Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study

Harvesting anterior iliac crest or calvarial bone grafts to augment severely resorbed edentulous jaws: a systematic review and meta-analysis of patient-reported outcomes

The aim of this systematic review was to compare patient-reported outcomes after harvesting calvarial or anterior iliac crest bone grafts to repair severe jaw defects and enable implant placement. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials databases, and OpenGrey were searched for studies on patient satisfaction, pain, disturbances in daily functioning, sensory alterations, donor site aesthetics, and complication rates. Of the 1946 articles identified, 43 reporting 40 studies fulfilled the inclusion criteria; the studies were one randomized controlled clinical trial, one retrospective controlled clinical trial, and 23 prospective and 15 retrospective cohort studies. A meta-analysis of two studies (74 patients) showed no difference in satisfaction (mean difference (MD) - 0.13, 95% confidence interval (CI) - 1.17 to 0.92; P = 0.813) or postoperative pain (directly postoperative: MD -2.32, 95% CI -5.20 to 0.55, P = 0.113; late postoperative: MD -0.01, 95% CI -0.14 to 0.11, P = 0.825) between donor sites. However, the level of evidence is limited, due to the retrospective, non-randomized design of one study. Postoperative gait disturbances were highly prevalent among the anterior iliac crest patients (28-100% after 1 week). The incidence rates of sensory disturbances and other complications were low, and the donor site aesthetic outcomes were favourable for both graft types. To conclude, harvesting bone grafts from the calvarium or anterior iliac crest to augment the severely resorbed edentulous jaw results in similar patient satisfaction. However, the findings for postoperative pain and disturbances in daily living suggest a trend in favour of calvarial bone grafts if harvested using an adjusted technique.

Microscopic observations and inflammatory cytokine productions of human macrophage phagocytising submicron titanium particles

This study was performed to microscopically observe and measure inflammatory cytokine production by human macrophages phagocytosing submicron titanium (Ti) particles. Observations with secondary electron microscopy (SEM), SEM/electron probe microanalysis (EPMA) and transmission electron microscopy (TEM) indicated that macrophages [phorbol-12-myristate-13-acetate (PMA)-differentiated THP-1 cells] at 24 h in culture actively phagocytosed and accumulated submicron Ti particles in intracellular phagosomes, in which refinement of Ti particles occurred. The macrophages were also cultured for 24 h in four media with and without submicron Ti particles and lipopolysaccharide (LPS; components of bacteria). Whilst neither stimulus reduced cell viability, submicron Ti particles and LPS activation independently and synergistically caused the macrophages to produce three inflammatory cytokines (TNF-alpha, IL-1beta and IL-6) at high levels in the culture supernatants. The inflammatory and osteolysis conditions caused by macrophages phagocytosing submicron Ti particles would be worsened by challenge with LPS in patients wearing Ti prostheses.

Implant treatment without bone grafting in edentulous severely resorbed maxillas: a long-term follow-up study

PURPOSE

To evaluate retrospectively the surgical outcome of tilted implants in severely resorbed edentulous maxillas as an alternative to bone grafting and the prosthodontic outcome of posterior extension bridges on tilted implants.

PATIENTS AND METHODS

A total of 33 consecutive patients with severely resorbed edentulous maxillas participated in the study. In these patients, the maxillary bone volumes were insufficient for conventional placement of implants to support a fixed prosthesis. As an alternative to bone transplantation, a surgical technique with fenestration of the maxillary sinus to visualize the total amount of maxillary bone was used, followed by implant placement in a tilted manner along the anterior maxillary sinus wall. Thus, 4 to 6 implants of optimal length could be installed in each patient. Nineteen patients were included in this long-term follow-up study and were eligible for clinical evaluation at 8 to 12 years (mean, 10 years) after second-stage surgery. Each patient was examined clinically and radiographically.

RESULTS

The 19 patients had a total of 103 implants. In 2 of these patients, 3 fixtures were lost during the first year after second-stage surgery. All other patients had all implants intact with functionally fixed dental prostheses, corresponding to a success rate of 97%. Radiographic examination showed bone resorption in 10% of the implants (10 implants in 5 patients with a total number of 27 implants), with a mean bone loss of 1.2 mm. Mucositis was seen in 47% of the patients.

CONCLUSIONS

This long-term follow-up study (mean time, 10 years) demonstrates that patients with a severely resorbed maxilla can be treated successfully with conventional implant treatment. This simplified surgical technique can be an alternative to the more resource-demanding technique with bone grafting.

Sinus lifting before Le Fort I maxillary osteotomy: a suitable method for oral rehabilitation of edentulous patients with skeletal class-III conditions: review of the literature and report of a case

BACKGROUND

Functional rehabilitation of patients afflicted with severe mandibular and maxillary alveolar atrophy might be challenging especially in malformed patients.

METHODS

Treatment planning using sinus lifting and implant placement before Le Fort I maxillary osteotomy in a patient with severe mandibular and posterior maxillary alveolar atrophy and skeletal class-III conditions due to cleft palate are described.

RESULTS

A full functional and esthetic rehabilitation of the patient was achieved by a stepwise surgical approach performed through sinus lifting as the primary approach followed by implant placement and subsequent Le Fort I maxillary osteotomy to correct the maxillo-mandibular relation.

CONCLUSION

Stabilisation of the maxillary complex by a sinus lifting procedure in combination with computer aided implant placement as preorthodontic planning procedure before Le Fort I maxillary osteotomy seems to be suitable in order to allow ideal oral rehabilitation especially in malformed patients.