sdj-10053

Evaluation of different modalities of intraorally harvested bone graft in oral and maxillofacial reconstructive surgery

*Suha N Aloosi & **Waleed Jaleel

*College of Dentistry, University of Sulaimani

**College of Medicine, University of Sulaimani

DOI: https://doi.org/10.17656/sdj.10053

Abstract

Objectives: Although the iliac crest is most often used in major jaw reconstruction for dental implants and other maxillofacial reconstructive surgeries it has the disadvantages of higher costs, alteration of ambulation, and the need for hospitalization and general anesthesia. , bone grafts harvested from the maxilla and mandible offer several benefits. This study was conducted to the quality and the quantity of intraorally harvested bone graft from different sites, and assessing the suitability of each donor site for the selected recipient site.

Material and Method: Twenty-two patients (27 bone graft donor sites) (5 of them with bilateral alveolar reconstruction), of both sexes (9 males and 17 females), were operated on by harvesting intraoral bone grafts from different sites used in different reconstructive surgeries. Specific intraoral donor sites were used for specific type of surgery according to the feasibility and need. Preoperative and intraoperative evaluation of the recipient defect size and selecting proper intraoral donor sites was the paramount parameter in our study.

Results: The success rate was 96.2% in a follow-up period of 6-18 months, the patients were evaluated for bone graft stability, ability to insert the dental implant, stability of the implant, stability in orthognathic surgery, and the satisfactory aesthetic and functional results, all the patient had satisfactory results and only one case of particulates cortical bone had developed fibrous union ,

Conclusion: Intraoral bone graft can successfully be used for treating small and selected facial and alveolar defect with minimal complications in the donor sites, patients report minimal discomfort and morbidity and all complications were temporary. Types of fixation, prompt graft adaptation were the most important factors for success. Symphysis of the mandible has the advantage of easy access and visibility and can easily be done under local anesthesia. However, for reconstruction of a bigger bony defect, an extraoral bone.

Keyword: Intra-oral donor site, bone graft, reconstructive surgery

References:

1.      Wang HL, Al-Shammari K. HVC ridge deficiency classification: a therapeutically oriented classification. Int J Periodontics Restorative Dent. 2002;22(4):335-43.

2.      McAllister BS, Haghighat K. Bone augmentation techniques. J Periodontol. 2007;78(3):377-96.

              3.     Cawood JI, Stoelinga PJ. International Research Group on Reconstructive Preprosthetic Surgery. Consensus report. Int J Oral Maxillofac Surg 2000;29(3):159-62

             4.    Habal M, Reddi A. Different forms of bone grafts. Bone grafts and bone substitutes Philadelphia: Saunders. 1992;9.

             5.    Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res. 1983(174):28-42.

             6.    Pieri F, Corinaldesi G, Fini M, Aldini NN, Giardino R, Marchetti C. Alveolar ridge augmentation with titanium mesh and a combination of autogenous bone and anorganic bovine bone: a 2-      year        prospective study. J Periodontol. 2008;79(11):2093-103.

            7.           Corinaldesi G, Pieri F, Sapigni L, Marchetti C. Evaluation of survival and success rates of dental implants placed at the time of or after alveolar ridge augmentation with an autogenous      mandibular bone graft and titanium mesh: a 3- to 8-year retrospective study. Int J Oral Maxillofac Implants. 2009;24(6):1119-28.

8.              Khamees J, Darwiche MA, Kochaji N. Alveolar ridge augmentation using chin bone graft, bovine bone mineral, and titanium mesh: Clinical, histological, and histomorphomtric study. J Indian Soc Periodontol. 2012;16(2):235-40.

7.               Fu JH, Wang HL. Horizontal bone augmentation: the decision tree. Int J Periodontics Restorative Dent. 2011;31(4):429-36.

8.               Klijn RJ, Meijer GJ, Bronkhorst EM, Jansen JA. Sinus floor augmentation surgery using autologous bone grafts from various donor sites: a meta-analysis of the total bone volume. Tissue Eng Part B Rev. 2010;16(3):295-303.

