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Harvesting anterior iliac crest or calvarial bone grafts to augment severely resorbed edentulous jaws: a systematic review and meta-analysis of patient-reported outcomes

Open AccessPublished:October 12, 2022DOI:https://doi.org/10.1016/j.ijom.2022.09.002

      Abstract

      The aim of this systematic review was to compare patient-reported outcomes after harvesting calvarial or anterior iliac crest bone grafts to repair severe jaw defects and enable implant placement. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials databases, and OpenGrey were searched for studies on patient satisfaction, pain, disturbances in daily functioning, sensory alterations, donor site aesthetics, and complication rates. Of the 1946 articles identified, 43 reporting 40 studies fulfilled the inclusion criteria; the studies were one randomized controlled clinical trial, one retrospective controlled clinical trial, and 23 prospective and 15 retrospective cohort studies. A meta-analysis of two studies (74 patients) showed no difference in satisfaction (mean difference (MD) − 0.13, 95% confidence interval (CI) − 1.17 to 0.92; P = 0.813) or postoperative pain (directly postoperative: MD −2.32, 95% CI −5.20 to 0.55, P = 0.113; late postoperative: MD −0.01, 95% CI −0.14 to 0.11, P = 0.825) between donor sites. However, the level of evidence is limited, due to the retrospective, non-randomized design of one study. Postoperative gait disturbances were highly prevalent among the anterior iliac crest patients (28–100% after 1 week). The incidence rates of sensory disturbances and other complications were low, and the donor site aesthetic outcomes were favourable for both graft types. To conclude, harvesting bone grafts from the calvarium or anterior iliac crest to augment the severely resorbed edentulous jaw results in similar patient satisfaction. However, the findings for postoperative pain and disturbances in daily living suggest a trend in favour of calvarial bone grafts if harvested using an adjusted technique.

      Keywords

      Autologous bone is considered the gold standard graft for compromised bone,
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      Autogenous bone grafts in oral implantology—is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures.
      • Dimitriou R.
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      • Angoules A.G.
      • Kanakaris N.K.
      • Giannoudis P.V.
      Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review.
      as it combines all of the required properties: osteoconduction, osteoinduction, and osteogenesis. Autologous bone is histocompatible and non-immunogenic. It is widely used in several surgical procedures for bony defect augmentation, including reconstruction of the mandible or maxilla to allow for reliable implant placement. For the repair of large defects, a frequently used and preferred donor site is the anterior part of the iliac crest.
      • Sakkas A.
      • Wilde F.
      • Heufelder M.
      • Winter K.
      • Schramm A.
      Autogenous bone grafts in oral implantology—is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures.
      • Dimitriou R.
      • Mataliotakis G.I.
      • Angoules A.G.
      • Kanakaris N.K.
      • Giannoudis P.V.
      Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review.
      • Zouhary K.J.
      Bone graft harvesting from distant sites: concepts and techniques.
      • Sittitavornwong S.
      • Gutta R.
      Bone graft harvesting from regional sites.
      However, the calvarial bone of the skull serves as a common alternative.
      • Putters T.
      • Schortinghuis J.
      • Raghoebar G.
      • Bronckers A.
      Calvarial bone grafts to augment the atrophied maxilla: experience, morbidity and histology.
      • Depeyre A.
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      • Lauwers L.
      • Raoul G.
      • Ferri J.
      Retrospective evaluation of 211 patients with maxillofacial reconstruction using parietal bone graft for implants insertion.
      • Touzet S.
      • Ferri J.
      • Wojcik T.
      • Raoul G.
      Complications of calvarial bone harvesting for maxillofacial reconstructions.
      • Touzet-Roumazeille S.
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      • Ferri J.
      • Lauwers L.
      Parietal bone graft for implant-borne prosthesis: a retrospective study.
      As a donor site, the anterior iliac crest has several practical benefits: it is easily accessible and can provide ample amounts of cortical and cancellous bone.
      • Dimitriou R.
      • Mataliotakis G.I.
      • Angoules A.G.
      • Kanakaris N.K.
      • Giannoudis P.V.
      Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review.
      • Putters T.
      • Schortinghuis J.
      • Raghoebar G.
      • Bronckers A.
      Calvarial bone grafts to augment the atrophied maxilla: experience, morbidity and histology.
      • Touzet S.
      • Ferri J.
      • Wojcik T.
      • Raoul G.
      Complications of calvarial bone harvesting for maxillofacial reconstructions.
      Moreover, when using a two-team surgical approach, the harvesting can be done simultaneously with the augmentation surgery, thereby reducing the surgery time.
      • Scheerlinck L.M.
      • Muradin M.S.
      • van der Bilt A.
      • Meijer G.J.
      • Koole R.
      • Van Cann E.M.
      Donor site complications in bone grafting: comparison of iliac crest, calvarial, and mandibular ramus bone.
      A common drawback of this procedure is the inherent donor site morbidity including pain, sensory alterations, and gait problems.
      • Dimitriou R.
      • Mataliotakis G.I.
      • Angoules A.G.
      • Kanakaris N.K.
      • Giannoudis P.V.
      Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review.
      An alternative is the outer cortex of the posterior parietal skull bone. The calvarium provides ample amounts of cortical bone, but cancellous bone can also be obtained using a safe scraper.
      • Schortinghuis J.
      • Putters T.F.
      • Raghoebar G.M.
      Safe harvesting of outer table parietal bone grafts using an oscillating saw and a bone scraper: a refinement of technique for harvesting cortical and “cancellous”-like calvarial bone.
      Although the reports of morbidity following calvarial bone graft harvesting are promising,
      • Putters T.
      • Schortinghuis J.
      • Raghoebar G.
      • Bronckers A.
      Calvarial bone grafts to augment the atrophied maxilla: experience, morbidity and histology.
      • Smolka W.
      Calvarial grafts for alveolar ridge reconstruction prior to dental implant placement: an update.
      the possibility of dura exposure or dura tearing are among the major arguments against calvarial bone grafting. Nevertheless, this risk has been minimized since the introduction of modified harvesting techniques.
      • Putters T.
      • Schortinghuis J.
      • Raghoebar G.
      • Bronckers A.
      Calvarial bone grafts to augment the atrophied maxilla: experience, morbidity and histology.
      • Schortinghuis J.
      • Putters T.F.
      • Raghoebar G.M.
      Safe harvesting of outer table parietal bone grafts using an oscillating saw and a bone scraper: a refinement of technique for harvesting cortical and “cancellous”-like calvarial bone.
      Regardless of the donor site, the related morbidity is a frequently mentioned drawback.
      • Zouhary K.J.
      Bone graft harvesting from distant sites: concepts and techniques.
      • Sittitavornwong S.
      • Gutta R.
      Bone graft harvesting from regional sites.
      Some studies comparing anterior iliac crest and calvarial donor sites have indicated higher rates of minor complications following anterior iliac crest harvesting, such as postoperative pain, sensory alterations, and gait disturbances, and lower rates of severe complications after calvarial bone graft harvesting,
      • Zouhary K.J.
      Bone graft harvesting from distant sites: concepts and techniques.
      • Scheerlinck L.M.
      • Muradin M.S.
      • van der Bilt A.
      • Meijer G.J.
      • Koole R.
      • Van Cann E.M.
      Donor site complications in bone grafting: comparison of iliac crest, calvarial, and mandibular ramus bone.
      • Riachi F.
      • Naaman N.
      • Tabarani C.
      • Berberi A.
      • Salameh Z.
      Comparison of morbidity and complications of harvesting bone from the iliac crest and calvarium: a retrospective study.
      for example dural exposure. Therefore, the aim of this systematic review was to compare the patient-reported outcomes of harvesting from the calvarium and/or the anterior iliac crest to augment the maxilla and mandible with bone grafts. The morbidity and complications were also evaluated for these donor sites.

      Methods

      Protocol development

      This systematic review was conducted following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions version 6.0. The reporting of this study complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement
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      • McKenzie J.E.
      • Bossuyt P.M.
      • Boutron I.
      • Hoffmann T.C.
      • Mulrow C.D.
      • Shamseer L.
      • Tetzlaff J.M.
      • Akl E.A.
      • Brennan S.E.
      • Chou R.
      • Glanville J.
      • Grimshaw J.M.
      • Hróbjartsson A.
      • Lalu M.M.
      • Li T.
      • Loder E.W.
      • Mayo-Wilson E.
      • McDonald S.
      • McGuinness L.A.
      • Stewart L.A.
      • Thomas J.
      • Tricco A.C.
      • Welch V.A.
      • Whiting P.
      • Moher D.
      The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
      and AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews; https://amstar.ca/index.php) to ensure quality and completeness. The study protocol has been registered in the PROSPERO database (International Prospective Register of Systematic Reviews; registration number CRD42021163926).

