title: Iliac crest autogenous bone graft versus alloplastic graft and guided bone regeneration in the reconstruction of atrophic maxillae: a 5-year retrospective study on cost-effectiveness and clinical outcome.
abstract: BACKGROUND
  Reconstruction of the atrophic maxillae with autogenous bone graft and jawbone-anchored bridges is a well-proven technique. However, the morbidity associated with the concept should not be neglected. Furthermore, the costs for such treatment, including general anesthesia and hospital stay, are significant. Little data are found in the literature with regard to a cost-benefit approach to various treatment alternates.
  
  
  OBJECTIVE
  The aim of this retrospective study was to compare from a health-economical and clinical perspective the reconstruction of the atrophic maxillae prior to oral implant treatment either with autogenous bone grafts harvested from the iliac crest or the use of demineralized freeze-dried bone (DFDB) in combination with a thermoplastic carrier (Regeneration Technologies Inc., Alachua, FL, USA) and guided bone regeneration (GBR).
  
  
  METHODS
  A total of 26 patients (13 + 13) were selected and matched with regard to indication, sex, and age. The study was performed 5 years after the completion of the treatment. Implant survival, morbidity, and complications were analyzed. Furthermore, a detailed analysis of the total cost for the respective treatment modality was performed, including material, costs for staff, sick leave, etc.
  
  
  RESULTS
  The study revealed no statistical difference with regard to implant survival for the respective groups. The average total cost, per patient, for the DFDB group was 22.5% of the total cost for a patient treated with autogenous bone grafting procedures.
  
  
  CONCLUSIONS
  The study concluded that reconstruction of atrophic maxillae with a bone substitute material (DFDB) in combination with GBR can be performed with an equal treatment outcome and with less resources and a significant reduced cost in selected cases compared with autogenous bone grafts from the iliac crest.
authors.affiliation: Department of ENT/Oral & Maxillofacial Surgery, NÄL Medical Centre Hospital, Trollhättan, Sweden. dahlinchrister@hotmail.com
authors.forename: Christer
authors.initials: C
authors.lastname: Dahlin
authors.forename: Anita
authors.initials: A
authors.lastname: Johansson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000540:Alveolar Ridge Augmentation / Q000191:economics / Q000379:methods*; D001284:Atrophy; D018775:Bone Demineralization Technique; D018786:Bone Substitutes / Q000191:economics / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000191:economics / Q000379:methods*; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005612:Freeze Drying; D006085:Graft Survival; D048091:Guided Tissue Regeneration / Q000191:economics / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D007085:Ilium / Q000601:surgery; D008297:Male; D008437:Maxilla / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D013516:Oral Surgical Procedures, Preprosthetic / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000191:economics; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D000078329:Workforce
chemical_list: D018786:Bone Substitutes