A mass guide for the harvest of cortico-cancellous bone from the posterior iliac crest for mandibular reconstruction

Ferretti, Carlo; Premviyasa, Vinayagie; Reyneke, Johan P.; Ripamonti, Ugo

doi:10.1016/j.bjoms.2019.04.012

Cited by 7 publications

(9 citation statements)

References 13 publications

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“…Shen published a series of forty-five cases of double-barrel fibula with implant rehabilitation in eleven of them, with good esthetic and functional results (6); however, the author did not describe the implant success rate or the peri-implant bone resorption. Ferreti described the vertical reconstruction of mandibular atrophy by means of iliac crest grafts but did not show its application in cases of segmental defect or reconstruction with peroneal flap (20). None of the works consulted compared the ratio between the width of the flap and the remaining mandible.…”

Section: Discussionmentioning

confidence: 99%

Mandibular Reconstruction With Fibula Flap and Dental Implants Through Virtual Surgical Planning and Three Different Techniques: Double-Barrel Flap, Implant Dynamic Navigation and CAD/CAM Mesh With Iliac Crest Graft

et al. 2021

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IntroductionVertical discrepancy between the fibula flap and the native mandible results in difficult prosthetic rehabilitation. The aim of this study was to evaluate the outcomes of 3D reconstruction of the mandible in oncologic patients using three different techniques through virtual surgical planning (VSP), cutting guides, customized titanium mesh and plates with CAD/CAM technology, STL models and intraoperative dynamic navigation for implant placement. Material and methodsMaterial and MethodsThree different techniques for mandibular reconstruction and implant rehabilitation were performed in 14 oncologic patients. Five patients (36%) underwent VSP, cutting guides, STL models and a customized double-barrel titanium plate with a double-barrel flap and immediate implants. In six patients (43%), VSP, STL models and a custom-made titanium mesh (CAD/CAM) for 3D reconstruction with iliac crest graft over a fibula flap with deferred dental implants were performed. Three patients (21%) underwent VSP with cutting guides and customized titanium plates for mandibular reconstruction and implant rehabilitation using intraoperative dynamic navigation was accomplished. Vertical bone reconstruction, peri-implant bone resorption, implant success rate, effects of radiotherapy in vertical reconstruction, bone resorption and implant failure, mastication, aesthetic result and dysphagia were evaluated.ResultsSignificant differences in bone growth between the double-barrel technique and iliac crest graft with titanium mesh technique were found (p<0.002). Regarding bone resorption, there were no significant differences between the techniques (p=0.11). 60 implants were placed with an osseointegration rate of 91.49%. Five implants were lost during the osseointegration period (8%). Peri-implant bone resorption was measured with a mean of 1.27 mm. There was no significant difference between the vertical gain technique used and implant survival (p>0.385). Implant survival rates were higher in non-irradiated patients (p<0.017). All patients were rehabilitated with a fixed implant-supported prosthesis reporting a regular diet (80%), normal swallowing (85.7%) and excellent aesthetic results.ConclusionsMulti-stage implementation of VSP, STL models and cutting guides, CAD/CAM technology, customized plates and in-house dynamic implant navigation for mandibular defects increases bone-to-bone contact, resolves vertical discrepancy and improves operative efficiency with reduced complication rates and minimal bone resorption. It provides accurate reconstruction that optimizes implant placement, thereby improving facial symmetry, aesthetics and function.

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Section: Discussionmentioning

confidence: 99%

Mandibular Reconstruction With Fibula Flap and Dental Implants Through Virtual Surgical Planning and Three Different Techniques: Double-Barrel Flap, Implant Dynamic Navigation and CAD/CAM Mesh With Iliac Crest Graft

et al. 2021

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“…Shen [17] reported 45 double-barrel flaps with implant rehabilitation in 11 patients with good functional and esthetic results, although no implant success rate or bone resorption were described. Ferreti [18] and Sethi [19] described vertical reconstruction with iliac crest graft in atrophic mandible but they do not report segmental mandibulectomy or reconstruction with fibula flap. Lizio [20] reported 5 cases of vertical distraction of the fibula flap in mandibular reconstruction with a mean vertical bone gain of 14 mm and a mean peri-implant bone resorption of 2.5 mm.…”

Section: Discussionmentioning

confidence: 99%

“…The double-barrel fibula flap is the ideal technique in order to reconstruct the mandibular height and to solve the problem of vertical discrepancy. It has the following advantages: (1) a great length of bone that allows us to reconstruct defects in the double-barrel between 8 cm and 10 cm; (2) no delayed surgery compared with the vertical distraction and onlay grafts [18]; (3) great suitability for dental implants and early prosthetic rehabilitation [2]; (4) high vascularity allows us to perform osteotomies to shape the double-barrel flap without vascular compromise of the flap; (5) possibility of using an osteocutaneous flap for the reconstruction of composite defects where an associated soft tissue defect needs to be reconstructed; (6) low donor site morbidity; (7) it is the better technique in patients who are going to receive radiotherapy due to the high vascularity of the flap with minimal bone resorption; and (8) minimal peri-implant bone resorption. The disadvantage of this technique is that it is not advisable to reconstruct defects greater than 10 cm because the length required is almost 24 cm, which can lead to higher donor site morbidity.…”

