Reconstruction of Severely Atrophied Alveolar Ridges with Calvarial Onlay Bone Grafts and Dental Implants.
ABSTRACT Objective: Severely atrophied alveolar ridges are most commonly reconstructed with free autologous bone grafts from the iliac crest. The use of these grafts, however, is frequently associated with bone resorption as possible late complication after implant surgery and prosthetic loading. Other donor sites, especially intraoral donor sites, show limited availability. The aim of this present study was to evaluate the clinical and radiographical outcome of alveolar ridge reconstruction with bone from the calvarium and subsequent implant rehabilitation. Patients and Methods: Reconstruction was performed by using calvarial split grafts in case of severe and complex alveolar ridge defects induced by trauma or bone atrophy. Fifteen patients were treated at 19 different intraoral recipient sites (15 sites in the maxilla, four in the mandible). Autologous block grafts were used for combined vertical and horizontal grafting. After a 3-month healing period, patients received dental implants. A total of 99 dental implants (OsseoSpeed™, Astra Tech AB, Mölndal, Sweden) were inserted and left to heal in a submerged position for 3 months before the prosthetic implant-based rehabilitation was performed. Results: No donor site complications occurred during or after surgery. At the intraoral recipient sites two infections occurred, leading to partial loss of the grafts. Implant placement, however, was possible in all cases. Two of 99 implants were lost in two patients prior to prosthetic loading. Patients were followed up clinically and radiographically for an average observation period of 28 months. Implant survival rate and success rates were 97.85 and 95.7%, respectively, and a minimal marginal bone loss was documented. Discussion: The low morbidity at the donor sites and the good marginal bone stability in the reconstructed regions indicate that calvarial bone grafts represent a viable treatment alternative to grafts from the iliac crest.
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ABSTRACT: The present study describes a new protocol for the manufacturing of custom-made hydroxyapatite scaffolds using computer-aided design/computer-aided manufacturing (CAD/CAM), to augment posterior mandibular bone and minimize surgery when severe atrophy is present. Computed tomographic images of an atrophic posterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model. This model was transferred as a stereolithographic file to a CAD program, where virtual 3D reconstructions of the alveolar ridge were performed, drawing 2 anatomically shaped, custom-made scaffolds. Computer-aided-manufacturing software generated a set of tool-paths for manufacture on a computer-numerical-control milling machine into the exact shape of the 3D projects. Clinically sized, anatomically shaped scaffolds were generated from commercially available porous hydroxyapatite blocks. The custom-made scaffolds well matched the shape of the bone defects and could be easily implanted during surgery. This matching of the shape helped to reduce the time for the operation and contributed to the good healing of the defects. At the 6-month recall, a newly formed and well-integrated bone was observed, completely filling the mandibular posterior defects, and implants were placed, with good primary stability. At the 1-year follow-up examination, the implant-supported restorations showed a good functional and esthetic integration. Although this is an interim report, this study demonstrates that anatomically shaped custom-made scaffolds can be fabricated by combining computed tomographic scans and CAD/CAM techniques. Further studies are needed to confirm these results.The Journal of craniofacial surgery 05/2013; 24(3):856-859. · 0.81 Impact Factor