Evaluation of Three Bone Grafting Techniques for Severely Resorbed Maxillae in Conjunction With Immediate Endosseous Implants

Significant atrophy of the edentulous maxilla was treated with one of three bone grafting techniques: (1) onlay augmentation of the alveolar crest; (2) inlay grafting of the floors of the nose and maxillary sinuses following a Le Fort I osteotomy; and (3) inlay grafting of the maxillary sinus. Autogeneic iliac composite bone blocks were used with immediate placement of Brånemark implants. The first 10 consecutively treated patients for each treatment regime were followed between 33 and 95 months. Sixty-eight percent to 86% (onlay 83%, Le Fort I 68%, inlay 86%) of the 124 total implants placed into the bone graft were well integrated at the latest follow-up. However, although the primary intention was to provide all patients with a fixed prosthesis, five patients received a removable overdenture because of a reduced number of existing implants. Also, two patients in the Le Fort I group received removable overdentures due to a remaining large sagittal discrepancy between the jaws. In general, patients had good intraoral function; eight patients had minor phonetic problems, and three were not fully satisfied with the esthetic result. The specific indication for each of the techniques described is discussed and constitutes valuable means for treatment of severely atrophic maxillae. Keywords: atrophy of maxilla, bone grafting, Brånemark implants, endosseous implants