      Information sources and search strategy

      A thorough search of the literature was conducted with the help of a biomedical literature specialist; the search was completed on May 1, 2020 and updated on June 21, 2021. The primary database used was MEDLINE (via PubMed); Embase, the Cochrane Central Register of Controlled Trials, and OpenGrey were also searched. The search was supplemented by a hand-search of the references. Medical subject heading (MeSH) terms and free text words were combined in the search strategy according to the syntax rules of each database. Supplementary Material Table S1 depicts the strategy used in each database.
      The following research question was formed: “Do patient-reported outcomes differ between patients treated with bone block grafts harvested from the calvarium and patients treated with bone block grafts harvested from the iliac crest, in the case of bone augmentation of the maxilla and/or mandible for dental implant placement?”.
      Consequently, the researchers based the literature search on the following PICO index: the population (P) comprised patients ≥ 18 years of age undergoing bone augmentation of the maxilla and/or mandible for dental implant placement; the intervention (I) was bone grafts harvested from the calvarium; the control (C) was bone grafts harvested from the anterior iliac crest; the outcome (O) was patient-reported outcomes (PROs). More specifically, the primary outcome was PROs in terms of general satisfaction (measured on a scale such as a visual analogue scale (VAS), or by means of a dichotomous question). Secondary outcomes were the severity (measured on a scale such as a VAS) and prevalence of postoperative pain assessed after 1 week, 1 month, 6 months, or> 6 months postoperatively; donor graft harvesting-related disturbances in daily functioning (i.e., difficulty when lying in bed, gait disturbances, headaches, difficulty with wearing clothes); sensory alterations (i.e., anaesthesia, hypoesthesia, hyperesthesia, or paraesthesia alongside the scar or due to injury of the lateral femoral cutaneous nerve); the aesthetic outcome at the donor site (i.e., patient satisfaction with donor site aesthetics), contour alterations, and abnormal scar formation; and the prevalence of major perioperative complications (i.e., bicortical harvesting of the iliac crest, fracture of the iliac crest, trepanation of the skull with or without dura tear, excessive haemorrhage) and minor perioperative complications (i.e. haematoma, infection, seroma, wound dehiscence).
      The following inclusion criteria were applied: (1) randomized controlled clinical trials (RCTs), non-randomized controlled clinical trials (CCTs) with a minimum sample of 10 patients (five per group, or in the case of a split-mouth design at least five sites per group), and case series with more than five patients; (2) the repair of an extremely resorbed mandible and/or maxilla with bone block grafts from the calvarium or anterior iliac crest to optimize prosthetic function, or for the placement of dental implants; (3) detailed information available on PROs and procedure morbidities. No restriction was placed on language or year of publication. When necessary, a native speaker was asked to translate the title, abstract, or full text.
      Exclusion criteria were (1) patients treated with bone grafts harvested from donor sites other than the calvarium or anterior iliac crest; (2) patients with known bone disorders or medical conditions that could affect the donor site (parietal skull or anterior iliac crest); (3) systematic reviews, case reports, letters to the editor, expert opinions, conference abstracts.

      Eligibility criteria

      Two reviewers (D.E.W. and B.v.M) independently assessed the titles and abstracts identified in the initial search according to the inclusion and exclusion criteria. If the title and abstract provided limited information, or in the case of any doubt, the study was moved to the next round (full-text assessment). If a study compared anterior iliac crest or calvarial bone grafting with a control group not relevant to this review, such as a group treated with bone harvesting from other donor sites or treated with bone substitutes, it was assessed as a single-arm study. The results of the study assessments were compared, and Cohen’s kappa (κ) and the percentage of agreement were calculated. Any disagreement was resolved through consensus. The full texts of the articles retained after title and abstract reading were assessed independently according to the eligibility criteria by the same observers. Cohen’s κ and the percentage agreement were calculated, and any disagreement was resolved through consensus.

      Risk of bias assessment

      The risk of bias of RCTs was assessed using the Cochrane Collaboration Risk of Bias 2 (RoB 2) tool from the Cochrane Handbook for Systematic Reviews of Interventions version 6.0,
      • Sterne J.A.C.
      • Hernán M.A.
      • McAleenan A.
      • Reeves B.C.
      • Higgins J.P.T.
      Chapter 25: assessing risk of bias in a non-randomized study.
      which assesses the following study-level aspects: (1) randomization (allocation sequence), (2) allocation concealment, (3) blinding, (4) completeness of outcome data, and (5) selective outcome reporting. This tool classifies studies into low, high, or unclear risk of bias.
      The Newcastle–Ottawa Scale (NOS)
      • Wells G.
      • Shea B.
      • O’Connell D.
      • Peterson J.
      • Welch V.
      • Losos M.
      • Tugwell P.
      The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses.
      was used to assess the quality of the non-randomized studies (non-RCTs). Each study is judged on eight items, categorized into three groups: (1) selection of the study groups, (2) comparability of the groups, and (3) ascertainment of either the exposure or outcome of interest of the case–control or cohort studies, respectively.
      Discrepancies between the two reviewers when assessing the quality of the included studies were resolved in a consensus meeting. A third reviewer (G.M.R.) was consulted to give a final judgment in the case a persistent disagreement. The percentage of agreement between the reviewers and Cohen’s κ were calculated per item/domain of the tool used.

      Data extraction

      The data extraction was performed by the first reviewer (D.E.W.) using a predefined standardized form. A random sample of 30% of the extracted data was checked by the second reviewer (B.v.M.). Data on the study and patient characteristics, and the primary and secondary endpoints, were extracted. The method of assessment, moment of assessment (number of days or months postoperatively), and the outcomes were noted. If the moment of assessment varied among the studies regarding a certain outcome, the results were grouped by time frame (first week postoperatively, first month postoperatively, 6 months postoperatively,>6 months postoperatively). If various rating scales were used for a continuous outcome, the scales were recalculated to a 0–10 score, with 0 representing the absence of the outcome (‘no pain’, or ‘not satisfied’) and 10 representing full presence of the outcome (‘worst perceivable pain’ or ‘highly satisfied’).

      Statistical analysis

      Inter-observer agreement was calculated using IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA). Data on the primary outcome (patient satisfaction) and secondary outcomes (intensity and prevalence of pain, problems in daily functioning, alterations of sensitivity, patient satisfaction with scar aesthetics, and prevalence of perioperative complications) were collected using Microsoft 365 Excel (version 16.50). The pooled mean difference (MD) and 95% confidence interval (CI) were calculated for the continuous variables, i.e. patient satisfaction and postoperative pain VAS scores, as these were the variables that were most comparable between the two distinct surgical sites. Statistical heterogeneity was regarded as substantial if I
      • Dimitriou R.
      • Mataliotakis G.I.
      • Angoules A.G.
      • Kanakaris N.K.
      • Giannoudis P.V.
      Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review.
      > 50%. The meta-analysis was performed using R package meta (version 3.5.3; R Foundation for Statistical Computing, Vienna, Austria), using a random-effects model because of clinical heterogeneity.

      Results

      Study identification and selection

      A total of 3123 papers were identified. After excluding duplicates, 1946 papers were retrieved and screened by title and abstract (Fig. 1). Subsequently, 1870 papers were excluded (a list of all identified and excluded papers not presented in this review can be requested from the corresponding author). Disagreements (n = 64) were resolved in a consensus meeting. For the titles and abstracts screening, the percentage of agreement between the reviewers was 94% and Cohen’s κ was 0.62. The full texts of the remaining 76 reports were screened and subsequently 43 reports were included.
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      • Wortmann D.E.
      • Boven C.G.
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      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Raghoebar G.M.
      • Brouwer T.J.
      • Reintsema H.
      • Van
      • Oort R.P.
      Augmentation of the maxillary sinus floor with autogenous bone for the placement of endosseous implants: a preliminary report.
      • Chiapasco M.
      • Abati S.
      • Romeo E.
      • Vogel G.
      Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges.
      • Raghoebar G.M.
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      • Vissink A.
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      Morbidity and complications of bone grafting of the floor of the maxillary sinus for the placement of endosseous implants.
      • Stellingsma K.
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      • Stegenga B.
      • Meijer H.
      • Raghoebar G.
      Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
      • Joshi A.
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      An investigation of post-operative morbidity following iliac crest graft harvesting.
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      Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study.
      • Weingart D.
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      Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
      • Gerressen M.
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      Purely cancellous vs. corticocancellous bone in sinus floor augmentation with autogenous iliac crest: a prospective clinical trial.
      • Virnik A.S.
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      • Stettner H.
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      Comparison of the peripheral and central effects of opiates after iliac crest transplants: reconstruction of severely atrophied maxilla.
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      Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis.
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      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
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      Treatment of the atrophic edentulous maxilla: short implants versus bone augmentation for placing longer implants. Five-month post-loading results of a pilot randomised controlled trial.
      • Esposito M.
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      Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
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      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
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      Impact of donor site for bone graft harvesting for dental implants on health-related and oral health-related quality of life.
      • Reissmann D.R.
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      Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants.
      • Pistilli R.
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      Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
      • Sassano P.
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      Calvarial onlay graft and submental incision in treatment of atrophic edentulous mandibles: an approach to reduce postoperative complications.
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      Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest.
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      A prospective study on the morbidity resulting from calvarial bone harvesting for intraoral reconstruction.
      • Mertens C.
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      Reconstruction of the severely atrophic edentulous maxillae with calvarial bone grafts.
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      Gait analysis of patients subjected to the atrophic mandible augmentation with iliac bone graft.
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      Computer-guided calvarial mono-cortical bone blocks harvest: a novel approach for three-dimensional alveolar reconstruction of atrophic maxilla.
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      Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: a prospective pilot study.
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      Maxillary and mandibular reconstruction using calvarial bone grafts and Branemark implants: a preliminary report.
      • Lundgren S.
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      Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.
      • Kübler N.R.
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      Comparative studies of sinus floor elevation with autologous or allogeneic bone tissue.
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      Donor site morbidity in two different approaches to anterior iliac crest bone harvesting.
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      Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study.
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      Maxillary sinus augmentation: histologic and histomorphometric analysis.
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      • Suba Z.
      A prospective multicenter randomized clinical trial of autogenous bone versus beta-tricalcium phosphate graft alone for bilateral sinus elevation: histologic and histomorphometric evaluation.
      • Barone A.
      • Covani U.
      Maxillary alveolar ridge reconstruction with nonvascularized autogenous block bone: clinical results.
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      • Amoroso P.F.
      Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants.
      • Deppe H.
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      Sinus augmentation with intra- vs extraorally harvested bone grafts for the provision of dental implants: clinical long-term results.
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      Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.
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      Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.
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      Dental implants placed in severely atrophic jaws reconstructed with autogenous calvarium, bovine bone mineral, and collagen membranes: a 3- to 19-year retrospective follow-up study.
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      • Wilde F.
      Risk factors for post-operative complications after procedures for autologous bone augmentation from different donor sites.
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      • Mustafa K.
      • Gjengedal H.
      Patient experience following iliac crest-derived alveolar bone grafting and implant placement.
      Among these, three articles included data from studies described in other articles as well
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Felice P.
      • Soardi E.
      • Pellegrino G.
      • Pistilli R.
      • Marchetti C.
      • Gessaroli M.
      • Esposito M.
      Treatment of the atrophic edentulous maxilla: short implants versus bone augmentation for placing longer implants. Five-month post-loading results of a pilot randomised controlled trial.
      • Esposito M.
      • Barausse C.
      • Pistilli R.
      • Sammartino G.
      • Grandi G.
      • Felice P.
      Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
      • Reissmann D.R.
      • Dietze B.
      • Vogeler M.
      • Schmelzeisen R.
      • Heydecke G.
      Impact of donor site for bone graft harvesting for dental implants on health-related and oral health-related quality of life.
      • Reissmann D.R.
      • Poxleitner P.
      • Heydecke G.
      Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants.
      ; thus the data from both reports were combined. Finally, 40 studies were included for data collection and quality assessment (Fig. 1). The percentage of agreement was 91.4% and Cohen’s κ was 0.82 for the full text assessment. Most studies reported data of just one of the arms and thus had no control group.
      Fig. 1
      Fig. 1Flowchart of the study identification and selection process.

