Rehabilitation of the severely atrophied maxilla by horseshoe Le Fort I osteotomy (HLFO).
OBJECTIVE
The purpose of this study was to determine the long-term outcome of the horseshoe Le Fort I osteotomy (HLFO) as a preprosthetic operation technique for implant insertion in the extremely atrophied maxilla.


METHODS
36 patients (8 male, 28 female, average age 57.6 years) underwent HLFO combined with iliac crest bone grafting. They were divided into 2 groups: group A with 12 patients who simultaneously received 100 implants; group B with 24 patients where 176 implants were inserted in 18 patients in a second-stage procedure. Clinical and radiographic outcome with regard to implant osseointegration, alveolar bone height in the canine and molar regions, peri-implant bone loss and satisfaction of patients (esthetics, masticatory function, overall treatment) were investigated in all cases.


RESULTS
The overall 2-year failure-free fraction of implants was 95.5%; the 5-year failure-free fraction was 89.3%. In the 1-step group the 2-year and 5-year failure-free fractions were 95.9% and 86.9%, respectively, in the 2-step group 95.0% and 91.3% (log rank test P=.57). A total of 27 implants were lost during the entire follow-up: 14 in 6 patients of the 1-stage and 13 in 9 patients of the 2-stage group. The mean loss of alveolar bone after augmentation in the canine and molar regions was almost equal in both groups (overall means for the 2 regions 3.67 +/- 2.77 and 4.42 +/- 2.72 mm, respectively). The relationship between the jaws and thereby the esthetic profile could be improved in all cases. All patients were satisfied with the dental rehabilitation and the achieved new esthetic appearance.


CONCLUSIONS
HLFO combined with iliac bone grafting is a feasible preprosthetic technique prior to implant insertion in cases of severe atrophy of the maxillary alveolar ridge, leading to satisfying implant survival and rehabilitation of function.
Yerit
Kaan C
KC
University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Austria. kaan.yerit@univie.ac.at
Posch
Martin
M
Guserl
Ulrich
U
Turhani
Dritan
D
Schopper
Christian
C
Wanschitz
Felix
F
Wagner
Arne
A
Watzinger
Franz
F
Ewers
Rolf
R
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000145:classification; D000539:Alveolar Process / Q000473:pathology; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001284:Atrophy; D016025:Bone Transplantation; D003481:Cuspid; D015921:Dental Implants; D019232:Dental Restoration Failure; D004955:Esthetics, Dental; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008409:Mastication / Q000502:physiology; D008437:Maxilla / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D008963:Molar; D016348:Osseointegration / Q000502:physiology; D019340:Osteotomy, Le Fort / Q000145:classification*; D017060:Patient Satisfaction; D016896:Treatment Outcome
D015921:Dental Implants