title: Morbidity of harvesting of retromolar bone grafts: a prospective study.
abstract: 20 retromolar bone grafts were harvested in outpatients for augmentation of the implant site from January to June 2000 (10 female, 10 male, 40.9 +/- 12.8 years, minimum 17 years, maximum 66 years). The aim of the study was to assess typical complications of this procedure in a prospective manner. For the determination of the superficial sensory function of the inferior alveolar and the lingual nerve, an objective method was used. The bone grafts were harvested for single tooth reconstruction. In 14 cases a ridge augmentation and in 6 cases an endoscopically controlled crestal sinus floor elevation was performed. Preoperatively, the height of bone above the cranial aspect of the inferior alveolar nerve in the retromolar region was assessed radiologically with known markers. The maximum mouth opening was determined. The superficial sensory function of the inferior alveolar and the lingual nerve was assessed with the Pointed-Blunt Test, the Two-Point-Discrimination Test and the objective method of the 'Pain and Thermal Sensitivity' Test (PATH Test). Moreover, the pulp sensitivity of the teeth of the donor site was determined by cold vitality testing. All tests were repeated 1 week postoperatively. Intraoperatively, the width of the retromolar region was measured with a caliper. The patients rated the operative strain on a visual analogue scale. The height of bone above the inferior alveolar nerve in the retromolar region was 11.0 +/- 2.2 mm. The width of the retromolar area was 14.2 +/- 1.9 mm. Postoperatively, the maximal mouth opening changed significantly (40.8 +/- 3.5 mm preoperatively, 38.9 +/- 3.7 mm postoperatively, P = 0.006). However, the reduction was not relevant clinically. A direct injury of the inferior alveolar or lingual nerve did not occur. A sensitivity impairment could not be detected for either of the nerves by the different test methods 1 week postoperatively. The operative strain related to the donor site was significantly less than the strain generated by the implant placement (rating on a visual analogue scale 2.8 +/- 1.0 and 4.1 +/- 2.0, respectively, P = 0.027). Retromolar bone grafts are a viable method for augmentation of the implant site in conjunction with single tooth reconstruction with low strain on the patient and minimal risk of complications.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany. emeka.nkenke@mkg.imed.uni-erlangen.de
authors.forename: Emeka
authors.initials: E
authors.lastname: Nkenke
authors.forename: Martin
authors.initials: M
authors.lastname: Radespiel-Tröger
authors.forename: Jörg
authors.initials: J
authors.lastname: Wiltfang
authors.forename: Stefan
authors.initials: S
authors.lastname: Schultze-Mosgau
authors.forename: Gerhard
authors.initials: G
authors.lastname: Winkler
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Neukam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000540:Alveolar Ridge Augmentation / Q000379:methods; D000556:Ambulatory Surgical Procedures; D001294:Attitude to Health; D016025:Bone Transplantation; D003758:Dental Implantation, Endosseous; D019250:Dental Implants, Single-Tooth; D003782:Dental Pulp / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008036:Lingual Nerve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008340:Mandibular Nerve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008437:Maxilla / Q000601:surgery; D008443:Maxillary Sinus / Q000601:surgery; D008875:Middle Aged; D009068:Movement; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D012677:Sensation / Q000502:physiology; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000523:psychology; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000523:psychology