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J Oral Maxillofac Surg65:2039-2046, 2007

Maxillary Alveolar Ridge Reconstruction

With Nonvascularized Autogenous Block

Bone: Clinical Results Antonio Barone, DDS, PhD,* and Ugo Covani, MD, DDS†

Purpose: The purposes of this study were to evaluate the clinical success of bone reconstruction of theseverely atrophic maxilla using autogenous bone harvested from the anterosuperior edge of iliac wing

and to analyze the clinical success and the marginal bone level of dental implants placed 4 to 5 monthsafter bone grafting and before prosthetic rehabilitation.

Patients and Methods: Fifty-six patients (18 men, 38 women) aged 27 to 63 years were included inthe study and required treatment for maxillary atrophy. All patients selected were scheduled for onlay bone graft and titanium implants in a 2-stage procedure. The dental implants were inserted 4 to 5 monthsafter grafting.

Results: No major complications were observed from the donor sites. A total of 129 onlay bone grafts

were used to augment 56 severely resorbed maxillas. Three out of 129 bone grafts had to be removedbecause of early exposure occurring with bone grafts placed to increase the vertical dimension of thealveolar ridge. One hundred sixty-two implants were placed in the area of bone augmentation. Sevenimplants failed to integrate and were successfully re-placed without any need for additional bone grafting.The clinical measurements for bone resorption around implants revealed a mean bone loss of 0.05 mm( 0.2); the marginal bone level evaluated with periapical radiographies was 0.3 mm ( 0.4) at implant

placement and 0.1 mm ( 0.3) 6 months after placement.

Conclusion: The success rate of the block grafts was very good. The clinical and radiographic bone

observations showed a very low rate of resorption after bone graft and implant placement. Therefore, onthe basis of this preliminary study, iliac bone grafts (from the anterosuperior edge of the iliac wing) canbe considered a promising treatment for severe maxillary atrophy.© 2007 American Association of Oral and Maxillofacial Surgeons

J Oral Maxillofac Surg 65:2039-2046, 2007

Implant-supported rehabilitation of the edentulous

ridge require adequate volume and integrity of the

alveolar bone. Loss of teeth leads to a pattern of

bone resorption that can contribute to severe jaw

atrophy and eventually to an unfavorable maxillo-

mandibular relationship.1,2 Reconstruction of se-

verely resorbed jaws requires different surgical pro-

cedures depending on the severity of the bone

atrophy. These procedures often involve the use of

bone substitutes or the harvesting of autogenousbone from a donor site. Autogenous bone is be-

lieved to be the most effective bone graft materialand is still regarded as the “gold standard” for aug-

mentation procedures because of its osteogenicpotential. However, this graft has a limited availabil-

ity; furthermore, the surgical harvesting proceduresmight cause additional morbidity.3-5 To minimize

these risks, bone substitute materials such as syn-thetic scaffolds may be used to provide alternatives

to autogenous bone to improve bone volume.6 Al-though excellent clinical and histologic outcomeshave been reported,7,8 some types of bone defects

cannot be repaired with biomaterials because of local mechanical instability and defect size. There-

fore, in cases where large amounts of bone arerequired, autogenous bone is considered the first

choice and can be harvested from sites such as theiliac crest, tibia, skull, or mandible.9-12 The onlay/

inlay bone grafting techniques have been used insituations with a normal or acceptable maxilloman-

dibular relationship.

Received from the Department of Oral Pathology and Oral Medi-

cine, Nanoword Institute, School of Dental Medicine, University of

Genova, Italy.

*Assistant Professor.

†Associate Professor.

