Patients' appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone:a randomized controlled trial

BACKGROUND: Little is known about the impact of bone graft harvesting for pre-implant augmentation of the maxilla from a patient's perspective. To assess patient-reported outcome measures (PROMs) related to augmentation of the extremely resorbed edentulous maxilla with calvarial or anterior iliac crest bone. MATERIALS AND METHODS: For this randomised controlled trial, 20 consecutive edentulous patients needing extensive pre-implant surgery of the maxilla were randomly assigned to either calvarial (n = 10) or anterior iliac crest (n = 10) bone harvesting. Patient reports on procedure-related satisfaction, questionnaires on oral functionality (denture satisfaction, chewing ability) and oral health-related quality of life (OHIP-49NL) and subjective donor site-related outcomes (e.g. of post-operative pain, scar formation, physical mobility) were assessed. RESULTS: Irrespective of the harvesting site, patients were generally satisfied (median VAS score 93 (86-99) mm, p = 0.400) with the procedure and its final results. Post-operative pain was mild (median 40 (20-40) mm) and decreased to no pain (4 (0-16) mm) within 14 days. Early post-operative pain was significantly higher following anterior iliac crest harvesting (p < 0.00). Impact on physical mobility, daily functioning and satisfaction with the scar formation were similar in both groups. CONCLUSIONS: The assessed PROMs confirmed that bone graft harvesting from the calvarium or anterior iliac crest is an appropriate procedure, reflected by high levels of satisfaction, minor long-term sequela and improvement of perceived oral health. For clinical decision-making, decisions can be based on individual features and preferences. TRIAL REGISTRATION: NTR, NTR3968 , registered 1 July 2013

Histomorphometric and micro-CT analyses of calvarial bone grafts used to reconstruct the extremely atrophied maxilla

Background Calvarial bone grafts are successful in the reconstruction of the severely atrophied maxilla as a pre-implant procedure. However, not much is known about graft incorporation at the microscopic level. Purpose This study aimed to assess calvarial bone conversion 4 months after being grafted in the edentulous maxillary bone. Materials and methods In 13 patients (age:65.3 +/- 8.7 years) the atrophic maxilla was reconstructed with autologous calvarial bone. Biopsies were taken from fresh calvarial bone grafts and from the reconstructed maxillae after 4 months of healing. Micro-CT, histomorphometric, and histological analysis were performed. From three patients biopsies were obtained after 9, 11, or 45 months. Results The micro-CT analysis revealed that in the maxilla the calvarial bone was well preserved even after 45 months. Histology showed progressive incorporation of grafted bone within a maxillary bone. Osteoid and osteocytes were present in all biopsies indicating new bone formation and vital bone. Histomorphometrically, the percentage of grafted bone volume over total volume decreased from 79.8% (IQR78.7-83.3) in fresh calvarial grafts to 59.3% (IQR44.8-64.6) in healed grafts. The biopsies were taken after 9, 11, and 45 months showed similar values. Conclusions Calvarial bone grafts result in stable and viable bone, good incorporation into native maxillary bone, and a minor decrease in bone volume after healing. Consequently, they provide a solid base for implant placement in severely atrophied edentulous maxillary bone

Incorporation of anterior iliac crest or calvarial bone grafts in reconstructed atrophied maxillae:A randomized clinical trial with histomorphometric and micro-CT analyses

BACKGROUND: Autologous bone grafts have been applied successfully to severely atrophied maxilla via a preimplant procedure. Differences in graft incorporation at the microscopic level can be the decisive factor in the choice between anterior iliac crest and calvarial bone. PURPOSE: To compare conversion of anterior iliac crest bone and calvarial bone 4 months after grafting of the edentulous maxilla. MATERIALS AND METHODS: Twenty consecutive patients were randomly assigned to either anterior iliac crest (n = 10) or calvarial (n = 10) bone harvesting to reconstruct their atrophied maxillae. Biopsies were taken from both fresh bone grafts and reconstructed maxillae after 4 months healing, at time of implant placement. Micro-CT, histomorphometric and histological analyses were performed. RESULTS: Micro-CT analysis revealed that both the anterior iliac crest and calvarial bone grafts retained their volume and bone mass after being incorporated in the maxilla, but with a favor for calvarial bone grafts: calvarial bone grafts had a higher mineral density before and after incorporation. Both bone grafts types were well incorporated after 4 months of healing with preservation of bone volume and mineral density. Although the fresh bone biopsies were similar histomorphometrically, after 4 months of graft incorporation, the osteoid percentage and osteocyte count remained higher in the anterior iliac crest bone whereas the percentage of bone was higher in the calvarial bone grafts compared to the anterior iliac crest bone grafts. CONCLUSIONS: Both donor sites, that is, anterior iliac crest and calvarial bone, are well suited to provide a reliable and stable basis for implant placement 4 months after grafting with mineral density, porosity, and resorption rate in favor of calvarial bone grafts