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Stability of simultaneously placed dental implants with autologous bone grafts harvested from the iliac crest or intraoral jaw bone

BMC Oral Health (2015) 15(1)
DOI: 10.1186/s12903-015-0156-x
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Abstract

Background: Jaw bone and iliac bone are the most frequently used autologous bone sources for dental implant placement in patients with atrophic alveolar ridges. However, the comparative long-term stability of these two autologous bone grafts have not yet been investigated. The aim of this study was to compare the stability of simultaneously placed dental implants with autologous bone grafts harvested from either the iliac crest or the intraoral jaw bone for severely atrophic alveolar ridges. Methods: In total, 36 patients (21 men and 15 women) were selected and a retrospective medical record review was performed. We compared the residual increased bone height of the grafted bone, peri-implantitis incidence, radiological density in newly generated bones (HU values), and implant stability using resonance frequency analysis (ISQ values) between the two autologous bone graft groups. Results: Both autologous bone graft groups (iliac bone and jaw bone) showed favorable clinical results, with similar long-term implant stability and overall implant survival rates. However, the grafted iliac bone exhibited more prompt vertical loss than the jaw bone, in particular, the largest vertical bone reduction was observed within 6 months after the bone graft. In contrast, the jaw bone graft group exhibited a slower vertical bone resorption rate and a lower incidence of peri-implantitis during long-term follow-up than the iliac bone graft group. Conclusions: These findings demonstrate that simultaneous dental implantation with the autologous intraoral jaw bone graft method may be reliable for the reconstruction of edentulous atrophic alveolar ridges.