Address correspondence and reprint requests to Dr Barone:

Piazza Diaz 10, 55041 Camaiore (Lu), Italy; e-mail: barosurg@

libero.it

© 2007 American Association of Oral and Maxillofacial Surgeons

0278-2391/07/6510-0023$32.00/0

doi:10.1016/j.joms.2007.05.017

2039

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Some authors have reported the treatment of pa-

tients showing severe maxillary atrophy with usingonlay bone grafts in combination with simultaneousinsertion of endosteal implants. The survival rate of the implants after 3 years was 75%. It was concludedthat, in spite of the high implant failure rate, onlay bone grafting to the maxilla was a valuable method in

cases of severe maxillary atrophy.13

The onlay block grafts, when compared with particulate bone marrow, have shown reduced osteo-

genic activity and slow revascularization.14,15 Revas-cularization is the key factor for successful incorpo-ration and remodeling of the bone graft. Therevascularization process is dependent on the vascu-lar supply in the host area, and surgery should alwaysbe carried out as carefully as possible to preserve thesupply of blood vessels.16-18

Several studies have shown that intramembranousbone graft (calvaria and mandible), when compared

with endochondral bone grafts (iliac crest), may haveminimal resorption and better incorporation at thedonor site.19,20 More recently, some other authors21

have confirmed that bone resorption of the calvarialbone grafts was significantly less than that seen with iliac bone grafts. All these considerations could sug-gest that embryologic origins were responsible for differences in resorption patterns; however, it shouldbe taken into account that the microarchitectural fea-

tures (cortical/cancellous ratio) represent the maindeterminant in the volume maintenance of bonegrafts in the craniofacial skeleton.22,23

The purposes of this study were as follows: 1 ) toevaluate the clinical success of bone reconstruction of severely atrophic maxillas using autogenous block bone before dental implant placement; and 2 ) toanalyze the clinical success and the marginal boneloss of dental implants placed 4 to 5 months after

bone grafting and before prosthetic rehabilitation.

Patients and Methods

PATIENT POPULATION

Fifty-six patients (18 men, 38 women) aged 27 to63 years were included in the study. All patients

selected for this study required bone augmentationprocedures because of severe alveolar ridge atrophy

and were scheduled for onlay bone graft and titaniumimplants in a 2-stage procedure. The inclusion criteria

were as follows: the need for alveolar ridge recon-struction and implant placement in a 2-stage proce-dure; presence of severe maxillary bone atrophy; andpresence of healthy systemic conditions without any disease that would contraindicate surgery under gen-eral anesthesia.

Patients were not admitted to the study if any of the

following criteria were present: immune system dis-

eases; diabetes; pulmonary, renal, or cardiovascular

diseases; blood diseases; malignant neoplasias; hepa-titis; drug abuse; chemotherapy or radiotherapy. Inaddition, patients smoking more than 10 cigarettesper day were excluded from the study; patients smok-ing fewer than 10 cigarettes per day were requestedto stop smoking before and after surgery, although

their compliance could not be controlled. Each case was accurately evaluated examining diagnostic caststo assess the interarch relationship; moreover, pan-

oramic radiographs and computed tomography weretaken. Following these analyses, all patients, whenpartially edentulous, underwent any dental treatmentnecessary to provide an oral environment more favor-able to wound healing. All patients received andsigned a consent form.

Thirty-eight patients were fully edentulous and were treated with onlay bone grafts in the anterior maxilla and maxillary sinus augmentation in the pos-

terior area. The remaining 18 patients were partially edentulous and were treated with onlay bone grafts inthe atrophic area. All patients included in this study had an atrophic area with bone thickness rangingfrom 2 to 3 mm.

SURGERY

In all patients, surgery was performed under gen-eral anesthesia. One hour before surgery, 2 g of ceftri-

axone and 8 mg dexamethasone were administeredintravenously.

The iliac bone was exposed and autogenous grafts

were harvested with a slow-speed oscillating saw.Only the anterosuperior edge of iliac wing was harvested, keeping a safe distance of 2 cm from theanterosuperior iliac spine ( Fig 1 ). After osteotomy,the corticocancellous bone blocks were harvestedusing chisels ( Fig 2 ).

A second team of surgeons performed the augmen-tation of the atrophic maxilla. A crestal incision (atthe top of the edentulous alveolar crest) and 2 verticalreleasing incisions were performed; subsequently afull-thickness flap was raised and the palatal flap washeld with a 3-0 suture. The recipient site was thenrecontoured to improve graft adaptation, if needed,

and was perforated with a fissure bur to induce bleed-ing and promote the revascularization of the graft.