      Assessment of methodological quality

      A low risk of bias was seen in the following domains: ‘deviations from intended interventions’, ‘measurement of the outcome’, and ‘selection of the reported results’. An intermediate risk of bias was seen in the domains ‘randomization process’ and ‘bias due to missing outcome data’. A high risk of bias was observed in the ‘selection of the groups’ (69.2%). An unclear risk of bias was seen in ‘exposure’ (51.3%). The ‘comparability of the groups’ domain was only applicable to one retrospective comparative trial (Supplementary Material Table S2),
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      as the remaining studies had only one arm of interest for this review, and this was interpreted as a high risk of bias (97.4%). The Cohen’s weighted κ was 1.0 for ‘selection of the groups’, 1.0 for ‘comparability of the groups’, and 0.88 for ‘exposure’.

      Study characteristics and interventions

      The 40 included studies were one RCT, one CCT, 23 prospective cohort studies, and 15 retrospective cohort studies, published between 1993 and 2020 (Table 1). The follow-up ranged from 3 weeks to 228 months. Two studies declared funding from a research programme
      • Virnik A.S.
      • Gaggl A.
      • Likar R.
      • Stettner H.
      • Chiari F.M.
      Comparison of the peripheral and central effects of opiates after iliac crest transplants: reconstruction of severely atrophied maxilla.
      • Cansiz E.
      • Karabulut D.
      • Dogru S.C.
      • Akalan N.E.
      • Temelli Y.
      • Arslan Y.Z.
      Gait analysis of patients subjected to the atrophic mandible augmentation with iliac bone graft.
      and 25 studies did not mention funding or conflict of interest.
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Raghoebar G.M.
      • Brouwer T.J.
      • Reintsema H.
      • Van
      • Oort R.P.
      Augmentation of the maxillary sinus floor with autogenous bone for the placement of endosseous implants: a preliminary report.
      • Chiapasco M.
      • Abati S.
      • Romeo E.
      • Vogel G.
      Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges.
      • Raghoebar G.M.
      • Batenburg R.H.
      • Timmenga N.M.
      • Vissink A.
      • Reintsema H.
      Morbidity and complications of bone grafting of the floor of the maxillary sinus for the placement of endosseous implants.
      • Joshi A.
      • Kostakis G.C.
      An investigation of post-operative morbidity following iliac crest graft harvesting.
      • Nkenke E.
      • Weisbach V.
      • Winckler E.
      • Kessler P.
      • Schultze-Mosgau S.
      • Wiltfang J.
      • Neukam F.W.
      Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study.
      • Weingart D.
      • Bublitz R.
      • Petrin G.
      • Kälber J.
      • Ingimarsson S.
      Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
      • Gerressen M.
      • Hermanns-Sachweh B.
      • Riediger D.
      • Hilgers R.D.
      • Spiekermann H.
      • Ghassemi A.
      Purely cancellous vs. corticocancellous bone in sinus floor augmentation with autogenous iliac crest: a prospective clinical trial.
      • Barone A.
      • Ricci M.
      • Mangano F.
      • Covani U.
      Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis.
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      • Mertens C.
      • Steveling H.G.
      • Seeberger R.
      • Hoffmann J.
      • Freier K.
      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
      • Pistilli R.
      • Felice P.
      • Piatelli M.
      • Nisii A.
      • Barausse C.
      • Esposito M.
      Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
      • Sassano P.
      • Gennaro P.
      • Chisci G.
      • Gabriele G.
      • Aboh I.V.
      • Mitro V.
      • di Curzio P.
      Calvarial onlay graft and submental incision in treatment of atrophic edentulous mandibles: an approach to reduce postoperative complications.
      • Fretwurst T.
      • Nack C.
      • Al-Ghrairi M.
      • Raguse J.D.
      • Stricker A.
      • Schmelzeisen R.
      • Nelson K.
      • Nahles S.
      Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest.
      • Mertens C.
      • Freier K.
      • Engel M.
      • Krisam J.
      • Hoffmann J.
      • Freudlsperger C.
      Reconstruction of the severely atrophic edentulous maxillae with calvarial bone grafts.
      • Elhadidi M.
      • Aldahouk A.
      • Shawky M.
      • Elbehairy M.S.
      • Atef M.
      • El-Gengehi M.
      Computer-guided calvarial mono-cortical bone blocks harvest: a novel approach for three-dimensional alveolar reconstruction of atrophic maxilla.
      • Donovan M.G.
      • Dickerson N.C.
      • Hanson L.J.
      • Gustafson R.B.
      Maxillary and mandibular reconstruction using calvarial bone grafts and Branemark implants: a preliminary report.
      • Lundgren S.
      • Nystrom E.
      • Nilson H.
      • Gunne J.
      • Lindhagen O.
      Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.
      • Kübler N.R.
      • Will C.
      • Depprich R.
      • Betz T.
      • Reinhart E.
      • Bill J.S.
      • Reuther J.F.
      Comparative studies of sinus floor elevation with autologous or allogeneic bone tissue.
      • Barone A.
      • Crespi R.
      • Aldini N.N.
      • Fini M.
      • Giardino R.
      • Covani U.
      Maxillary sinus augmentation: histologic and histomorphometric analysis.
      • Szabó G.
      • Huys L.
      • Coulthard P.
      • Maiorana C.
      • Garagiola U.
      • Barabás J.
      • Németh Z.
      • Hrabák K.
      • Suba Z.
      A prospective multicenter randomized clinical trial of autogenous bone versus beta-tricalcium phosphate graft alone for bilateral sinus elevation: histologic and histomorphometric evaluation.
      • Barone A.
      • Covani U.
      Maxillary alveolar ridge reconstruction with nonvascularized autogenous block bone: clinical results.
      • Deppe H.
      • Mücke T.
      • Wagenpfeil S.
      • Hölzle F.
      Sinus augmentation with intra- vs extraorally harvested bone grafts for the provision of dental implants: clinical long-term results.
      • Restoy-Lozano A.
      • Dominguez-Mompell J.L.
      • Infante-Cossio P.
      • Lara-Chao J.
      • Espin-Galvez F.
      • Lopez-Pizarro V.
      Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.
      • Tessier P.
      Autogenous bone grafts taken from the calvarium for facial and cranial applications.
      All of the remaining studies declared that they did not have any funding or conflict of interest.
      Table 1Characteristics of the included studies.
      Author, yearStudy designStudy population
      Calvarium graftAnterior iliac crest graftComorbidity
      Comorbidity: patients with comorbidities affecting bone quality or quantity, or tissue healing capacity; or patients with pathological conditions at the donor site including previous surgery or irradiation of this area.
      Follow-up (months)Study typeSettingnSex (%)Age (years)

      Mean (range/SD)
      nSex (%)Age (years)

      Mean (range/SD)
      Comparative studies
      Kuik et al., 2016
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      28.8
      Median follow-up period.
      CCTMC27F: 48%

      M: 52%
      60 (55–66)27F: 56%

      M: 44%
      61.1 (55–67)Unknown
      Putters et al., 2018
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      (and Wortmann et al., 2019
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      )
      12
      Exact duration of the follow-up period.
      RCTSC10F: 50%

      M: 50%
      65.9 (SD 8.7)10F: 60%

      M: 40%
      63.5 (SD 7.0)Excluded
      Non-comparative prospective studies
      Raghoebar et al., 1993
      • Raghoebar G.M.
      • Brouwer T.J.
      • Reintsema H.
      • Van
      • Oort R.P.
      Augmentation of the maxillary sinus floor with autogenous bone for the placement of endosseous implants: a preliminary report.
      16
      Mean follow-up period.
      PCSSC022F: 48%

      M: 52%
      48 (19–64)Excluded
      Chiapasco et al., 1999
      • Chiapasco M.
      • Abati S.
      • Romeo E.
      • Vogel G.
      Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges.
      ,
      This study included two patients treated with calvarium bone grafts who did not fit the review inclusion criteria, thus only the anterior iliac crest group was included.
      12
      Mean follow-up period.
      PCSSC013F: 78%

      M: 22%
      42.1 (SD 12.5)Excluded
      Raghoebar et al., 1999
      • Raghoebar G.M.
      • Batenburg R.H.
      • Timmenga N.M.
      • Vissink A.
      • Reintsema H.
      Morbidity and complications of bone grafting of the floor of the maxillary sinus for the placement of endosseous implants.
      32
      Mean follow-up period.
      PCSSC065F: 48%

      M: 52%
      42 (SD 11)Excluded
      Stellingsma et al., 2003
      • Stellingsma K.
      • Bouma J.
      • Stegenga B.
      • Meijer H.
      • Raghoebar G.
      Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
      12
      No information provided on the details of the follow-up data.
      PCSSC019F: 83%