Section: Discussionmentioning

confidence: 99%

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Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft

Cuéllar

Caicoya

Cuéllar

et al. 2020

JCM

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Double-barrel flap, vertical distraction and iliac crest graft are used to reconstruct the vertical height of the fibula. Twenty-four patients with fibula flap were reconstructed comparing these techniques (eight patients in each group) in terms of height of bone, bone resorption, implant success rate and the effects of radiotherapy. The increase in vertical bone with vertical distraction, double-barrel flap and iliac crest was 12.5 ± 0.78 mm, 18.5 ± 0.5 mm, and 17.75 ± 0.6 mm, (p < 0.001). The perimplant bone resorption was 2.31 ± 0.12 mm, 1.23 ± 0.09 mm and 1.43 ± 0.042 mm (p < 0.001), respectively. There were significant differences in vertical bone reconstruction and bone resorption between double-barrel flap and vertical distraction and between iliac crest and vertical distraction (p < 0.001). The study did not show significant differences in implant failure (p = 0.346). Radiotherapy did not affect vertical bone reconstruction (p = 0.125) or bone resorption (p = 0.237) but it showed higher implant failure in radiated patients (p = 0.015). The double-barrel flap and iliac crest graft showed better stability in the height of bone and less bone resorption and higher implant success rates compared with vertical distraction. Radiation therapy did not affect the vertical bone reconstruction but resulted in a higher implant failure.

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“…Furthermore, bone blocks seem to maintain the volume of the initial augmentation site more than guided bone-regeneration techniques [ 11 ]. When the amount of bone that can be harvested intraorally is insufficient, the iliac crest is often the favored donor site compared to calvaria or tibia bone grafts [ 12 , 13 , 14 ]. Usually, bone grafts for oral augmentation are harvested from the anterior part of the iliac crest, where up to 26.29 mL of uncompressed cortico-cancellous graft can be gained [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Morbidity and Complications in Elderly Patients after Harvesting of Iliac Crest Bone Grafts

et al. 2021

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Background and objectives: In oral and maxillofacial operations, the iliac crest is a commonly used donor site from which to harvest bone for augmentation prior to dental implantation or for reconstruction of jaw defects caused by trauma or pathological lesions. In an aging society, the proportion of elderly patients undergoing iliac crest bone grafting for oral augmentation is growing. Although postoperative morbidity is usually moderate to low, the age and health of the patient should be considered as risk factors for complications and delayed mobilization after the operation. The aim of this retrospective study was to evaluate the postoperative morbidity and complications in elderly patients after the harvesting of iliac crest bone grafts for oral surgery. Material and Methods: Data were collected from a total of 486 patients (aged 7–85) who had a surgical procedure that included the harvesting of iliac crest bone grafts for intraoral transplantation. All patients were operated on between 2005 and 2021 in the Department for Oral and Maxillofacial Surgery of the University Hospital in Aachen, Germany. As parameters for postoperative morbidity and complications, gait disturbances, hypesthesia of cutaneous nerves, incision hernias, iliac crest fractures, delayed wound healing, and unfavorable scar formation at the donor site were all evaluated. Results: The study was performed with 485 patients due to the exclusion of one patient as the only one from whom grafts were taken from both sides. When younger and older patients were compared, neither gait disturbances (p = 0.420), nor hernias (p = 0.239), nor fractures (p = 0.239), nor hypesthesia (p = 0.297), nor wound healing delay (p = 0.294), nor scar problems (p = 0.586) were significantly different. However, the volume of the graft was significantly correlated with the duration of the hospital stay (ρ = 0.30; p < 0.01) but not with gait disturbances (ρ = 0.60; p = 0.597). Additionally, when controlling for age (p = 0.841), sex (p = 0.031), ASA class (p = 0.699), preexisting orthopedic handicaps (p = 0.9828), and the volume of the bone graft (p = 0.770), only male sex was associated with the likelihood of suffering gait disturbances (p = 0.031). Conclusions: In conclusion, harvesting bone grafts from the anterior iliac crest for intraoral augmentation is a safe procedure for both young and elderly patients. Although there is some postoperative morbidity, such as gait disturbances, hypesthesia, scar formation, or delayed wound healing at the donor site, rates for these minor complications are low and mostly of short duration. Major complications, such as fractures or incision hernias, are very rare. However, in our study, the volume of the bone graft was associated with a longer stay in hospital, and this should be considered in the planning of iliac crest bone graft procedures.

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A mass guide for the harvest of cortico-cancellous bone from the posterior iliac crest for mandibular reconstruction

Cited by 7 publications

References 13 publications

Mandibular Reconstruction With Fibula Flap and Dental Implants Through Virtual Surgical Planning and Three Different Techniques: Double-Barrel Flap, Implant Dynamic Navigation and CAD/CAM Mesh With Iliac Crest Graft

Mandibular Reconstruction With Fibula Flap and Dental Implants Through Virtual Surgical Planning and Three Different Techniques: Double-Barrel Flap, Implant Dynamic Navigation and CAD/CAM Mesh With Iliac Crest Graft

Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft

Postoperative Morbidity and Complications in Elderly Patients after Harvesting of Iliac Crest Bone Grafts

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