The harvested corticocancellous blocks were adaptedto the atrophic maxilla and attached to the residualridge with self-tapping screws (Cizeta, Milano, Italy)until the head reached the surface of the bone graft( Fig 3 ). Any sharp angles in the block grafts weresmoothed to avoid perforation of the overlaying flap.

An additional mixture of corticocancellous porcinebone particle and collagen (Osteobiol; Tecnoss,Coazze, Italy) was placed at the periphery of the

block grafts. Periosteal fenestration was performed at

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the base of buccal flap to obtain a tension-free adap-tation of the wound margins. The flap was sutured

with a resorbable suture that was removed after 2 weeks.

The following postoperative regimen was pre-

scribed: ceftriaxone (2 gr/day) for 5 days after sur-gery; dexamethasone (4 mg/day) for 2 additionaldays; and chlorhexidine mouthwash twice daily for 21 days. Provisional rehabilitations were made usingremovable prostheses which were placed 30 daysafter surgical procedure.

A bone graft was defined successful according tothe following criteria: absence of graft exposure andpostoperative infection; incorporation of the graft

with the recipient site; absence of bone radiolucency;bleeding from the bone graft after removing stabiliza-tion screws; and possibility for implant placement.

DENTAL IMPLANT TREATMENT

The implant phase was begun 4 to 5 months after consolidation of the grafted sites.

An alveolar crest incision was made and mucoperi-osteal flaps were elevated to expose the sites for

implant placement. The fixation screws were re-moved and the implant sites were prepared. Doubleacid-etched screw type implants (3I, Implant Innova-tions, West Palm Beach, FL) were placed using asurgical guide. All of the implants in this study were

FIGURE 1. Schematic drawing of the harvesting from the iliac crest.A, Frontal view; B, Sagittal view of the iliac wing. The green line showsthe osteotomy contour.

Barone and Covani. Maxillary Alveolar Ridge Reconstruction. J Oral Maxillofac Surg 2007.

FIGURE 2. Principles of harvesting corticocancellous bone from the iliac wing: A, Osteotomy; B, donor site after bone harvesting; C ,corticocancellous block.


BARONE AND COVANI 2041

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inserted at the alveolar crest level and showed goodprimary stability. The flaps were subsequently closed with silk sutures. The successive stage of surgicalprocedures was performed 6 months after implantplacement for all experimental sites. At this stage theclinical distance between the neck of the implants

(which were placed at the crestal level) and surround-ing crestal bone was measured at 4 sites (buccal,palatal, mesial, and distal) for each implant to evaluateany rate, if present, of bone resorption around theimplants.

RADIOGRAPHIC EVALUATION

Routine panoramic radiographs were taken for allclinical postgrafting procedures (before implant

placement). Moreover, to quantify the bone levelchanges around implants inserted in grafted sites, theperiapical radiographs were evaluated immediately and 6 months after implant placement (before pros-thetic rehabilitation). The distance from the implantshoulder and the first bone-implant contact (DIB) me-sially and distally to the implant was measured usingper iapical radiographs taken in a standardized man-ner.24,25 All measurements were taken by 1 examiner

(A.B.). The bone level measurements performed im-

mediately after implant placement was consideredthe baseline for further measurements ( Fig 4 ).Radiographic measurements of each implant were

calculated per patient by averaging the clinical param-eter for the implants per patient because the intra-subject variation was much lower than the intersub-

ject variation. Subsequently, the means and medians were calculated per patient. The comparison betweenbaseline and 6-month data was performed with the Stu-dent t test for paired data (the results were consideredstatistically significant at the level P .05).

ResultsNo major complications were observed from the

donor sites. One patient out of 56 required drainagefor a small hematoma. Six patients were still experi-encing pain 1 week after graft harvesting. Two weekslater, none of the patients had referred pain or diffi-culties during walking. A total of 129 onlay bonegrafts were used to augment 56 severely resorbedmaxillas. Thirty-seven out of 129 onlay bone grafts

were scheduled for vertical alveolar ridge augmenta-tion and the remaining 92 for horizontal alveolar ridge

augmentation ( Table 1 ). The exposure of the onlay

FIGURE 3. Monolateral augmentation of an atrophic maxilla. A, Preoperative panoramic radiograph; B, horizontal onlay augmentation; C ,panoramic radiograph 4 months after augmentation.