      M: 17%
      59 (SD11)Excluded
      Joshi and Kostakis, 2004
      • Joshi A.
      • Kostakis G.C.
      An investigation of post-operative morbidity following iliac crest graft harvesting.
      12
      No information provided on the details of the follow-up data.
      PCSSC098F: 62%

      M: 38%
      44 (16–75)Unknown
      Nkenke et al., 2004
      • Nkenke E.
      • Weisbach V.
      • Winckler E.
      • Kessler P.
      • Schultze-Mosgau S.
      • Wiltfang J.
      • Neukam F.W.
      Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study.
      1
      Exact duration of the follow-up period.
      PCSSC025F: 56%

      M: 44%
      52 (SD 9.6)Excluded
      Weingart et al., 2005
      • Weingart D.
      • Bublitz R.
      • Petrin G.
      • Kälber J.
      • Ingimarsson S.
      Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
      1
      Mean follow-up period.
      PCSSC046F: 56%

      M: 44%
      55 (20–69)Excluded
      Gerressen et al., 2009
      • Gerressen M.
      • Hermanns-Sachweh B.
      • Riediger D.
      • Hilgers R.D.
      • Spiekermann H.
      • Ghassemi A.
      Purely cancellous vs. corticocancellous bone in sinus floor augmentation with autogenous iliac crest: a prospective clinical trial.
      5.2
      Mean follow-up period.
      PCSSC015F: 60%

      M: 40%
      54.9 (39–72)Unknown
      Virnik et al., 2009
      • Virnik A.S.
      • Gaggl A.
      • Likar R.
      • Stettner H.
      • Chiari F.M.
      Comparison of the peripheral and central effects of opiates after iliac crest transplants: reconstruction of severely atrophied maxilla.
      8
      Median follow-up period.
      PCSNR020F: 50%

      M: 50%
      56.3 (43–62)Excluded
      Barone et al., 2011
      • Barone A.
      • Ricci M.
      • Mangano F.
      • Covani U.
      Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis.
      5
      Exact duration of the follow-up period.
      PCSSC0235F: 66%

      M: 34%
      54.3 (SD 10.2)Excluded
      Becker et al., 2011
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      48
      Exact duration of the follow-up period.
      PCSSC050F: 48%

      M: 52%
      52 (SD 2.0)Excluded
      Felice et al., 2011
      • Felice P.
      • Soardi E.
      • Pellegrino G.
      • Pistilli R.
      • Marchetti C.
      • Gessaroli M.
      • Esposito M.
      Treatment of the atrophic edentulous maxilla: short implants versus bone augmentation for placing longer implants. Five-month post-loading results of a pilot randomised controlled trial.
      (and Esposito et al., 2015
      • Esposito M.
      • Barausse C.
      • Pistilli R.
      • Sammartino G.
      • Grandi G.
      • Felice P.
      Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
      )
      12
      Exact duration of the follow-up period.
      PCSMC013F: 62%

      M: 38%
      52 (29–65)Excluded
      Marianetti et al., 2013
      • Marianetti T.M.
      • Staffoli S.
      • Di Nardo F.
      • Moro A.
      • Foresta E.
      • Gasparini G.
      • Pelo S.
      Intracortical versus anteromedial approach for iliac crest bone harvesting in preprosthetic surgery: a randomized prospective clinical trial.
      12
      Exact duration of the follow-up period.
      PCSSC073F: 59%

      M: 41%
      49.3 (SD 14.55)Excluded
      Mertens et al., 2013
      • Mertens C.
      • Steveling H.G.
      • Seeberger R.
      • Hoffmann J.
      • Freier K.
      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
      28
      Mean follow-up period.
      PCSSC12F: 73%

      M: 27%
      54 (30–71)0Excluded
      Reissmann et al., 2013
      • Reissmann D.R.
      • Dietze B.
      • Vogeler M.
      • Schmelzeisen R.
      • Heydecke G.
      Impact of donor site for bone graft harvesting for dental implants on health-related and oral health-related quality of life.
      (and Reissmann et al., 2018
      • Reissmann D.R.
      • Poxleitner P.
      • Heydecke G.
      Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants.
      )
      1
      Exact duration of the follow-up period.
      PCSSC015F: 60%

      M: 40%
      46.1 (SD 15.5)Excluded
      Pistilli et al., 2014
      • Pistilli R.
      • Felice P.
      • Piatelli M.
      • Nisii A.
      • Barausse C.
      • Esposito M.
      Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
      8
      Exact duration of the follow-up period.
      PCSMC014F: 50%

      M: 50%
      49.5 (38–62)Excluded
      Sassano et al., 2014
      • Sassano P.
      • Gennaro P.
      • Chisci G.
      • Gabriele G.
      • Aboh I.V.
      • Mitro V.
      • di Curzio P.
      Calvarial onlay graft and submental incision in treatment of atrophic edentulous mandibles: an approach to reduce postoperative complications.
      12
      Exact duration of the follow-up period.
      PCSSC6F: 67%

      M: 33%
      63 (60–67)0Excluded
      Fretwurst et al., 2015
      • Fretwurst T.
      • Nack C.
      • Al-Ghrairi M.
      • Raguse J.D.
      • Stricker A.
      • Schmelzeisen R.
      • Nelson K.
      • Nahles S.
      Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest.
      6
      Exact duration of the follow-up period.
      PCSSC020F: 75%

      M: 25%
      54.3 (20–78)Excluded
      Putters et al., 2015
      • Putters T.F.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      A prospective study on the morbidity resulting from calvarial bone harvesting for intraoral reconstruction.
      25
      Mean follow-up period.
      PCSMC36F: 61%

      M: 39%
      59 (SD 8.2)0Excluded
      Mertens et al., 2017
      • Mertens C.
      • Freier K.
      • Engel M.
      • Krisam J.
      • Hoffmann J.
      • Freudlsperger C.
      Reconstruction of the severely atrophic edentulous maxillae with calvarial bone grafts.
      54
      Exact duration of the follow-up period.
      PCSSC17F: 94%

      M: 6%
      54.3 (25–71)0Excluded
      Cansiz et al., 2019
      • Cansiz E.
      • Karabulut D.
      • Dogru S.C.
      • Akalan N.E.
      • Temelli Y.
      • Arslan Y.Z.
      Gait analysis of patients subjected to the atrophic mandible augmentation with iliac bone graft.
      0.75
      Exact duration of the follow-up period.
      PCSSC010F: 50%

      M: 50%
      43 (SD 10.4)Excluded
      Elhadidi et al., 2019
      • Elhadidi M.
      • Aldahouk A.
      • Shawky M.
      • Elbehairy M.S.
      • Atef M.
      • El-Gengehi M.
      Computer-guided calvarial mono-cortical bone blocks harvest: a novel approach for three-dimensional alveolar reconstruction of atrophic maxilla.
      4
      Exact duration of the follow-up period.
      PCSSC8NRNR0--Included
      Putters et al., 2019
      • Putters T.F.
      • Raghoebar G.M.
      • Klein-Nulend J.
      • Vissink A.
      • Schortinghuis J.
      Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: a prospective pilot study.
      4
      Exact duration of the follow-up period.
      PCSSC13F: 69%

      M: 31%
      68 (SD 9)0Excluded
      Non-comparative retrospective studies
      Donovan et al., 1994
      • Donovan M.G.
      • Dickerson N.C.
      • Hanson L.J.
      • Gustafson R.B.
      Maxillary and mandibular reconstruction using calvarial bone grafts and Branemark implants: a preliminary report.
      31
      Mean follow-up period.
      RCSSC24F: 67%

      M: 33%
      48 (20–67)0Unknown
      Lundgren et al., 1997
      • Lundgren S.
      • Nystrom E.
      • Nilson H.
      • Gunne J.
      • Lindhagen O.
      Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.
      22
      Mean follow-up period.
      RCSSC010F: 90%

      M: 10%
      55 (43–71)Excluded
      Kübler et al., 1999
      • Kübler N.R.
      • Will C.
      • Depprich R.
      • Betz T.
      • Reinhart E.
      • Bill J.S.
      • Reuther J.F.
      Comparative studies of sinus floor elevation with autologous or allogeneic bone tissue.
      6
      No information provided on the details of the follow-up data.
      RCSSC039NRNRExcluded
      Cricchio et al., 2003
      • Cricchio G.
      • Lundgren S.
      Donor site morbidity in two different approaches to anterior iliac crest bone harvesting.
      24
      Exact duration of the follow-up period.
      RCSSC070F: 61%

      M: 39%
      56 (38–69)Unknown
      Yerit et al., 2004
      • Yerit K.C.
      • Posch M.
      • Hainich S.
      • Turhani D.
      • Klug C.
      • Wanschitz F.
      • Wagner A.
      • Watzinger F.
      • Ewers R.
      Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study.
      144
      Mean follow-up period.
      RCSSC028F: 71%

      M: 29%
      58 (SD 10)Unknown
      Barone et al., 2005
      • Barone A.
      • Crespi R.
      • Aldini N.N.
      • Fini M.
      • Giardino R.
      • Covani U.
      Maxillary sinus augmentation: histologic and histomorphometric analysis.
      5
      Exact duration of the follow-up period.
      RCSSC018F: 67%

      M: 33%
      46.7 (37–60)Excluded
      Szabó et al., 2005
      • Szabó G.
      • Huys L.
      • Coulthard P.
      • Maiorana C.
      • Garagiola U.
      • Barabás J.
      • Németh Z.
      • Hrabák K.
      • Suba Z.
      A prospective multicenter randomized clinical trial of autogenous bone versus beta-tricalcium phosphate graft alone for bilateral sinus elevation: histologic and histomorphometric evaluation.
      6
      No information provided on the details of the follow-up data.
      RCSMC020F: 55%

