title: Reconstruction of the atrophic edentulous maxilla with free iliac crest grafts and implants: a 3-year report of a prospective clinical study.
abstract: OBJECTIVE
  The purpose of this study was to perform a longitudinal follow-up study of implant stability in grafted maxillae with the aid of clinical, radiological, and resonance frequency analysis (RFA) parameters.
  
  
  METHODS
  The atrophic edentulous maxillae in 29 patients were reconstructed with free iliac crest grafts using onlay/inlay or interpositional grafting techniques. The endpoint of the resorption pattern in the maxilla determined the grafting technique used. Endosteal implants were placed after 6 months of bone-graft healing. Implant stability was measured four times using RFA: when the implants were placed, after 6 to 8 months of healing, after 6 months and 3 years of bridge loading. Individual checkups were performed at the two later RFA registrations after removal of the supraconstructions (Procera Implant Bridge, Nobel Biocare AB, Göteborg, Sweden). Radiological follow up of marginal bone level was performed annually.
  
  
  RESULTS
  Twenty-five patients remained for the follow-up period. A total of 192 implants were placed and with a survival rate of 90% at the 3-year follow up. Women and an implant position with a class 6 resorption prior to reconstruction were factors with significant increased risk for implant failure (multivariate logistic regression). Twelve of the 20 failed implants were lost before loading (early failures). The change in the marginal bone level was 0.3 +/- 0.3 mm between baseline (bridge delivery) and the 3-year follow up. The implant stability quotient (ISQ) value for all implants differed significantly between abutment connection (60.2 +/- 7.3) and after 6 months of bridge loading (62.5 +/- 5.5) (Wilcoxon signed ranks test for paired data, p=.05) but were nonsignificant between 6 months of bridge loading and 3 years of bridge loading (61.8 +/- 5.5). There was a significant difference between successful and failed implants when the ISQ values were compared for individual implants at placement (Mann-Whitney U test, p=.004). All 25 patients were provided with fixed implant bridges at the time of the 3-year follow up.
  
  
  CONCLUSIONS
  This clinical follow up using radiological examinations and RFA measurements indicates a predictable and stable long-term result for patients with atrophic edentulous maxillae reconstructed with autogenous bone and with delayed placement of endosteal implants. The ISQ value at the time of placement can probably serve as an indicator of level of risk for implant failure.
authors.affiliation: Department of Oral & Maxillofacial Surgery, Umeå University, Umeå, Sweden. mats.sjostrom@odont.umu.se
authors.forename: Mats
authors.initials: M
authors.lastname: Sjöström
authors.forename: Lars
authors.initials: L
authors.lastname: Sennerby
authors.forename: Hans
authors.initials: H
authors.lastname: Nilson
authors.forename: Stefan
authors.initials: S
authors.lastname: Lundgren
mesh_terms: D000368:Aged; D000540:Alveolar Ridge Augmentation; D001284:Atrophy; D001696:Biomechanical Phenomena; D016025:Bone Transplantation / Q000379:methods*; D000044:Dental Abutments; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003779:Denture Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007575:Jaw, Edentulous / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D015921:Dental Implants