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bone graft was observed in 3 patients who received afull maxillary reconstruction. Each patient showed

the exposure of 1 block occurring 3 to 5 weeks after grafting. The exposed part of the blocks graft ap-peared necrotic (given the discoloration and soft con-sistency when examined with the explorer) and wasremoved using a diamond bur under water cooling.Despite any treatments, all the block grafts showingan early exposure had to be completely removedbecause of infection. In another clinical case wheresigns of exposure appeared 3 months after grafting, a

surgical procedure was performed to remove the sur-gical fixation screws and to place implants. A success-ful treatment of the exposure was observed with a

soft tissues closure over the graft. No further infection

or dehiscence was observed. Subsequently, 6 months

after placement the implants showed evident mar-

ginal bone resorption. All the observed complications

were associated with onlay bone grafts placed to

increase the vertical dimension of the alveolar ridges

( Table 2 ).

During the re-entry procedures for implant place-

ment all the bone grafts were successfully incorpo-

rated and fixed at the recipient site. The fixation

screws were removed and bleeding from the bone

graft was observed, indicating revascularization of

the grafted bone. Only 5 fixation screws out of 215

used for bone block stabilization on recipient sites

showed a marginal bone resorption between 1.5

and 2 mm around the head. The mixture of corti-

cocancellous porcine bone particle and collagen

placed at the periphery and over the grafts ap-

peared well integrated with the recipient sites. One

hundred sixty-two implants ranging in length from

10 to 15 mm were placed in the area of bone

augmentation. All implants were inserted with sat-

isfactory primary stability.

The complete rehabilitation of the totally eden-

tulous patients required implants placed in aug-

mented maxillary sinuses and were not included in

this study.

Six months after implant placement, 7 implants

failed to integrate and no signs of infection were

noted during the healing period. The failed implants

were successfully re-placed at the time of exposure

without any need for additional bone grafting. The

remaining 155 implants were successful according to

the criteria of success26 and were fully surrounded by

bone. The clinical measurements for bone resorption

around implants showed a mean marginal bone loss of

0.05 mm ( 0.2). Moreover, the mean marginal bone

level value, measured by periapical radiograph, was

0.3 mm ( 0.4) at implant placement and 0.1 mm

( 0.3) 6 months after placement. The reduction of

the marginal bone level value from baseline to the

6-month evaluation could reflect differences in min-

eralization of the grafted bone, which within 6

months showed an increase in mineralization and

incorporation at the recipient site ( Table 3 ).

FIGURE 4. Periapical radiographic evaluation: A, at implant place-ment and B, 6 months after placement.


Table 1. CLINICAL CHARACTERISTICS OF 56 PATIENTS WHO UNDERWENT MAXILLARY RECONSTRUCTION USINGBLOCK BONE GRAFTS

Block Graft No. of Blocks Complications No. of Implants Placed No. of Implants Failed

Vertical augmentation 37 4 47 2Horizontal augmentation 92 — 115 5Total 129 4 162 7



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Discussion

Autogenous bone grafts have been widely used toaugment alveolar ridges affected by severe atrophy.

Autogenous bone can be harvested from the intraoraland/or extraoral sites and can serve as a good treat-

ment procedure for alveolar ridges augmentation. Thepresent study showed that the corticocancellous

block grafts, harvested from the anterosuperior edgeof the iliac wing, was a reliable treatment with a high success rate for extensive reconstruction of atrophicmaxillas. Morbidity was very low in all treated cases;moreover, the postoperative pain and gait distur-bances were referred by only 6 out 56 patients until tothe third week after surgery. The success rate of the

autogenous grafts in this study (96.8%) was consistent with those reported by other authors.11,27,28

Sometimes the resorption of the edentulous maxillacan create a reverse maxillomandibular relation or anincreased vertical distance between the jaws. Thelatter situation may require a vertical augmentation. Inthe present study, 37 block grafts were used for ver-tical augmentation and were responsible for the 4failures observed in the whole study. Therefore, from

these findings it can be suggested that the failure ratefor vertical augmentation was higher than for horizon-tal augmentation. The exposure of block grafts wasobserved in 4 patients. Three patients showed anearly exposure that caused a partial necrosis of thegraft and required complete removal, while the pa-tient with the late exposure was easily treated with fixation screw removal and implant placement. Al-though the number of cases was limited, it might be

suggested that the time of exposure is a determining

factor in the outcome of this complication.