      M: 45%
      52 (28–67)Excluded
      Barone and Covani, 2007
      • Barone A.
      • Covani U.
      Maxillary alveolar ridge reconstruction with nonvascularized autogenous block bone: clinical results.
      4.5
      No information provided on the details of the follow-up data.
      RCSSC056F: 68%

      M: 32%
      NR (27–630Excluded
      Pelo et al., 2010
      • Pelo S.
      • Boniello R.
      • Moro A.
      • Gasparini G.
      • Amoroso P.F.
      Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants.
      44
      Exact duration of the follow-up period.
      RCSSC019F: 63%

      M: 37%
      58.8 (48–68)Excluded
      Deppe et al., 2012
      • Deppe H.
      • Mücke T.
      • Wagenpfeil S.
      • Hölzle F.
      Sinus augmentation with intra- vs extraorally harvested bone grafts for the provision of dental implants: clinical long-term results.
      6
      Exact duration of the follow-up period.
      RCSSC054F: 57%

      M: 43%
      57.2 (NR)Excluded
      Restoy-Lozano et al., 2015
      • Restoy-Lozano A.
      • Dominguez-Mompell J.L.
      • Infante-Cossio P.
      • Lara-Chao J.
      • Espin-Galvez F.
      • Lopez-Pizarro V.
      Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.
      45
      Mean follow-up period.
      RCSSC11F: 80%

      M: 20%
      44 (R: 18–62)0Excluded
      Quiles et al., 2015
      • Quiles J.C.
      • Souza F.A.
      • Bassi A.P.
      • Garcia Jr, I.R.
      • Franca M.T.
      • Carvalho P.S.
      Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.
      132
      No information provided on the details of the follow-up data.
      RCSSC25NRNR0Unknown
      Chiapasco et al., 2018
      • Chiapasco M.
      • Tommasato G.
      • Palombo D.
      • Scarnò D.
      • Zaniboni M.
      • Del
      • Fabbro M.
      Dental implants placed in severely atrophic jaws reconstructed with autogenous calvarium, bovine bone mineral, and collagen membranes: a 3- to 19-year retrospective follow-up study.
      228
      Mean follow-up period.
      RCSSC72F: 75%

      M: 25%
      48 (R: 16–72)0Excluded
      Sakkas et al., 2018
      • Sakkas A.
      • Schramm A.
      • Winter K.
      • Wilde F.
      Risk factors for post-operative complications after procedures for autologous bone augmentation from different donor sites.
      24
      No information provided on the details of the follow-up data.
      RCSSC038NRNRExcluded
      Gjerde et al., 2020
      • Gjerde C.G.
      • Shanbhag S.
      • Neppelberg E.
      • Mustafa K.
      • Gjengedal H.
      Patient experience following iliac crest-derived alveolar bone grafting and implant placement.
      94
      Mean follow-up period.
      RCSSC044F: 54%

      M: 46%
      61.2 (SD 13.1)Excluded
      CCT, controlled clinical trial; F, female; M, male; MC, multicentre; NR, not reported; PCS, prospective cohort study; RCS, retrospective cohort study; RCT, randomized clinical trial; SC, single centre; SD, standard deviation;
      a Comorbidity: patients with comorbidities affecting bone quality or quantity, or tissue healing capacity; or patients with pathological conditions at the donor site including previous surgery or irradiation of this area.
      b Median follow-up period.
      c Exact duration of the follow-up period.
      d Mean follow-up period.
      e This study included two patients treated with calvarium bone grafts who did not fit the review inclusion criteria, thus only the anterior iliac crest group was included.
      f No information provided on the details of the follow-up data.
      The techniques used for calvarial harvesting were similar to that described by Tessier,
      • Tessier P.
      Autogenous bone grafts taken from the calvarium for facial and cranial applications.
      Kellman,
      • Kellman R.M.
      Safe and dependable harvesting of large outer-table calvarial bone grafts.
      and Schortinghuis.
      • Putters T.
      • Schortinghuis J.
      • Raghoebar G.
      • Bronckers A.
      Calvarial bone grafts to augment the atrophied maxilla: experience, morbidity and histology.
      • Schortinghuis J.
      • Putters T.F.
      • Raghoebar G.M.
      Safe harvesting of outer table parietal bone grafts using an oscillating saw and a bone scraper: a refinement of technique for harvesting cortical and “cancellous”-like calvarial bone.
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      The information on the prevention of intracranial perforations and filling of the contour defect varied. The calvarial defects were repaired by means of synthetic bone substitutes, such as polymethyl methacrylate (PMMA)
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      • Raghoebar G.M.
      • Brouwer T.J.
      • Reintsema H.
      • Van
      • Oort R.P.
      Augmentation of the maxillary sinus floor with autogenous bone for the placement of endosseous implants: a preliminary report.
      • Putters T.F.
      • Raghoebar G.M.
      • Klein-Nulend J.
      • Vissink A.
      • Schortinghuis J.
      Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: a prospective pilot study.
      or titanium mesh or calcium phosphate cement.
      • Restoy-Lozano A.
      • Dominguez-Mompell J.L.
      • Infante-Cossio P.
      • Lara-Chao J.
      • Espin-Galvez F.
      • Lopez-Pizarro V.
      Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.
      The remaining studies did not repair the defect
      • Mertens C.
      • Steveling H.G.
      • Seeberger R.
      • Hoffmann J.
      • Freier K.
      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
      • Sassano P.
      • Gennaro P.
      • Chisci G.
      • Gabriele G.
      • Aboh I.V.
      • Mitro V.
      • di Curzio P.
      Calvarial onlay graft and submental incision in treatment of atrophic edentulous mandibles: an approach to reduce postoperative complications.
      • Donovan M.G.
      • Dickerson N.C.
      • Hanson L.J.
      • Gustafson R.B.
      Maxillary and mandibular reconstruction using calvarial bone grafts and Branemark implants: a preliminary report.
      • Quiles J.C.
      • Souza F.A.
      • Bassi A.P.
      • Garcia Jr, I.R.
      • Franca M.T.
      • Carvalho P.S.
      Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.
      • Chiapasco M.
      • Tommasato G.
      • Palombo D.
      • Scarnò D.
      • Zaniboni M.
      • Del
      • Fabbro M.
      Dental implants placed in severely atrophic jaws reconstructed with autogenous calvarium, bovine bone mineral, and collagen membranes: a 3- to 19-year retrospective follow-up study.
      or did not report information on a repair.
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Reissmann D.R.
      • Dietze B.
      • Vogeler M.
      • Schmelzeisen R.
      • Heydecke G.
      Impact of donor site for bone graft harvesting for dental implants on health-related and oral health-related quality of life.
      • Reissmann D.R.
      • Poxleitner P.
      • Heydecke G.
      Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants.
      • Mertens C.
      • Freier K.
      • Engel M.
      • Krisam J.
      • Hoffmann J.
      • Freudlsperger C.
      Reconstruction of the severely atrophic edentulous maxillae with calvarial bone grafts.
      In one study, augmentation was combined with direct implant placement.
      • Putters T.F.
      • Raghoebar G.M.
      • Klein-Nulend J.
      • Vissink A.
      • Schortinghuis J.
      Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: a prospective pilot study.
      Most of the anterior iliac crest monocortical blocks were harvested from the medial site.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Chiapasco M.
      • Abati S.
      • Romeo E.
      • Vogel G.
      Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges.
      • Raghoebar G.M.
      • Batenburg R.H.
      • Timmenga N.M.
      • Vissink A.
      • Reintsema H.
      Morbidity and complications of bone grafting of the floor of the maxillary sinus for the placement of endosseous implants.
      • Nkenke E.
      • Weisbach V.
      • Winckler E.
      • Kessler P.
      • Schultze-Mosgau S.
      • Wiltfang J.
      • Neukam F.W.
      Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study.
      • Virnik A.S.
      • Gaggl A.
      • Likar R.
      • Stettner H.
      • Chiari F.M.
      Comparison of the peripheral and central effects of opiates after iliac crest transplants: reconstruction of severely atrophied maxilla.
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      • Felice P.
      • Soardi E.
      • Pellegrino G.
      • Pistilli R.
      • Marchetti C.
      • Gessaroli M.
      • Esposito M.
      Treatment of the atrophic edentulous maxilla: short implants versus bone augmentation for placing longer implants. Five-month post-loading results of a pilot randomised controlled trial.
      • Esposito M.
      • Barausse C.
      • Pistilli R.
      • Sammartino G.
      • Grandi G.
      • Felice P.
      Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
      • Marianetti T.M.
      • Staffoli S.
      • Di Nardo F.
      • Moro A.
      • Foresta E.
      • Gasparini G.
      • Pelo S.
      Intracortical versus anteromedial approach for iliac crest bone harvesting in preprosthetic surgery: a randomized prospective clinical trial.
      • Pistilli R.
      • Felice P.
      • Piatelli M.
      • Nisii A.
      • Barausse C.
      • Esposito M.
      Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
      • Fretwurst T.
      • Nack C.
      • Al-Ghrairi M.
      • Raguse J.D.
      • Stricker A.
      • Schmelzeisen R.
      • Nelson K.
      • Nahles S.
      Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest.
      • Cansiz E.
      • Karabulut D.
      • Dogru S.C.
      • Akalan N.E.
      • Temelli Y.
      • Arslan Y.Z.
      Gait analysis of patients subjected to the atrophic mandible augmentation with iliac bone graft.
      • Lundgren S.
      • Nystrom E.
      • Nilson H.
      • Gunne J.
      • Lindhagen O.
      Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.
      • Yerit K.C.
      • Posch M.
      • Hainich S.
      • Turhani D.
      • Klug C.
      • Wanschitz F.
      • Wagner A.
      • Watzinger F.
      • Ewers R.
      Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study.
      • Barone A.
      • Crespi R.
      • Aldini N.N.
      • Fini M.
      • Giardino R.
      • Covani U.
      Maxillary sinus augmentation: histologic and histomorphometric analysis.
      • Quiles J.C.
      • Souza F.A.
      • Bassi A.P.
      • Garcia Jr, I.R.
      • Franca M.T.
      • Carvalho P.S.
      Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.
      • Sakkas A.
      • Schramm A.
      • Winter K.
      • Wilde F.
      Risk factors for post-operative complications after procedures for autologous bone augmentation from different donor sites.
      Care for the lateral femoral cutaneous nerve, haemostasis, and the location of the incision was described in varying detail. Postoperative interventions, such as standard physical therapy and advice to use crutches, were only mentioned in 12 studies.
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Chiapasco M.
      • Abati S.
      • Romeo E.
      • Vogel G.
      Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges.
      • Weingart D.
      • Bublitz R.
      • Petrin G.
      • Kälber J.
      • Ingimarsson S.
      Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
      • Virnik A.S.
      • Gaggl A.
      • Likar R.
      • Stettner H.
      • Chiari F.M.
      Comparison of the peripheral and central effects of opiates after iliac crest transplants: reconstruction of severely atrophied maxilla.
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      • Fretwurst T.
      • Nack C.
      • Al-Ghrairi M.
      • Raguse J.D.
      • Stricker A.
      • Schmelzeisen R.
      • Nelson K.
      • Nahles S.
      Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest.
      • Putters T.F.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      A prospective study on the morbidity resulting from calvarial bone harvesting for intraoral reconstruction.
      • Cansiz E.
      • Karabulut D.
      • Dogru S.C.
      • Akalan N.E.
      • Temelli Y.
      • Arslan Y.Z.
      Gait analysis of patients subjected to the atrophic mandible augmentation with iliac bone graft.
      • Elhadidi M.
      • Aldahouk A.
      • Shawky M.
      • Elbehairy M.S.
      • Atef M.
      • El-Gengehi M.
      Computer-guided calvarial mono-cortical bone blocks harvest: a novel approach for three-dimensional alveolar reconstruction of atrophic maxilla.
      • Cricchio G.
      • Lundgren S.
      Donor site morbidity in two different approaches to anterior iliac crest bone harvesting.
      • Barone A.
      • Covani U.
      Maxillary alveolar ridge reconstruction with nonvascularized autogenous block bone: clinical results.
      • Sakkas A.
      • Schramm A.
      • Winter K.
      • Wilde F.
      Risk factors for post-operative complications after procedures for autologous bone augmentation from different donor sites.

