Survival Analysis of Endosseous Implants in Grafted and Nongrafted Edentulous Maxillae

Purpose: The aim of this study was to analyze and compare the survival rates of endosseous implants placed in the edentulous maxillae of patients in whom bone augmentation was undertaken prior to or in conjunction with implant placement with survival rates in patients who did not undergo bone augmentation. Materials and Methods: This study included 2 retrospective patient groups: the graft group, which included 64 patients with 437 implants, and the nongraft group, which included 118 patients with 683 implants. The patients were treated consecutively between 1990 and 1996. In addition, the retrospective patient groups were also followed prospectively using a standardized clinical and radiographic study design. Results: The implant survival rate was 75.1% for the graft group and 84.0% for the nongraft group after a mean follow-up of 5 to 6 years, a statistically significant difference. However, there was no difference with regard to the prosthesis survival rate, and after reoperation, more grafted patients had a fixed prosthesis at the end of the study (87.5% versus 85.3%). Implant failure appeared to be related to the original jawbone volume in the anterior regions. In the premolar region, where the inlay graft technique was used, the implant survival rate for the graft group was comparable to that of the nongraft group. The graft group had significantly more failures than the nongraft group in the incisor region, but not in the canine, premolar, or molar regions. Discussion: The majority of implant failures occurred before loading. Occlusal overload during the healing period may have been a causative factor. Conclusions: The overall implant survival rate was lower in grafted maxillae than in nongrafted maxillae after a mean of 5 to 6 years of follow-up. Analysis revealed that jawbone volume in the anterior regions at the start of treatment was directly related to implant survival rates in both groups: the greater the volume, the higher the survival rate. Moreover, the implant survival rate was similar in grafted posterior edentulous maxillae of classes V and VI and in nongrafted posterior edentulous maxillae of classes III and IV.