Onlay bone grafts from iliac crest: a retrospective analysis

Abstract

This study was performed to address the outcomes of patients treated with onlay grafts from the iliac crest to augment the deficient jaw. The results of 173 consecutive patients who underwent bone grafting prior to implant surgery are presented. The grafts were taken from the anterior iliac crest to repair alveolar bone deficiencies that were too large to be corrected using intraoral bone grafts. Three months postoperatively, 869 implants were placed into 190 onlay grafts (167 grafts in the maxilla, 23 in the mandible). The follow-up ranged from 3 months to 23 years post implantation. All patients received a fixed prosthesis. Parameters examined included healing of the donor site and bone grafts, implant survival, peri-implant condition, and donor site morbidity. The overall survival rate for all implants was calculated to be 95% AE 2.7% according to Kaplan-Meier analysis. The implant survival rate compares favourably with those reported in studies using intraoral and extraoral bone.

Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft

“…Shen [17] reported 45 double-barrel flaps with implant rehabilitation in 11 patients with good functional and esthetic results, although no implant success rate or bone resorption were described. Ferreti [18] and Sethi [19] described vertical reconstruction with iliac crest graft in atrophic mandible but they do not report segmental mandibulectomy or reconstruction with fibula flap. Lizio [20] reported 5 cases of vertical distraction of the fibula flap in mandibular reconstruction with a mean vertical bone gain of 14 mm and a mean peri-implant bone resorption of 2.5 mm.…”

“…It has the advantage of providing cortico-cancellous bone with good irrigation. However, it has several disadvantages: (1) it requires a second surgical procedure; (2) it is necessary to overcorrect approximately 25% of its height to compensate its partial resorption and carry out the subsequent remodeling [19]; (3) morbidity is derived from the approach to the iliac crest; (4) there is partial vertical resorption of the graft during ossification; (5) there is a possibility of exposure of the titanium mesh and bone graft, especially in irradiated patients; and (6) there is need to wait 6 months for ossification before placing the implants, making the prosthetic rehabilitation longer. This technique is indicated in patients who are not going to receive radiotherapy and in patients with extensive defects at the level of the symphysis and mandibular body.…”

Alveolar Ridge Augmentation Techniques in Implant Dentistry

“…Harvesting from mandibular ramus is more utilized than harvesting from symphisis since complications like significant change in the facial contours and post-operative sensory changes may occur in symphisis harvesting. Risk of neurovascular damage and difficult surgical access remain as disadvantages of harvesting from ramus, though [2,41,42].…”

“…Easy surgical access and high amounts of osteoblasts make symphisis a preferable donor site. On the other hand, complications such as changes in the jaw contour, devitality of teeth and mental nerve damage may occur [34,42].…”

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, osteoin-ductive, 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 2 Case Reports in Dentistry 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.…”