      Primary outcome: patient-reported satisfaction

      Regarding the calvarial bone grafts, seven studies (206 patients in total) reported satisfaction with the procedure in general: the median VAS score ranged from 8.8 to 10
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      ; 94–100% of the patients would recommend the procedure to others
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Mertens C.
      • Steveling H.G.
      • Seeberger R.
      • Hoffmann J.
      • Freier K.
      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
      • Donovan M.G.
      • Dickerson N.C.
      • Hanson L.J.
      • Gustafson R.B.
      Maxillary and mandibular reconstruction using calvarial bone grafts and Branemark implants: a preliminary report.
      • Quiles J.C.
      • Souza F.A.
      • Bassi A.P.
      • Garcia Jr, I.R.
      • Franca M.T.
      • Carvalho P.S.
      Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.
      and 90–100% would undergo the same procedure again if necessary
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Mertens C.
      • Steveling H.G.
      • Seeberger R.
      • Hoffmann J.
      • Freier K.
      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
      • Donovan M.G.
      • Dickerson N.C.
      • Hanson L.J.
      • Gustafson R.B.
      Maxillary and mandibular reconstruction using calvarial bone grafts and Branemark implants: a preliminary report.
      • Quiles J.C.
      • Souza F.A.
      • Bassi A.P.
      • Garcia Jr, I.R.
      • Franca M.T.
      • Carvalho P.S.
      Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.
      • Chiapasco M.
      • Tommasato G.
      • Palombo D.
      • Scarnò D.
      • Zaniboni M.
      • Del
      • Fabbro M.
      Dental implants placed in severely atrophic jaws reconstructed with autogenous calvarium, bovine bone mineral, and collagen membranes: a 3- to 19-year retrospective follow-up study.
      (Table 2).
      Table 2Patient-reported satisfaction with the procedure (primary outcome) and postoperative pain (secondary outcome).
      Satisfaction with the procedure
      Results for patient-reported satisfaction with the procedure in general, assessed by means of a VAS score (with 0 representing not satisfied and 10 representing highly satisfied), and responses to a dichotomous question (yes/no) regarding whether they were satisfied, would recommend the treatment to others with a similar problem, and whether they would undergo the same treatment again if necessary.
      Rating, VAS (0–10)

      Mean (R/SD) or median (IQR)
      Question–Satisfied?

      ‘Yes’ (%)
      Question–Recommend?

      ‘Yes’ (%)
      Question–Redo?

      ‘Yes’ (%)
      CalvariumAICCalvariumAICCalvariumAICCalvariumAIC
      Comparative studies
      Kuik et al., 2016
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      10 (IQR 9.4–10)10 (IQR 8.3–10)969610089
      Putters et al., 2018
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      (and Wortmann et al., 2019
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      )
      8.8 (IQR 8.1–10)9.5 (IQR 9.0–9.5)100100100100
      Non-comparative prospective studies
      Stellingsma et al., 2003
      • Stellingsma K.
      • Bouma J.
      • Stegenga B.
      • Meijer H.
      • Raghoebar G.
      Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
      90
      Joshi and Kostakis, 2004
      • Joshi A.
      • Kostakis G.C.
      An investigation of post-operative morbidity following iliac crest graft harvesting.
      9285
      Barone et al., 2011
      • Barone A.
      • Ricci M.
      • Mangano F.
      • Covani U.
      Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis.
      97
      Becker et al., 2011
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      9580
      Felice et al., 2011
      • Felice P.
      • Soardi E.
      • Pellegrino G.
      • Pistilli R.
      • Marchetti C.
      • Gessaroli M.
      • Esposito M.
      Treatment of the atrophic edentulous maxilla: short implants versus bone augmentation for placing longer implants. Five-month post-loading results of a pilot randomised controlled trial.
      (and Esposito et al., 2015
      • Esposito M.
      • Barausse C.
      • Pistilli R.
      • Sammartino G.
      • Grandi G.
      • Felice P.
      Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
      )
      10
      This study did not provide details on whether the value reported was the mean or median. Additionally, no SD, range, or IQR was provided.
      100
      Marianetti et al., 2013
      • Marianetti T.M.
      • Staffoli S.
      • Di Nardo F.
      • Moro A.
      • Foresta E.
      • Gasparini G.
      • Pelo S.
      Intracortical versus anteromedial approach for iliac crest bone harvesting in preprosthetic surgery: a randomized prospective clinical trial.
      97100
      Mertens et al., 2013
      • Mertens C.
      • Steveling H.G.
      • Seeberger R.
      • Hoffmann J.
      • Freier K.
      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
      100100
      Putters et al., 2015
      • Putters T.F.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      A prospective study on the morbidity resulting from calvarial bone harvesting for intraoral reconstruction.
      95
      Non-comparative retrospective studies
      Donovan et al., 1994
      • Donovan M.G.
      • Dickerson N.C.
      • Hanson L.J.
      • Gustafson R.B.
      Maxillary and mandibular reconstruction using calvarial bone grafts and Branemark implants: a preliminary report.
      9494
      Lundgren et al., 1997
      • Lundgren S.
      • Nystrom E.
      • Nilson H.
      • Gunne J.
      • Lindhagen O.
      Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.
      9580
      Cricchio et al., 2003
      • Cricchio G.
      • Lundgren S.
      Donor site morbidity in two different approaches to anterior iliac crest bone harvesting.
      94
      Yerit et al., 2004
      • Yerit K.C.
      • Posch M.
      • Hainich S.
      • Turhani D.
      • Klug C.
      • Wanschitz F.
      • Wagner A.
      • Watzinger F.
      • Ewers R.
      Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study.
      9.5 (R 8–10)100
      Deppe et al., 2012
      • Deppe H.
      • Mücke T.
      • Wagenpfeil S.
      • Hölzle F.
      Sinus augmentation with intra- vs extraorally harvested bone grafts for the provision of dental implants: clinical long-term results.
      83
      Quiles et al., 2015
      • Quiles J.C.
      • Souza F.A.
      • Bassi A.P.
      • Garcia Jr, I.R.
      • Franca M.T.
      • Carvalho P.S.
      Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.
      97100100
      Chiapasco et al., 2018
      • Chiapasco M.
      • Tommasato G.
      • Palombo D.
      • Scarnò D.
      • Zaniboni M.
      • Del
      • Fabbro M.
      Dental implants placed in severely atrophic jaws reconstructed with autogenous calvarium, bovine bone mineral, and collagen membranes: a 3- to 19-year retrospective follow-up study.
      9090
      Gjerde et al., 2020
      • Gjerde C.G.
      • Shanbhag S.
      • Neppelberg E.
      • Mustafa K.
      • Gjengedal H.
      Patient experience following iliac crest-derived alveolar bone grafting and implant placement.
      85
      Postoperative pain
      Results for the severity of postoperative pain, assessed by means of a VAS score (with 0 representing no pain and 10 representing the worst perceivable pain), with the corresponding timing of the assessment in months; the prevalence of pain at 1 week, 1 month, and> 6 months is also reported.
      SeverityPrevalence (%)
      Rating, VAS (0–10)

      Mean (R/SD) or median (IQR)
      Timing (months)1st week1 month> 6 months
      CalvariumAICCalvariumAICCalvariumAICCalvariumAIC
      Comparative studies
      Kuik et al., 2016
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      0.5 (IQR 0.0–3.0)

      0.0 (IQR 0.1–0.0)
      4.7 (IQR 2.4–8.0)

      0.0 (IQR 0.0–0.0)
      0.25
      Postoperative pain was assessed directly after harvesting on recall, and at follow-up 2.5 years later.


