Sinus augmentation with intra- vs extraorally harvested bone grafts for the provision of dental implants: Clinical long-term results

Objective: To report the long-term outcome of sinus augmentation with intra- vs extraorally harvested autogenous bone grafts. Method and Materials: Between January 1993 and August 2009, 146 patients (86 women and 60 men) were consecutively treated with sinus elevation procedures. In February 2010, 127 patients were re-evaluated. Bone grafts were harvested from the iliac crest (54 patients, group 1) and from the mandibular symphysis (73 patients, group 2). A total of 179 sinus augmentation procedures were performed (105 in group 1 and 74 in group 2). All patients received fixed prostheses. Results: A total of 456 Frialit II implants were placed in the 127 patients: 244 implants in extraorally harvested bone (group 1) and 212 in intraorally harvested bone (group 2). Patients had a mean bone graft consolidation period of 5.8 months in group 1 and of 5.2 months in group 2. During a minimum 3-month healing phase following implant placement, 35 of 456 implants failed (12.0% of group 1 and 4.5% of group 2) to become integrated in grafted bone. A total of 421 implants proceeded to occlusal loading with a fixed prosthesis. After a mean followup period of 110.2 months (range, 6 to 204 months), 34 implants were lost (25 in group 1 and 9 in group 2, for a total of 387 implants (91.9%) still functioning. Conclusion: Sinus augmentation procedures using intra- and extraorally harvested bone grafts can provide implant stability in the long term. However, major preoperative discomfort and more bone loss was seen when bone was harvested from the iliac crest. If autogenous bone is mandatory in sinus elevation procedures, extraorally harvested bone grafts can still be recommended, especially when bilateral procedures are indicated. Parole chiave: bone graft, bone resorption, dental implant, sinus augmentation