Analysis of the Survival of Dental Implants Installed in Reconstructed Maxilla with Autogenous Iliac Crest Graft: 7- to 9-Year Follow-Up
The aim of this study was to analyze the survival of dental implants installed in maxillae reconstructed with autogenous iliac crest grafts and to assess patient satisfaction with the treatment by means of a questionnaire. The study conducted medical record reviews and clinical/radiographic assessments of 10 patients with severe maxillary atrophy who had undergone reconstruction with autogenous iliac crest grafts and rehabilitation with dental implants between 2008 and 2011. Patients were assessed for the survival of the implants, considering implant diameter and length, smoking status, diagnosis of diabetes, type of loss, and region of implant loss. In addition, a questionnaire with specific questions on the patients' satisfaction with the treatment was administered. Seventy-six implants were installed in the sampled patients, and only 1 loss was observed (late loss in the anterior maxilla region) after an average follow-up of 7.9 years, which corresponds to a 98.60% survival rate. The installed implants were of the most frequently used dimension (3.75 × 10 mm). One sampled patient was diabetic, and a second patient was both diabetic and a smoker. No loss of implants was observed in these 2 patients. All patients reported being completely satisfied with the treatment and would undergo the procedure again or refer it to a friend/relative. Six patients reported regular maintenance of the prosthesis, and only 3 had changed the prosthesis prior to the time of questionnaire administration. The results of this limited study with a restricted sample population suggest that the reconstruction of the maxilla with an autogenous iliac crest graft provides both adequate implant survival and patient satisfaction.

Figure 1. (a) Clinical intraoral view of alveolar ridge with severe jaw atrophy, included in the study. (b) Panoramic radiograph demonstrating the extensive pneumatization of the maxillary sinuses and the need for reconstruction. Figure 2. (a) After mucoperiosteal incision and displacement it was possible to perceive the existing bone atrophy. (b) Access to the jaw. Note the elevation of the sinus membrane creating a space for filling with particulate bone graft. Figure 3. Notice the reconstruction homogeneity after filling of the maxillary sinuses, bone blocks installation, and filling of the gaps between blocks with crushed bone.

Cone beam computerized tomography enables observation of the excellent result achieved with the reconstruction.

Figure 5. (a) After mucoperiosteal incision and displacement, the graft screws were removed. (b) Implants were installed according to the manufacturer's recommended drilling sequence. Figure 6. (a) Panoramic radiograph showing 8 installed implants, as well as their adequate parallelism and distribution. (b) Rehabilitation over implants using an acrylic resin hybrid prosthesis.

Questionnaire model administered to the patients.

Figure 8. Kaplan-Meier survival analysis. Figure 9. Results of the questionnaire administered to the patients.
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