      27
      00
      Putters et al., 2018
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      (and Wortmann et al., 2019
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      )
      3.5 (IQR 1.0–5.0)

      0.3 (IQR 0.0–1.0)

      0.1 (IQR 0.0–0.1)
      4.0 (IQR 2.0–4.0)

      0.6 (IQR 0.2–2.1)

      0.2 (IQR 0.1–0.3)
      0.25
      In this study, the maximum pain scores were seen on days 2 and 3.


      1
      Postoperative pain was assessed directly after harvesting on recall, and at follow-up 2.5 years later.


      12
      202000
      Non-comparative prospective studies
      Stellingsma et al., 2003
      • Stellingsma K.
      • Bouma J.
      • Stegenga B.
      • Meijer H.
      • Raghoebar G.
      Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
      85
      Joshi and Kostakis, 2004
      • Joshi A.
      • Kostakis G.C.
      An investigation of post-operative morbidity following iliac crest graft harvesting.
      8269
      Nkenke et al., 2004
      • Nkenke E.
      • Weisbach V.
      • Winckler E.
      • Kessler P.
      • Schultze-Mosgau S.
      • Wiltfang J.
      • Neukam F.W.
      Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study.
      3.7 (SD 1.4)0.25
      Weingart et al., 2005
      • Weingart D.
      • Bublitz R.
      • Petrin G.
      • Kälber J.
      • Ingimarsson S.
      Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
      1.4 (SD 0.7)1
      Virnik et al., 2009
      • Virnik A.S.
      • Gaggl A.
      • Likar R.
      • Stettner H.
      • Chiari F.M.
      Comparison of the peripheral and central effects of opiates after iliac crest transplants: reconstruction of severely atrophied maxilla.
      2.2
      This study reported that the use of additional pain medication was not necessary in any patient; other reports on pain or the use of medication were not provided.
      0.250
      Barone et al., 2011
      • Barone A.
      • Ricci M.
      • Mangano F.
      • Covani U.
      Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis.
      5.5 (R 3–8)

      3.3 (R 2–6)
      0.25

      0.5
      99640
      Becker et al., 2011
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      5 
      This study did not provide details on whether the value reported was the mean or median. Additionally, no SD, range, or IQR was provided.


      2.5 
      This study did not provide details on whether the value reported was the mean or median. Additionally, no SD, range, or IQR was provided.


      0 
      This study did not provide details on whether the value reported was the mean or median. Additionally, no SD, range, or IQR was provided.
      0.25

      1

      12
      48360
      Felice et al., 2011
      • Felice P.
      • Soardi E.
      • Pellegrino G.
      • Pistilli R.
      • Marchetti C.
      • Gessaroli M.
      • Esposito M.
      Treatment of the atrophic edentulous maxilla: short implants versus bone augmentation for placing longer implants. Five-month post-loading results of a pilot randomised controlled trial.
      (and Esposito et al., 2015
      • Esposito M.
      • Barausse C.
      • Pistilli R.
      • Sammartino G.
      • Grandi G.
      • Felice P.
      Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
      )
      1001000
      Mertens et al., 2013
      • Mertens C.
      • Steveling H.G.
      • Seeberger R.
      • Hoffmann J.
      • Freier K.
      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
      012000
      Reissmann et al., 2013
      • Reissmann D.R.
      • Dietze B.
      • Vogeler M.
      • Schmelzeisen R.
      • Heydecke G.
      Impact of donor site for bone graft harvesting for dental implants on health-related and oral health-related quality of life.
      (and Reissmann et al., 2018
      • Reissmann D.R.
      • Poxleitner P.
      • Heydecke G.
      Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants.
      )
      2.9 (SD 2.5)
      This represents the maximum pain felt during the first week.
      0.25100100
      Pistilli et al., 2014
      • Pistilli R.
      • Felice P.
      • Piatelli M.
      • Nisii A.
      • Barausse C.
      • Esposito M.
      Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
      0.6 (SD 0.8)1
      Sassano et al., 2014
      • Sassano P.
      • Gennaro P.
      • Chisci G.
      • Gabriele G.
      • Aboh I.V.
      • Mitro V.
      • di Curzio P.
      Calvarial onlay graft and submental incision in treatment of atrophic edentulous mandibles: an approach to reduce postoperative complications.
      71
      Fretwurst et al., 2015
      • Fretwurst T.
      • Nack C.
      • Al-Ghrairi M.
      • Raguse J.D.
      • Stricker A.
      • Schmelzeisen R.
      • Nelson K.
      • Nahles S.
      Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest.
      NR
      The pain that occurred in the patients was well controlled with non-steroidal analgesics.
      Putters et al., 2015
      • Putters T.F.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      A prospective study on the morbidity resulting from calvarial bone harvesting for intraoral reconstruction.
      100250
      Mertens et al., 2017
      • Mertens C.
      • Freier K.
      • Engel M.
      • Krisam J.
      • Hoffmann J.
      • Freudlsperger C.
      Reconstruction of the severely atrophic edentulous maxillae with calvarial bone grafts.
      013600
      Putters et al., 2019
      • Putters T.F.
      • Raghoebar G.M.
      • Klein-Nulend J.
      • Vissink A.
      • Schortinghuis J.
      Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: a prospective pilot study.
      3.6 (R 20–70)0.2584
      Non-comparative retrospective studies
      Donovan et al., 1994
      • Donovan M.G.
      • Dickerson N.C.
      • Hanson L.J.
      • Gustafson R.B.
      Maxillary and mandibular reconstruction using calvarial bone grafts and Branemark implants: a preliminary report.
      0
      This study did not provide details on whether the value reported was the mean or median. Additionally, no SD, range, or IQR was provided.
      12000
      Lundgren et al., 1997
      • Lundgren S.
      • Nystrom E.
      • Nilson H.
      • Gunne J.
      • Lindhagen O.
      Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.
      20200
      Kübler et al., 1999
      • Kübler N.R.
      • Will C.
      • Depprich R.
      • Betz T.
      • Reinhart E.
      • Bill J.S.
      • Reuther J.F.
      Comparative studies of sinus floor elevation with autologous or allogeneic bone tissue.
      55
      Cricchio et al., 2003
      • Cricchio G.
      • Lundgren S.
      Donor site morbidity in two different approaches to anterior iliac crest bone harvesting.
      86430
      Barone et al., 2005
      • Barone A.
      • Crespi R.
      • Aldini N.N.
      • Fini M.
      • Giardino R.
      • Covani U.
      Maxillary sinus augmentation: histologic and histomorphometric analysis.
      2200
      Barone and Covani, 2007
      • Barone A.
      • Covani U.
      Maxillary alveolar ridge reconstruction with nonvascularized autogenous block bone: clinical results.
      110
      Deppe et al., 2012
      • Deppe H.
      • Mücke T.
      • Wagenpfeil S.
      • Hölzle F.
      Sinus augmentation with intra- vs extraorally harvested bone grafts for the provision of dental implants: clinical long-term results.
      54440
      Quiles et al., 2015
      • Quiles J.C.
      • Souza F.A.
      • Bassi A.P.
      • Garcia Jr, I.R.
      • Franca M.T.
      • Carvalho P.S.
      Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.
      19
      Chiapasco et al., 2018
      • Chiapasco M.
      • Tommasato G.
      • Palombo D.
      • Scarnò D.
      • Zaniboni M.
      • Del
      • Fabbro M.
      Dental implants placed in severely atrophic jaws reconstructed with autogenous calvarium, bovine bone mineral, and collagen membranes: a 3- to 19-year retrospective follow-up study.
      0.0 (IQR 0.0–4.0)0.5
      Gjerde et al., 2020
      • Gjerde C.G.
      • Shanbhag S.
      • Neppelberg E.
      • Mustafa K.
      • Gjengedal H.
      Patient experience following iliac crest-derived alveolar bone grafting and implant placement.
      4.4 (SD 2.7)NR382
      AIC, anterior iliac crest; IQR, interquartile range; NR, not reported; R, range; SD, standard deviation; VAS, visual analogue scale.
      a Results for patient-reported satisfaction with the procedure in general, assessed by means of a VAS score (with 0 representing not satisfied and 10 representing highly satisfied), and responses to a dichotomous question (yes/no) regarding whether they were satisfied, would recommend the treatment to others with a similar problem, and whether they would undergo the same treatment again if necessary.
      b This study did not provide details on whether the value reported was the mean or median. Additionally, no SD, range, or IQR was provided.
      c Results for the severity of postoperative pain, assessed by means of a VAS score (with 0 representing no pain and 10 representing the worst perceivable pain), with the corresponding timing of the assessment in months; the prevalence of pain at 1 week, 1 month, and> 6 months is also reported.
      d Postoperative pain was assessed directly after harvesting on recall, and at follow-up 2.5 years later.
      e In this study, the maximum pain scores were seen on days 2 and 3.
      f This study reported that the use of additional pain medication was not necessary in any patient; other reports on pain or the use of medication were not provided.
      g This represents the maximum pain felt during the first week.
      h The pain that occurred in the patients was well controlled with non-steroidal analgesics.
      Regarding the anterior iliac crest bone grafts, 13 studies (696 patients in total) reported general patient satisfaction: the median VAS score ranged from 9.5 to 10
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Esposito M.
      • Barausse C.
      • Pistilli R.
      • Sammartino G.
      • Grandi G.
      • Felice P.
      Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
      • Yerit K.C.
      • Posch M.
      • Hainich S.
      • Turhani D.
      • Klug C.
      • Wanschitz F.
      • Wagner A.
      • Watzinger F.
      • Ewers R.
      Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study.
      ; 92–100% of the patients would recommend the procedure to others
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Joshi A.
      • Kostakis G.C.
      An investigation of post-operative morbidity following iliac crest graft harvesting.
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      • Marianetti T.M.
      • Staffoli S.
      • Di Nardo F.
      • Moro A.
      • Foresta E.
      • Gasparini G.
      • Pelo S.
      Intracortical versus anteromedial approach for iliac crest bone harvesting in preprosthetic surgery: a randomized prospective clinical trial.
      • Lundgren S.
      • Nystrom E.
      • Nilson H.
      • Gunne J.
      • Lindhagen O.
      Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.
      • Cricchio G.
      • Lundgren S.
      Donor site morbidity in two different approaches to anterior iliac crest bone harvesting.
      and 80–100% of the participants would be willing to undergo the same treatment again if necessary
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Stellingsma K.
      • Bouma J.
      • Stegenga B.
      • Meijer H.
      • Raghoebar G.
      Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
      • Joshi A.
      • Kostakis G.C.
      An investigation of post-operative morbidity following iliac crest graft harvesting.
      • Barone A.
      • Ricci M.
      • Mangano F.
      • Covani U.
      Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis.
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      • Esposito M.
      • Barausse C.
      • Pistilli R.
      • Sammartino G.
      • Grandi G.
      • Felice P.
      Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
      • Marianetti T.M.
      • Staffoli S.
      • Di Nardo F.
      • Moro A.
      • Foresta E.
      • Gasparini G.
      • Pelo S.
      Intracortical versus anteromedial approach for iliac crest bone harvesting in preprosthetic surgery: a randomized prospective clinical trial.
      • Lundgren S.
      • Nystrom E.
      • Nilson H.
      • Gunne J.
      • Lindhagen O.
      Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.
      • Yerit K.C.
      • Posch M.
      • Hainich S.
      • Turhani D.
      • Klug C.
      • Wanschitz F.
      • Wagner A.
      • Watzinger F.
      • Ewers R.
      Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study.
      • Deppe H.
      • Mücke T.
      • Wagenpfeil S.
      • Hölzle F.
      Sinus augmentation with intra- vs extraorally harvested bone grafts for the provision of dental implants: clinical long-term results.
      (Table 2).

