Vertical ridge augmentation of the atrophic posterior mandible with interpositional block grafts: bone from the iliac crest versus bovine anorganic bone

Pietro Felice, Claudio Marchetti, Adriano Piattelli, Gerardo Pellegrino, Vittorio Checchi, Helen Worthington, Marco Esposito
European Journal of Oral Implantology 2008, 1 (3): 183-98

PURPOSE: To compare the efficacy, complications and patient preference of two different techniques for vertical bone augmentation of the posterior mandible: bone blocks harvested from the iliac crest versus anorganic bovine bone blocks (Bio-Oss(R)) were used as inlays.

MATERIALS AND METHODS: Ten partially edentulous patients, requiring bilateral and vertical bone augmentation of the posterior mandible (having 5 to 7mm of residual crestal height and at least 5mm thickness above the mandibular canal to allow for implant placement) had their posterior mandibles randomly allocated to both interventions. Resorbable barriers were used to cover the grafts. After 4 months, implants were inserted, and after a further 4 months, provisional prostheses were inserted. Definitive prostheses were delivered 4 months later. Prosthesis and implant failures, the amount of vertically regenerated bone measured on computerised tomography (CT) scans, any complications, the time needed to fully recover mental nerve sensitivity and patient preference were all recorded. All patients were followed up for up to 1 month after the delivery of the final restorations.

RESULTS: Up to 5 months post-loading no patients dropped out or were excluded. Both procedures obtained significant bone gain and achieved the desired results. Four months after grafting, autogenous bone loss was on average 1.1mm (P=0.088) and Bio-Oss 0.6mm (P=0.001). There were no statistically significant differences in bone gain and maintenance among the two procedures. The sides treated with Bio-Oss recovered their full mental nerve sensitivity significantly faster than those treated with autogenous bone (4 versus 6.3 days). Three complications occurred during graft healing; two in the autogenous bone group and one determining the complete failure of the augmentation procedure. No implants or prosthesis could be placed in the planed area. There was no statistically significant differences in the occurrence of complications between the procedures. After implant placement one complication occurred in the autogenous bone group (probably as a consequence of a previous complication). Patients significantly preferred the treatment with Bio-Oss: 3 weeks after augmentation seven patients preferred Bio-Oss and three patients found the treatments to be 'equally good' (odds ratio 0.045 [5% confidence interval (CI) 0.00 to 0.87], P=0.04). One month after delivery of the final prostheses, eight patients preferred Bio-Oss and two patients found the treatments to be 'equally good' (odds ratio 0.03 [95% CI 0.00 to 0.64], P=0.02).

CONCLUSIONS: This pilot study suggests that it might be sensible to use Bio-Oss blocks rather than bone harvested from the iliac crest as the interpositional graft in the treatment of resorbed posterior mandible, as patient discomfort is reduced.

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