Some controversies still exist regarding the place-

ment of implants simultaneously with bone grafting.

Some authors have reported the placement of dental

implants simultaneously with block grafts.11,29,30

One-stage surgery reduces the number of surgical

interventions and the healing time. However, most of

the authors have reported better results with the

2-stage than with the 1-stage approach.11,27,31,32 The

findings from the above reported studies have shown

that the condition for implant integration was im-

proved after an initial period of healing for the bone

graft.33 This has been associated with the revascular-

ization process of the block grafts allowing a good

integration to the recipient site. Thereafter, when

implants are placed the conditions can be considered

similar to those of nongrafted bone.

Several authors reported that membranous bone

grafts maintain their volume to a greater extent com-

pared with endochondral bone grafts.21,34,35 The reasonfor that could be that bone grafts of membranous origin

have higher cortical bone quality than those of endo-

chondral origin. Moreover, some other authors ob-

served that cortical bone grafts will maintain their vol-

ume better than cancellous bone grafts, independent of

embryogenic origin.22,23 The underlying mechanisms

behind bone graft resorption are not still understood,

but factors such as the microarchitecture of the graft,

degree of vascularization during healing, and local

trauma to the graft, might play a fundamental role. The

cancellous portion of the bone grafts has an important

function, stimulating the osteogenic cells and undiffer-entiated marrow cells to grow and lay down bone on

their surface. Cancellous bone grafts revascularize much

more quickly than cortical bone grafts; however, corti-

cal bone is much stronger.36 The combination of corti-

cal and cancellous bone in grafts promotes early

vascularization and maximum graft maintenance. Corti-

cocancellous bone grafts, harvested from the antero-

superior margin of the iliac wing, were used in this

study. This is a different harvesting site compared with

traditional sites such as the medial wall of the iliac crest.

The present study showed reduced resorption for endo-

Table 2. NUMBER AND CHARACTERISTIC OF COMPLICATIONS OCCURRING AFTER ONLAY BONE GRAFT

Patients Block Graft Type of Complications Time of Occurrence Outcome

# 1 Vertical Graft exposure 3 wks Block removal# 2 Vertical Graft exposure 3 wks Block removal# 3 Vertical Graft exposure 5 wks Block removal# 4 Vertical Infection 12 wks Healing*

*Complete healing after screws removal.


Table 3. MARGINAL BONE LEVEL FOR 155IMPLANTS PLACED IN AUTOGENOUS BLOCK GRAFT

Marginal Bone Level (mm) Baseline* 6 Mo

Mean 0.3 0.1SD 0.4 0.3Range 0–1.6 0–1

*Evaluation at implant placement.



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chondral bone grafts, evaluating the bone loss around

the fixation screws (4 to 5 months after bone grafting)and the dental implants (6 months after placement).

Implant treatment of severely resorbed maxillas isconsidered a demanding procedure showing a higher failure rate compared with the implant treatment of patients with adequate bone volume. The implant

failure was divided into early (before loading) and late(after loading). Several studies on bone grafting tech-nique reported that the rate of early implant failure

was higher than the late failure.37,38 In the presentinvestigation, the failure rate was 5.1%. It should betaken into account that all the implant failures oc-curred during the first 6 months after placement and

without any prosthetic treatment. The marginal bonelevel of 0.3 mm at the baseline was higher than the

value of 0.1 mm 6 months after placement, which suggested an increase of the bone level after 6months. On the contrary, the clinical evaluation using

a probe showed a stability of the bone level. Oneinterpretation was that the bone adjacent to the im-plants increased the mineralization and incorporationat the recipient site through time.

