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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
Correspondence to: Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands.
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.
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.
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.
Moreover, when using a two-team surgical approach, the harvesting can be done simultaneously with the augmentation surgery, thereby reducing the surgery time.
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.
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.
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.
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.
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,
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
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,
Chapter 25: assessing risk of bias in a non-randomized study.
in: Higgins J.P.T. Thomas J. Chandler J. Cumpston M. Li T. Page M.J. Welch V.A. Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 (updated July 2019). Cochrane,
2019
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.
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
> 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.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
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.
Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
A prospective multicenter randomized clinical trial of autogenous bone versus beta-tricalcium phosphate graft alone for bilateral sinus elevation: histologic and histomorphometric evaluation.
Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants.
Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.
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.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
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.
Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
; 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. 1Flowchart of the study identification and selection process.
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),
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
Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
A prospective multicenter randomized clinical trial of autogenous bone versus beta-tricalcium phosphate graft alone for bilateral sinus elevation: histologic and histomorphometric evaluation.
Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.
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.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
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.
Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
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.
Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
A prospective multicenter randomized clinical trial of autogenous bone versus beta-tricalcium phosphate graft alone for bilateral sinus elevation: histologic and histomorphometric evaluation.
Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants.
Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.
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.
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.
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.
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)
Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.
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.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
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.
Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
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.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
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
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
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.
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.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
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.
Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
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.
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.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
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.
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.
Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
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.
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
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.
Short implants versus bone augmentation for placing longer implants in atrophic maxillae: one-year post-loading results of a pilot randomised controlled trial.
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,
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
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.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Patients’ appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone: a randomized controlled trial.
Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla.
Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
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.
The comparative case series also demonstrated that early postoperative pain, assessed on recall, was significantly higher for the anterior iliac crest patients.
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.
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
Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.
Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants.
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