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Reconstruction of the atrophic edentulous maxilla with free iliac crest grafts and implants: a 3-year report of a prospective clinical study.
Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
Umeå University, Faculty of Medicine, Department of Odontology, Prosthetic Dentistry.
Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
2007 (English)In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 9, no 1, 46-59 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The purpose of this study was to perform a longitudinal follow-up study of implant stability in grafted maxillae with the aid of clinical, radiological, and resonance frequency analysis (RFA) parameters. MATERIALS AND METHODS: The atrophic edentulous maxillae in 29 patients were reconstructed with free iliac crest grafts using onlay/inlay or interpositional grafting techniques. The endpoint of the resorption pattern in the maxilla determined the grafting technique used. Endosteal implants were placed after 6 months of bone-graft healing. Implant stability was measured four times using RFA: when the implants were placed, after 6 to 8 months of healing, after 6 months and 3 years of bridge loading. Individual checkups were performed at the two later RFA registrations after removal of the supraconstructions (Procera Implant Bridge, Nobel Biocare AB, Goteborg, Sweden). Radiological follow up of marginal bone level was performed annually. RESULTS: Twenty-five patients remained for the follow-up period. A total of 192 implants were placed and with a survival rate of 90% at the 3-year follow up. Women and an implant position with a class 6 resorption prior to reconstruction were factors with significant increased risk for implant failure (multivariate logistic regression). Twelve of the 20 failed implants were lost before loading (early failures). The change in the marginal bone level was 0.3 +/- 0.3 mm between baseline (bridge delivery) and the 3-year follow up. The implant stability quotient (ISQ) value for all implants differed significantly between abutment connection (60.2 +/- 7.3) and after 6 months of bridge loading (62.5 +/- 5.5) (Wilcoxon signed ranks test for paired data, p=.05) but were nonsignificant between 6 months of bridge loading and 3 years of bridge loading (61.8 +/- 5.5). There was a significant difference between successful and failed implants when the ISQ values were compared for individual implants at placement (Mann-Whitney U test, p=.004). All 25 patients were provided with fixed implant bridges at the time of the 3-year follow up. CONCLUSION: This clinical follow up using radiological examinations and RFA measurements indicates a predictable and stable long-term result for patients with atrophic edentulous maxillae reconstructed with autogenous bone and with delayed placement of endosteal implants. The ISQ value at the time of placement can probably serve as an indicator of level of risk for implant failure.

Place, publisher, year, edition, pages
2007. Vol. 9, no 1, 46-59 p.
Keyword [en]
National Category
Medical and Health Sciences
URN: urn:nbn:se:umu:diva-12369DOI: 10.1111/j.1708-8208.2007.00034.xPubMedID: 17362496OAI: diva2:152040
Available from: 2007-11-15 Created: 2007-11-15 Last updated: 2016-10-26Bibliographically approved
In thesis
1. On healing of titanium implants in iliac crest bone grafts
Open this publication in new window or tab >>On healing of titanium implants in iliac crest bone grafts
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Bone grafts and titanium implants are commonly used for surgical/prosthetic rehabilitation of the atrophic edentulous maxilla. The factors which influence bone graft healing and implant integration are not sufficiently understood.

The aim of this dissertation was to evaluate autogenous bone grafting and delayed placement of titanium endosteal implants for reconstruction of the atrophic maxilla, including the effects of different patient factors on bone graft healing and integration of titanium implants into grafted bone.

A total of 46 patients with severe maxillary atrophy received onlay- (n=35) or interpositional bone grafts (n=11) and 6 mo. later received 341 titanium endosteal implants. All bone grafts were harvested from the iliac crest. All patients received fixed dental bridges and were followed clinically and with radiographical examinations for 3 yr.

In Papers I and II, a total of 68 titanium microimplants were placed and retrieved from the bone grafts at various time points for histological analysis of the bone graft-implant interface. Integration was better after 6 mo. healing than placement in conjunction with bone grafting. Implant integration was similar for the two bone-grafting techniques.

In Papers III and IV, originally including 29 patients and 222 implants, implant stability was measured with resonance frequency analysis (RFA) at placement, abutment connection, after 6 mo. of loading (III) and after 3 yr. of loading (IV). Ten non-grafted patients measured at the same time points were used as controls (III). RFA showed equal implant stability in grafted bone vs. non-grafted bone (III). Stability did not change from the 6-mo. to the 3-yr. control. Cumulative survival was 90% after 3 yr. (21 implants failed). Thirteen implants were lost prior to loading and 8 during functional loading. The group of failed implants showed a lower primary RFA stability than those that remained stable for 3 yr. All patients received and maintained a fixed dental bridge throughout the study.

In Paper V, the graft volume changes (GVC) during the 6-mo. healing period prior to implant placement were studied in 30 patients using computerized tomography. Blood samples were taken from 25 patients in conjunction with bone grafting and were analysed for 13 haematological factors. Bone mineral density (BMD) was measured in 21 patients. Biopsies of the bone grafts were analysed for bone volume fraction (BVF). GVC (loss) was correlated with decreased BMD of the lumbar vertebrae L2-L4. There was no correlation between the haematological factors and GVC. Implant failure was not correlated with BMD, BVF or GVC.

This dissertation shows that surgical/prosthetic rehabilitation of the atrophic edentulous maxilla with autogenous iliac crest bone grafts and delayed placement of titanium implants after 6 mo. of graft healing is effective, reproducible and functional. RFA at placement may be able to predict later implant failure.

76 p.
Umeå University odontological dissertations, ISSN 0345-7532 ; 94
Surgery, Edentulous atrophic maxilla, Autogenous bone graft, Endosteal implants, Microimplants, Resonance frequency analysis, Implant survival, Graft volume changes, Kirurgi
Research subject
urn:nbn:se:umu:diva-914 (URN)91-7264-199-1 (ISBN)
Public defence
2006-11-24, Sal B, 9 tr, By 1D, Tandläkarhögskolan, Umeå, 13:00 (English)
Available from: 2006-11-03 Created: 2006-11-03 Last updated: 2009-10-29Bibliographically approved

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