In conclusion, the use of onlay block bone (harvested from the anterosuperior edge of iliac wing) for the reconstruction of severely atrophic maxillas hasbeen shown to be a reliable treatment procedure. Thesuccess rate of the block grafts was very successful

and comparable with those reported by other au-thors. Moreover, the augmentation procedure al-lowed the insertion of implants in the grafted area 4

to 5 months after surgery. The clinical and radio-graphic observations showed a very low rate of boneresorption after bone graft and implant placement.Therefore, on the basis of this preliminary study, iliacbone grafts from the anterosuperior edge of the iliac

wing can be considered a promising treatment for

severe maxillary atrophy.

References1. Cawood JI, Howell RA: A classification of the edentulous jaws.

Int J Oral Maxillofac Surg 17:232, 19882. Cawood JI, Howell RA: Reconstructive preprosthetic surgery. I.

Anatomical consideration. Int J Oral Maxillofac Surg 20:75,1991

3. Nkenke E , Radespiel-Tröger M, Wiltfang J, et al: Morbidity of harvesting of retromolar bone grafts: A prospective study. ClinOral Implants Res 13:514, 2002

4. Sasso RC, Lehuec JC, Shaffrey C: Iliac crest bone graft donor site pain after anterior lumbar interbody fusion: A prospectivepatient satisfaction outcome assessment. J Spinal Disord Tech 18:S77, 2005

5. Cricchio G, Lundgren S: Donor site morbidity in two differentapproaches to anterior iliac crest bone harvesting. Clin ImplantDent Relat Res 5:161, 2003

6. Queiroz TP, Hochuli-Viera E, Cabrini Gabrielli MA, et al: Use of bovine bone graft and bone membrane in defects surgically created in the cranial vault of rabbits. Histologic comparativeanalysis. Int J Oral Maxillofac Implants 21:29, 2006

7. Thorwarth M, Schultze-Mosgau S, Kessler P, et al: Bone regen-eration in osseous defects using a resorbable nanoparticular hydroxyapatite. J Oral Maxillofac Surg 63:1626, 2005

8. Orsini G, Traini T, Scarano A, et al: Maxillary sinus augmenta-tion with Bio-Oss particles: A light, scanning, and transmissionelectron microscopic study in man. J Biomed Mater Res 74B:448, 2005

9. Donovan MG, Dickerson NC, Hellstein JW, et al: Autologouscalvarial and iliac bone graft in miniature swine. J Oral Maxil-

lofac Surg 51:898, 199310. Iturriaga MTM, Ruiz CC: Maxillary reconstruction with calvar-

ium bone graft and endosseous implants. J Oral Maxillofac Surg62:344, 2004

11. Sjostrom M, Lundgren S, Sennerby L: A histomorphometriccomparison of the bone graft-titanium interface between inter-positional and onlay/inlay bone grafting technique. Int J OralMaxillofac Implants 21:52, 2006

12. Reinert S, Konig S, Bremerich A, et al: Stability of bone graftingand placement of implants in the severely atrophic maxilla. Br JOral Maxillofac Surg 41:249, 2003

13. Astrand P, Nord PG, Branemark PI: Titanium implants andonlay bone graft to the atrophic edentulous maxilla: A 3-year longitudinal study. Int J Oral Maxillofac Surg 25:25, 1996

14. Marciani RD, Conty AA, Synhorst JB, et al: Cancellous bonemarrow grafts in irradiated dog and monkey mandibles. Oral

Surg Oral Med Oral Pathol 47:17, 197915. Enneking WF, Eady JL, Burchardt H: Autogenous cortical bonegrafts in the reconstruction of segmental skeletal defects.

J Bone Joint Surg Am 62:1039, 198016. Albrektsson T: Repair of the bone graft. Scand J Plast Reconstr

Surg 14:1, 198017. Siebert JW, Angrigiani C, McCarthy JG, et al: Blood supply of

the Le Fort I maxillary segment: An anatomic study. PlastReconstr Surg 100:843, 1997

18. Pinkerton KC, Wimsmatt JA: A simple, atraumatic techniquefor the dissection of nasal mucosa during Le Fort I osteotomy.