9.               Federico Brugnami AC, and Cataldo Leone. Keio J Med 2009;58(1):24-8.

10.            Pikos MA. Mandibular block autografts for alveolar ridge augmentation. Atlas Oral Maxillofac Surg Clin North Am. 2005;13(2):91-107.

11.            Cordaro L, Amade DS, Cordaro M. Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement. Clin Oral Implants Res. 2002;13(1):103-11.

12.            Cordaro L. Bilateral simultaneous augmentation of the maxillary sinus floor with particulated mandible. Report of a technique and preliminary results. Clin Oral Implants Res. 2003;14(2):201-6.

13.            Choung PH, Kim SG. The coronoid process for paranasal augmentation in the correction of midfacial concavity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(1):28-33.

14.            Pourabbas R, Nezafati S. Clinical results of localized alveolar ridge augmentation with bone grafts harvested from symphysis in comparison with ramus. J Dent Res Dent Clin Dent Prospects. 2007;1(1):7-12.

15.            Buchman SR, Ozaki W. The ultrastructure and resorptive pattern of cancellous onlay bone grafts in the craniofacial skeleton. Ann Plast Surg. 1999;43(1):49-56.

16.            Breine U, Branemark PI. Reconstruction of alveolar jaw bone. An experimental and clinical study of immediate and preformed autologous bone grafts in combination with osseointegrated implants. Scand J Plast Reconstr Surg. 1980;14(1):23-48.

17.            Misch CM. Comparison of intraoral donor sites for onlay grafting prior to implant placement. Int J Oral Maxillofac Implants. 1997;12(6):767-76.

18.            Montazem A, Valauri DV, St-Hilaire H, Buchbinder D. The mandibular symphysis as a donor site in maxillofacial bone grafting: a quantitative anatomic study. J Oral Maxillofac Surg. 2000;58(12):1368-71.

19.            Raghoebar GM, Louwerse C, Kalk WW, Vissink A.

Morbidity of chin bone harvesting. Clin Oral Implants Res. 2001;12(5):503-7.

20.            Clavero J, Lundgren S. Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison         of              donor        site            morbidity                   and complications.              Clin            Implant    Dent         Relat         Res. 2003;5(3):154-60.

21.            Hernandez-Alfaro F, Sancho-Puchades M, GuijarroMartinez R. Total reconstruction of the atrophic maxilla with intraoral bone grafts and biomaterials: a prospective clinical study with cone beam computed tomography validation. Int J Oral Maxillofac Implants. 2013;28(1):241-51.

22.            Henderson D and Poswillo D.  A colour atlas and textbook of orthognathic surgery: the surgery of facial skeletal deformity. London :Wolfe Medical;1985.

23.            Epker BN, Stella JP, Fish LC. Dentofacial deformities: integrated orthodontic and surgical correction. 1995.

24.            Nkenke E, Schultze-Mosgau S, Radespiel-Troger M, Kloss F, Neukam FW. Morbidity of harvesting of chin grafts: a prospective study. Clin Oral Implants Res. 2001;12(5):495-502.

25.            Nkenke E, Radespiel-Troger M, Wiltfang J, SchultzeMosgau S, Winkler G, Neukam FW. Morbidity of harvesting of retromolar bone grafts: a prospective study. Clin Oral Implants Res. 2002;13(5):514-21.

26.            Capelli M. Autogenous bone graft from the mandibular ramus: a technique for bone augmentation. Int J Periodontics Restorative Dent. 2003;23(3):277-85.

27.            Proussaefs P, Lozada J, Kleinman A, Rohrer MD. The use of ramus autogenous block grafts for vertical alveolar ridge augmentation and implant placement: a pilot study. nt J Oral Maxillofac Implants. 2002;17(2):238-48.

28.            Wood RM, Moore DL. Grafting of the maxillary sinus with intraorally harvested autogenous bone prior to implant placement. Int J Oral Maxillofac Implants. 1988;3(3):209-14.

29.            Mintz SM, Ettinger A, Schmakel T, Gleason MJ.

Contralateral coronoid process bone grafts for orbital floor reconstruction: an anatomic and clinical study. J Oral Maxillofac Surg.1998;56(10):1140-4; discussion 4-5.

