bone increase and high risk of accidental perforation of the membrane, without the possibility of surgical repair than the lateral approach. In patients with severely maxillary bone resorption is recommended a conventional approach with surgical lateral window because of perceived limitations with the transcrestal approach (42).…”

“…Currently, in absence of an adequate bone height, the results obtained by the use of short implants may be comparable to those of longer ones placed in regenerated bone, (6) but further investigations are needed to confirm the long-term follow-up data at 5 months published to date. The severely atrophic maxilla is still a challenge, many clinical approaches have been recommended to increase the amount of available bone (12)(13)(14). Schneider's membrane elevation can be achieved through a lateral (15) or transcrestal (8) surgical approach to increase the residual subantral bone (15)(16)(17)(18)(19).…”

Sinus Floor Augmentation Surgery Using Autologous Bone Grafts from Various Donor Sites: A Meta-Analysis of the Total Bone Volume

“…15, 16 An advantage of intraoral donor sites is that the graft can be harvested under local anesthesia. However, the amount of bone that can be gained is limited.…”