J Oral Maxillofac Surg 56:687, 199819. Zins JE, Whitaker LA: Membranous vs. endochondral bone:

Implication for craniofacial reconstruction. Plast Reconstr Surg72:778, 1983

20. Borstlap WA, Heidbuchel KLWM, Freihofer HPM, et al: Early secondary bone grafting of alveolar cleft defects: A comparisonbetween chin and rib grafts. J Craniomaxillofac Surg 18:210,1990

21. Iizuka T, Smolka W, Hallerman W, et al: Extensive augmenta-tion of the alveolar ridge using autogenous calvarial split bonegrafts for dental rehabilitation. Clin Oral Implant Res 15:607,2004

22. Ozaki W, Buchman SR: Volume maintenance of onlay bonegraft in the craniofacial skeleton: Microarchitecture versus em-bryologic origin. Plast Reconstr Surg 102:291, 1998

23. Rosenthal AH, Buchman SR: Volume maintenance of inlay bonegraft in the craniofacial skeleton. Plast Reconstr Surg 112:802,2003

24. Weber HP, Buser D, Fiorellini JP, et al: Radiographic evaluationof crestal bone levels adjacent to nonsubmerged titanium im-plants. Clin Oral Implants Res 3:181, 1992

25. Buser D, Weber HP, Bragger U, et al: Tissue integration of

one-stage ITI implants: 3-year results of a longitudinal study with hollow-cylinder and hollow-screw implants. Int J OralMaxillofac Implants 6:405, 1991

26. Albrektsson T, Zarb GA, Worthington P, et al: The long-termefficacy of currently used dental implants: A review and criteriaof success. Int J Oral Maxillofac Implants 1:11, 1986

27. Lundgren S, Rasmusson L, Sjostrom M, et al: Simultaneous or delayed placement of titanium implants in free autogenous iliacbone grafts. Int J Oral Maxillofac Surg 28:31, 1999

28. Schwartz-Arad D, Levin L: Intraoral autogenous block onlay bone grafting for extensive reconstruction of atrophic maxil-lary alveolar ridges. J Periodontol 76:636, 2005

29. Verhoeven JW, Cune MS, Ruijter J: Permucosal implants com-bined with iliac crest onlay grafts used in extreme atrophy of the mandible: Long-term results of a prospective study. ClinOral Implant Res 17:58, 2006


8/3/2019 5-2007 JOMS_BARONE


30. van Steenberghe D, Naert I, Bossuyt M, et al: The rehabilitationof the severely resorbed maxilla by simultaneous placement of autogenous bone grafts and implants: A 10-year evaluation. ClinOral Invest 102, 1997

31. Lundgren S, Rasmusson L, Sjostrom M, et al: Simultaneous or delayedplacement of titanium implants in free autogenous iliac bone grafts.Histological analysis of the bone graft-titanium interface in 10 con-secutive patients. Int J Oral Maxillofac Surg 28:31, 1999

32. Triplett RG, Schow S: Autologous bone grafts and endosseous

implants: Complementary techniques. J Oral Maxillofac Surg54:486, 1996

33. Lundgren S, Nystrom E, Nilson H, et al: Bone grafting to themaxillary sinuses, nasal floor and anterior maxilla in the atro-phic edentulous maxilla. A two-stage technique. Int J OralMaxillofac Surg 26:428, 1997

34. Mish CM: Comparison of intraoral donor sites for onlay graftingprior to implant placement. Int J Oral Maxillofac Implants12:767, 1997

35. Smolka W, Eggensperger N, Carollo V, et al: Changes in the volume and density of calvarial split bone grafts after alveolar ridge augmentation Clin Oral Implant Res 17:149, 2006

36. Burchardt H: The biology of bone graft repair. Clin OrthopRelat Res 174:28, 1983

37. Esposito M, Hirsch J-M, Lekholm U, et al: Biological factors

contributing to failures of osseointegrated oral implants (I).Success criteria and epidemiology. Eur J Oral Sci 106:527, 1998

38. Joansson B, Wannfors K, Ekenbach J, et al: Implant and sinusbone grafts in 1-stage procedure on severely atrophied maxil-lae: Surgical aspects of a 3-year follow-up period. Int J OralMaxillofac Implants 14:811, 1999


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