30.            Berry RL, Edwards RC, Paxton MC. Nasal augmentation using the mandibular coronoid as an autogenous graft: report of case. J Oral Maxillofac Surg.1994;52(6):633-8; discussion 8-9.

31.            Raghoebar GM, Timmenga NM, Reintsema H,

Stegenga B, Vissink A. Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months. Clin Oral Implants Res. 2001;12(3):279-86.

32.            Kainulainen VT, Sandor GK, Oikarinen KS, Clokie CM. Zygomatic bone: an additional donor site for alveolar bone reconstruction. Technical note. Int J Oral Maxillofac Implants. 2002;17(5):723-8.

33.            Bedrossian E, Tawfilis A, Alijanian A. Veneer grafting: a technique for augmentation of the resorbed alveolus prior to implant placement. A clinical report. Int J Oral Maxillofac Implants. 2000;15(6):853-8.

34.            Yates DM, Brockhoff HC, 2nd, Finn R, Phillips C. Comparison of intraoral harvest sites for corticocancellous bone grafts. J Oral Maxillofac Surg. 2013;71(3):497-504.

35.            Schwartz-Arad D, Ofec R, Eliyahu G, Ruban A, Sterer N. Long Term Follow-Up of Dental Implants Placed in Autologous Onlay Bone Graft. Clin Implant Dent Relat Res. 2016;18(3):449-61.

36.            Sabhlok S, Waknis PP, Gadre KS. Applications of coronoid process as a bone graft in maxillofacial surgery. J Craniofac Surg. 2014;25(2):577-80.

37.            McCarthy C, Patel RR, Wragg PF, Brook IM. Dental implants and onlay bone grafts in the anterior maxilla: analysis of clinical outcome. Int J Oral Maxillofac Implants. 2003;18(2):238-41.

38.            Nkenke E, Neukam FW. Autogenous bone harvesting and grafting in advanced jaw resorption: morbidity, resorption and implant survival. Eur J Oral Implantol. 2014;7 Suppl 2:S203-17.

39.            Louis PJ. Bone grafting the mandible. Oral Maxillofac Surg Clin North Am. 2011;23(2):209-27, v.

40.            Gungormus M, Yavuz MS. The ascending ramus of the mandible as a donor site in maxillofacial bone grafting. J Oral Maxillofac Surg. 2002;60(11):1316-8.

41.            Singh S. Management of infrabony defects in mandibular molars in a patient with generalized aggressive periodontitis using autogenous bone graft from maxillary tuberosity. J Indian Soc Periodontol. 2010;14(1):53-6.

42.            Silva FM, Cortez AL, Moreira RW, Mazzonetto R.

Complications of intraoral donor site for bone grafting prior to implant placement. Implant Dent. 2006;15(4):420-6.

43.            Khojasteh A, Behnia H, Shayesteh YS, Morad G,

Alikhasi M. Localized bone augmentation with cortical bone blocks tented over different particulate bone substitutes: a retrospective study. Int J Oral Maxillofac Implants. 2012;27(6):1481-93.

44.            Garg AK. Bone biology, harvesting, grafting for dental implants:               rationale and     clinical      applications: Quintessence Publishing Company; 2004.

45.            Matsumoto MA, Filho HN, Francischone a E,

Consolaro A. Microscopic analysis of reconstructed maxillary alveolar ridges using autogenous bone grafts from the chin and iliac crest. Int J Oral Maxillofac Implants. 2002;17(4):507-16.

46.            Gapski R, Wang HL, Misch CE. Management of incision design in symphysis graft procedures: a review of the literature. J Oral Implantol. 2001;27(3):134-42.

47.            Hendy CW, Smith KG, Robinson PP. Surgical anatomy of the buccal nerve. Br J Oral Maxillofac Surg. 1996;34(5):457-60.

48.            Alfaro           FH             OC.            Bone         grafting. Oral          implantol

2007(4):104-5.

