Endosseous Implants in Nonvascularized Bone Grafts: Outcome Analysis

Thursday, October 10, 2013
Olena Norris DDS, Oral and Maxillofacial Surgery, Boston University, Boston, MA
Matthew Steuer DMD, Oral and Maxillofacial Surgery, Boston University, Boston, MA
Pushkar Mehra BDS, DMD, Oral and Maxillofacial Surgery, Boston University, Boston, MA
David Cottrell DMD, Oral and Maxillofacial Surgery, Boston University, Boston, MA
Purpose:To evaluate osseointegration of dental implants placed into non-vascularized bone grafts and to assess differences in outcomes with regards to jaw defect (type, size, etiology) and type of graft (autograft, allograft, xenograft, and alloplast).

Materials and Methods:Retrospective review over a 7-year period (2003 - 2010). All patients were treated with non-vascularized bone grafts and subsequent placement of dental implants. A total of 523 implants were placed. Patients were allocated into one of four groups, based on recipient site: I - extraction socket (n = 94 implants), II - maxillary sinus (n = 164 implants), III - alveolar ridge (n = 141 implants); IV - continuity defects of mandible and/or maxilla (n = 124 implants). Details regarding demographics, co-morbidities, characteristic of the defect (type, size, etiology) were reviewed. Implant success was defined as retention of implant until second stage, absence of mobility, and ability to withstand functional load. Criteria for failure included implant mobility (> 1 mm), radiographic bone loss (> 1/3 implant height), infection, graft exposure and loss.

 Results: Overall, graft success rate was 99% and implant success rate was 97.1%. Mean follow-up was 6 months. Fifteen implants were removed due to mobility and/or infection.  Success rates for implants were as follows: group I = 100%; group II = 96.9%; group III = 97.8% and, group IV - 94.3%.

Conclusions:Endosseous implants have a high success rate when placed into alveolar defects reconstructed with non-vascularized bone grafts. The nature of the bony defect or type of non-vascularized graft used does not affect the final clinical outcome.

References:

Foster RD, Anthony JP, Sharma A, Pogrel MA. Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success. Head Neck.1999 Jan;21(1):66-71.

Clayman L. Implant reconstruction of the bone-grafted maxilla: reveiw of the literature and presentation of 8 cases. J Oral Maxillofac Surg. 2006. 64:674-682.