Figures

  • Fig. 1 Images show the simultaneous dental implantation with autologous iliac bone and intraoral jaw bone grafting procedure. a–c Dental implant fixtures are placed with inlay type iliac bone grafts in the maxillary sinus. a The iliac block bone (arrow) is grafted into the sinus floor and fixed with implant fixtures. b The dead space in the sinus floor is filled with mixed bone of autologous particulate iliac bone and demineralized bone matrix (DBM). c The initial bone healing is completed with homogeneous new bone formation around fixtures 6 months postoperatively. d–f Dental implantation with onlay type bone grafts for coverage of the exposed fixtures using autologous iliac particulate bones. d Partial exposure of implant fixtures is viable after implant placement on the irregular mandibular ridge (arrows). e The exposed fixtures are covered with a mixture of particulate iliac bone and DBM. f The grafted bone heals with new bone formation 5 months after bone graft. g–i Photographs show autologous jaw bone grafts, both of onlay- and inlay-type, for simultaneous implantation. g Autologous chin bone is harvested (arrows indicate chin bone harvested sites) and crushed into particulate, then onlay-type grafted for the exposed fixtures in the mandibular ridge (arrowheads indicate fibrin glue injection on particulate jaw bone graft site). h In the maxillary ridge, the exposed fixtures are covered with a mixed bone of particulate jaw bone and DBM (arrows). i Maxillary sinus windows are opened and sinus membrane elevated (arrow), the mixed bone of jaw bone and DBM is subantral inlay-type grafted after placement of implant fixtures
  • Fig. 2 a Schematic diagram shows the specific time points for the measurements and analyses in the present study. b–d Images show the method for residual bone height measurement in panoramic views. b Patient shows a thin residual bone height at the preoperative panoramic view (arrows) (T0). c Immediately after simultaneous implant placement with iliac bone grafting (T1), the alveolar bone height increases due to the graft material (arrows). d Five months after surgery (T2), the subantral inlay-type grafted bone volume is shrunk and elevated sinus floor is inferiorly moved because of bone healing and consolidation
  • Fig. 3 Long-term panoramic evaluation of simultaneous dental implantation cases with autologous iliac bone (a) and intraoral jaw bone grafts (b). a Dental implants are placed in both maxillary posterior ridges with subantral inlay-type iliac block and particulate bone graft. In panoramic analysis, the augmented alveolar bone heights in both maxillary posterior ridges (arrows in T3) are remarkably vertically reduced at the 5.5-year follow-up (arrows in T5). In particular, the radiograph of T5 (5.5 years postoperatively) shows coincidental bone resorption in the marginal alveolar bone (open arrows) and sinus floor (closed arrows) compared with radiographs at T1 or T3, indicating that the long-term grafted bone resorption could be related to the shrinkage volume of grafted iliac bone as well as peri-implantitis. b A case of intraoral jaw bone graft and simultaneous implantation. Implant fixtures are simultaneously placed and jaw bone is grafted onto the sinus floor (subantral inlay-type) and on the exposed fixtures in lower alveolar ridges (onlay-type). The grafted jaw bone is well maintained and shows a lesser vertical bone reductive pattern than the iliac bone graft in the marginal alveolar bone (open arrows) and sinus floor (closed arrows)
  • Fig. 4 Panoramic and computerized tomographic (CT) evaluation of the subantral inlay jaw bone graft site. a–c Preoperative panoramic and CT views (axial, coronal, and sagittal) show a thin alveolar bone height in left maxillary posterior ridge, even perforation of alveolar bone is observable (arrows). d–f Radiographs at 6 months after surgery (T3) showed the stabilization of implant fixtures with newly generated bone in the maxillary sinus floor (arrows)
  • Table 1 Number of implants placed simultaneously with autologous bone grafting, classified by fixture type and placement site
  • Table 2 Implant survival rate at all follow-up period and the ratio of residual grafted bone height at T5
  • Fig. 5 Box plots showing changes in mean vertical increased bone height in the panoramic views at each time point. a In subantral inlay type bone graft sites, Group 1 shows a greater reduction of residual bone height than Group 2. In Group 1, the mean increased vertical bone height is 10.8 ± 0.9 mm immediately after the operation (T1), but it promptly decreases to 8.2 ± 0.9 mm 6 months postoperatively (T2), and continuously reduces to 5.6 ± 1.2 mm by T5. However, in Group 2, there is no statistical difference in the mean increased bone height between T1 (9.6 ± 1.0 mm) and T2 (8.7 ± 1.0 mm), and this gradually decreases to T5 (7.3 ± 1.2 mm). b Onlay type bone graft sites show similar mean residual bone height changes to the inlay type bone graft sites. Group 1 exhibit more rapid vertical bone loss than Group 2. In both groups, the largest bone loss occurs between T1 and T2. Data represent mean ± standard deviation of increased vertical bone height at each time point, and different letters denote statistically significant differences (p < 0.05)
  • Fig. 6 Comparison of the changes in increased bone height after bone graft (a-d), analysis of radiological intensity (HU values) in the newly generated bone using CT views at T3 (e), and implant stability quotients (ISQ values) by resonance frequency analysis results at T2 (f). a & b In both inlay and onlay type bone grafts, Group 1 shows a more prompt vertical bone loss than Group 2; there is statistical difference in remaining bone height between the two groups at T4 and T5. The intraoral jaw bone graft group has more residual grafted bone height than the iliac bone graft group after 2–3 years postoperatively (p < 0.05). c & d Changes in the vertical bone height were compared in the maxillary and mandibular ridges. In the maxillary fixtures, the intraoral jaw bone graft group showed a statistically lower vertical bone resorption rate at T4 and T5 than the iliac bone graft group (p < 0.05). A similar tendency for vertical bone resorption was observed in the mandibular fixtures, with no statistical difference between the groups (p > 0.05). e CT views at T3 (1 year postoperatively) reveal similar HU values in the newly generated bones between the two groups (p > 0.05). f Implant stability tests by resonance frequency analysis at T2 (5–6 months postoperatively) exhibit similar ISQ values between the two groups (p > 0.05). Data represent mean ± standard deviation, and an asterisk (*) indicates a significant difference between Groups 1 and 2 (p < 0.05)

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Kang, Y. H., Kim, H. M., Byun, J. H., Kim, U. K., Sung, I. Y., Cho, Y. C., & Park, B. W. (2015). Stability of simultaneously placed dental implants with autologous bone grafts harvested from the iliac crest or intraoral jaw bone. BMC Oral Health, 15(1). https://doi.org/10.1186/s12903-015-0156-x

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