49.            Rontal M  ZS. Anatomy of the paranasal sinuses. New York: Thieme Medical Publishers; 1996.

50.            Procacci P, Lora V, Rossetto A, Gelpi F, Marconcini S, Armani L, et al. Success of bone grafts in atrophic posterior edentulous mandible: literature review. Minerva Stomatol. 2014.

51.            Stevenson S, Li XQ, Davy DT, Klein L, Goldberg VM. Critical biological determinants of incorporation of non-vascularized cortical bone grafts. Quantification of a complex process and structure. J Bone Joint Surg Am. 1997;79(1):1-16.

52.            Deshpande S, Deshmukh J, Deshpande S, Khatri R, Deshpande S. Vertical and horizontal ridge augmentation in anterior maxilla using autograft, xenograft and titanium mesh with simultaneous placement of endosseous implants. J Indian Soc Periodontol. 2014;18(5):661-5.

53.            Louis PJ, Gutta R, Said-Al-Naief N, Bartolucci AA. Reconstruction of the maxilla and mandible with particulate bone graft and titanium mesh for implant placement. J Oral Maxillofac Surg. 2008;66(2):235-45. 56. Oh TJ, Meraw SJ, Lee EJ, Giannobile WV, Wang HL. Comparative analysis of collagen membranes for the treatment of implant dehiscence defects. Clin Oral Implants Res. 2003;14(1):80-90.

57.            Bianchi A, Felice P, Lizio G, Marchetti C. Alveolar distraction osteogenesis versus inlay bone grafting in posterior mandibular atrophy: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(3):282-92.

58.            Felice P, Marchetti C, Piattelli A, Pellegrino G, Checchi V, Worthington H, et al. Vertical ridge augmentation of the atrophic posterior mandible with interpositional block grafts: bone from the iliac crest versus bovine anorganic bone. Eur J Oral Implantol. 2008;1(3):183-98.

59.            Chen ST, Beagle J, Jensen SS, Chiapasco M, Darby I. Consensus statements and recommended clinical procedures regarding surgical techniques. The Int J Oral Maxillofac Implants.2009;24 Suppl:272-8.

60.            Meijndert L, Meijer HJ, Stellingsma K, Stegenga B, Raghoebar GM. Evaluation of aesthetics of implantsupported single-tooth replacements using different bone augmentation procedures: a prospective randomized clinical study. Clin Oral Implants Res. 2007;18(6):715-9.

61.            Peleg M, Mazor Z, Garg AK. Augmentation grafting of the maxillary sinus and simultaneous implant placement in patients with 3 to 5 mm of residual alveolar bone height. Int J Oral Maxillofac Implants. 1999;14(4):549-56.

62.            Anusaksathien O, Giannobile WV. Growth factor delivery to re-engineer periodontal tissues. Curr Pharm Biotechnol. 2002;3(2):129-39.

63.            Jacob AS, Kumar ND. Effect of pre and post operative bleaching on microleakage of amalgam and composite restoration using 10% carbamide peroxidean invitro study. J Conserv Dent. 2007;10(1):33.

64.            Lee SJ, Park YJ, Park SN, Lee YM, Seol YJ, Ku Y, et al. Molded porous poly (L-lactide) membranes for guided bone regeneration with enhanced effects by controlled growth factor release. J Biomed Mater Res . 2001;55(3):295-303.

65.            Jackson RA, Nurcombe V, Cool SM. Coordinated fibroblast growth factor and heparan sulfate regulation of osteogenesis. Gene. 2006;379:79-91.

66.            Fiedler J, Brill C, Blum WF, Brenner RE. IGF-I and IGF-II stimulate directed cell migration of bone-marrowderived human mesenchymal progenitor cells. Biochem Biophys Res Commun 2006;345(3):1177-83.

67.            Dawson KH, Egbert MA, Myall RW. Pain following iliac crest    bone         grafting    of     alveolar    clefts.       J

Craniomaxillofac Surg. 1996;24(3):151-4.

Full Article - PDF

 © The Authors, published by University of Sulaimani, College of Dentistry

This work is licensed under a Creative Commons Attribution 4.0 International License.