      Secondary outcomes

      Postoperative pain

      Regarding pain severity, the reported median values for the highest pain experienced following calvarial harvesting, measured with a 0–10 VAS for all follow-up periods, ranged from 0.0 to 0.5,
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Mertens C.
      • Steveling H.G.
      • Seeberger R.
      • Hoffmann J.
      • Freier K.
      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
      • Mertens C.
      • Freier K.
      • Engel M.
      • Krisam J.
      • Hoffmann J.
      • Freudlsperger C.
      Reconstruction of the severely atrophic edentulous maxillae with calvarial bone grafts.
      • Putters T.F.
      • Raghoebar G.M.
      • Klein-Nulend J.
      • Vissink A.
      • Schortinghuis J.
      Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: a prospective pilot study.
      • Chiapasco M.
      • Tommasato G.
      • Palombo D.
      • Scarnò D.
      • Zaniboni M.
      • Del
      • Fabbro M.
      Dental implants placed in severely atrophic jaws reconstructed with autogenous calvarium, bovine bone mineral, and collagen membranes: a 3- to 19-year retrospective follow-up study.
      with the exception of a median VAS score of 3.5 on day 2 postoperative reported in one study
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      (Table 2). For anterior iliac crest harvesting, the median pain VAS score during the first week ranged from 2.2 to 5.5
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Nkenke E.
      • Weisbach V.
      • Winckler E.
      • Kessler P.
      • Schultze-Mosgau S.
      • Wiltfang J.
      • Neukam F.W.
      Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study.
      • Virnik A.S.
      • Gaggl A.
      • Likar R.
      • Stettner H.
      • Chiari F.M.
      Comparison of the peripheral and central effects of opiates after iliac crest transplants: reconstruction of severely atrophied maxilla.
      • Barone A.
      • Ricci M.
      • Mangano F.
      • Covani U.
      Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis.
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      • Reissmann D.R.
      • Poxleitner P.
      • Heydecke G.
      Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants.
      and then between 0.6 and 2.5 after 1 month.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      • Weingart D.
      • Bublitz R.
      • Petrin G.
      • Kälber J.
      • Ingimarsson S.
      Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      • Pistilli R.
      • Felice P.
      • Piatelli M.
      • Nisii A.
      • Barausse C.
      • Esposito M.
      Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
      The long-term median pain VAS score for both sites was 0.0
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Donovan M.G.
      • Dickerson N.C.
      • Hanson L.J.
      • Gustafson R.B.
      Maxillary and mandibular reconstruction using calvarial bone grafts and Branemark implants: a preliminary report.
      (Table 2).
      The RCT revealed that the postoperative course of pain intensity was significantly higher for the anterior iliac crest graft patients compared to calvarial bone graft patients.
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      The comparative case series also demonstrated that early postoperative pain, assessed on recall, was significantly higher for the anterior iliac crest patients.
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      Furthermore, the RCT showed higher pain scores for patients with a higher body mass index (BMI) in the anterior iliac crest group, but not in the calvarium group.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      With regard to pain prevalence, the two comparative studies reported equal outcomes for postoperative pain prevalence for the two sites: 20% during the first week
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      and 0%
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      after more than 6 months (Table 2).

      Disturbances in daily functioning and donor site sensory alterations

      None of the calvarial bone graft harvesting patients reported disturbances in daily functioning after 6 months
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      (Supplementary Material Table S3). In the first week, the anterior iliac crest patients experienced gait disturbances, ranging from 28% to 100%,
      • Chiapasco M.
      • Abati S.
      • Romeo E.
      • Vogel G.
      Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges.
      • Nkenke E.
      • Weisbach V.
      • Winckler E.
      • Kessler P.
      • Schultze-Mosgau S.
      • Wiltfang J.
      • Neukam F.W.
      Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study.
      • Becker S.T.
      • Warnke P.H.
      • Behrens E.
      • Wiltfang J.
      Morbidity after iliac crest bone graft harvesting over an anterior versus posterior approach.
      • Marianetti T.M.
      • Staffoli S.
      • Di Nardo F.
      • Moro A.
      • Foresta E.
      • Gasparini G.
      • Pelo S.
      Intracortical versus anteromedial approach for iliac crest bone harvesting in preprosthetic surgery: a randomized prospective clinical trial.
      • Fretwurst T.
      • Nack C.
      • Al-Ghrairi M.
      • Raguse J.D.
      • Stricker A.
      • Schmelzeisen R.
      • Nelson K.
      • Nahles S.
      Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest.
      • Lundgren S.
      • Nystrom E.
      • Nilson H.
      • Gunne J.
      • Lindhagen O.
      Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.
      • Cricchio G.
      • Lundgren S.
      Donor site morbidity in two different approaches to anterior iliac crest bone harvesting.
      and the necessity to use a walking aid which ranged from 11% to 100%.
      • Joshi A.
      • Kostakis G.C.
      An investigation of post-operative morbidity following iliac crest graft harvesting.
      • Barone A.
      • Ricci M.
      • Mangano F.
      • Covani U.
      Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis.
      • Pistilli R.
      • Felice P.
      • Piatelli M.
      • Nisii A.
      • Barausse C.
      • Esposito M.
      Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
      • Fretwurst T.
      • Nack C.
      • Al-Ghrairi M.
      • Raguse J.D.
      • Stricker A.
      • Schmelzeisen R.
      • Nelson K.
      • Nahles S.
      Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest.
      • Kübler N.R.
      • Will C.
      • Depprich R.
      • Betz T.
      • Reinhart E.
      • Bill J.S.
      • Reuther J.F.
      Comparative studies of sinus floor elevation with autologous or allogeneic bone tissue.
      • Barone A.
      • Covani U.
      Maxillary alveolar ridge reconstruction with nonvascularized autogenous block bone: clinical results.
      • Pelo S.
      • Boniello R.
      • Moro A.
      • Gasparini G.
      • Amoroso P.F.
      Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants.
      • Gjerde C.G.
      • Shanbhag S.
      • Neppelberg E.
      • Mustafa K.
      • Gjengedal H.
      Patient experience following iliac crest-derived alveolar bone grafting and implant placement.
      This was temporary for most of the patients, but some studies reported that 4–20% of the patients had difficulties for more than 6 months
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      • Cricchio G.
      • Lundgren S.
      Donor site morbidity in two different approaches to anterior iliac crest bone harvesting.
      (Supplementary Material Table S3).
      Neither of the comparative studies demonstrated a statistically significant difference regarding the prevalence of sensory alterations between the two donor sites
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      (Supplementary Material Table S3). Long-term objective sensory alterations following calvarial harvesting were seen in 0–15% of the patients.
      • Kuik K.
      • Putters T.F.
      • Schortinghuis J.
      • van Minnen B.
      • Vissink A.
      • Raghoebar G.M.
      Donor site morbidity of anterior iliac crest and calvarium bone grafts: a comparative case–control study.
      • Putters T.F.
      • Wortmann D.E.
      • Schortinghuis J.
      • van Minnen B.
      • Boven G.C.
      • Vissink A.
      • Raghoebar G.M.
      Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial.
      • Wortmann D.E.
      • Boven C.G.
      • Schortinghuis J.
      • Vissink A.
      • Raghoebar G.M.
      Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
      Subjective hyperesthesia was reported in 7%
      • Mertens C.
      • Steveling H.G.
      • Seeberger R.
      • Hoffmann J.
      • Freier K.
      Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.
      of the patients during the first week. Most sensory alterations following anterior iliac crest harvesting during the first postoperative week were reported as objective (0–52%)
      • Joshi A.
      • Kostakis G.C.
      An investigation of post-operative morbidity following iliac crest graft harvesting.
      • Nkenke E.
      • Weisbach V.
      • Winckler E.
      • Kessler P.
      • Schultze-Mosgau S.
      • Wiltfang J.
      • Neukam F.W.
      Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study.