Oral Maxillofac Surg (2014) 18:381–385 DOI 10.1007/s10006-014-0464-3
Calvarial grafts for alveolar ridge reconstruction prior to dental implant placement: an update Wenko Smolka
Received: 5 March 2014 / Accepted: 25 August 2014 / Published online: 25 September 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose The aims of this review were to analyze publications related to alveolar crest reconstruction using calvarial grafts and to evaluate the survival and success rates of implants placed into the augmented area. Methods An automated search was made in MEDLINE of clinical publications from 2000 to 2013. Only publications with at least five patients and a minimum follow-up of 6 months were included. Results Graft success ranged between 97 and 100 %. Donor site complications were minimal. The most frequent complications in the recipient site were wound dehiscence. Prosthodontic loading time in most of the studies was 3 months. Implant survival rates ranged between 95 and 100 %. Implant success rates were between 90.3 and 95.05 %. Conclusions Grafting procedures with calvarial transplants show a high graft success rate and a sufficient implant success rate. Calvarial bone grafts are a reliable procedure for alveolar crest reconstruction.
tibia, or calvarium [1–4]. The mandible is the first choice, if only a small amount of bone is needed. For more extensive reconstruction, the most commonly used bone graft has been the iliac bone. However, one major disadvantage of iliac transplants is a strong bone resorption. Animal studies as well as clinical studies have shown that almost one half of the iliac graft is resorbed 6 months after augmentation [5, 6]. Additionally, patients postoperatively often suffer from strong pain in the area of the donor site at the iliac crest. Calvarial bone grafts are known to resorb less . In a recent clinical study, it had been demonstrated that there is no statistically significant difference in the success rate of calvarial grafts compared to iliac crest grafts . However, despite the advantages of calvarial grafts, its use for alveolar reconstruction is still not popular. The aims of this review were to analyze publications related to calvarial grafts for alveolar reconstruction and to evaluate the results in terms of graft resorption, complications, and dental implant success rates.
Keywords Calvarial bone . Calvarial graft . Alveolar ridge augmentation . Alveolar reconstruction . Jaw reconstruction . Dental implant
Inclusion criteria and search strategy
Introduction For reconstruction of the alveolar crest prior to dental implant placement, autogenous bone grafting is still the “gold standard.” Various anatomic sites are available for harvesting bone grafts. The common donor sites are the mandible, iliac crest, W. Smolka (*) Department of Oral and Maxillofacial Surgery, Ludwig Maximilian University, Lindwurmstr. 2a, 80337 Munich, Germany e-mail: [email protected]
Publications indexed in MEDLINE, published between 2000 and 2013, were analyzed. Only publications with at least five patients and a minimum follow-up of 6 months were included. Patients had to present with bony defects as a result of atrophy, trauma, periodontal disease, or marginal tumor resection. Studies dealing with defects resulting from congenital malformations or osteoradionecrosis were excluded, due to the fact that the clinical situation is different and the results might be not comparable. An automated search was carried out in PubMed, with the following keywords: calvarial bone, calvarial graft, alveolar ridge augmentation, alveolar reconstruction, jaw reconstruction, and dental implant.
Nine articles could be found which met the previous mentioned criteria. They were published in the following journals: Clinical Implant Dentistry and Related Research; Clinical Oral Implants Research; Journal of Oral Implantology; Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology; Plastic and Reconstructive Surgery; and The International Journal of Oral & Maxillofacial Implants. These nine studies were included (Table 1), and the following data were determined: year of publication, type of study, patient’s details, surgical technique, and results [4, 7–14].
Indications The main reason for alveolar augmentation using calvarial grafts was bone atrophy, especially in Cawood and Howell class V and VI [9, 10, 13, 14]. The residual mandibular bone height ranged from 5.04 to 6.5 mm, and the residual maxillary bone height ranged from 3.73 to 4.7 mm [9, 10, 12]. Further indications were alveolar defects after trauma or marginal tumor resection [4, 8, 12, 14]. Chiapasco and coauthors did not perform graft procedures in the following situations: severe kidney and/or liver disease; congenital or acquired chemotherapy at time of first examination; sequelae or radiotherapy in the head and neck area; oral mucosa disease, such as lichen planus; poor oral hygiene; noncompliant patient; tobacco abuse (>20 cigarettes per day); noncompensated diabetes mellitus; ongoing bisphosphonate therapy with oral or parenteral administration; and active periodontal disease . Mertens and coauthors reported the following exclusion criteria: extensive vertical misrelationship between maxilla and mandible, defects resulting from oral cancer treatment, and patients with thin calvaria (