Heterotopic Ossification as a Complication of Iliac Crest Bone Harvesting in a Case of Implant Therapy

Heterotopic ossification is defined as the formation of bone in sites where it does not normally exist. Myositis ossificans is classified as a type of heterotopic ossification, where bone formation occurs following soft tissue trauma. A case is presented of a 65-year-old female patient, diagnosed with maxillary and mandibular atrophy, in whom myositis ossificans developed secondary to iliac crest bone harvesting for preprosthetic augmentation prior to placement of maxillary and mandibular implants. Approximately 3 months after bone was harvested from the right anterior iliac crest, and despite a routine recovery from the bone grafting procedure, the patient developed persistent pain, described in her own words as "incapacitating," in the right lower quadrant of her abdomen. She was evaluated by a number of different specialists before a diagnosis of myositis ossificans was reached by her orthopedist. Management of the pain proved difficult, but eventually the symptoms improved to the extent that there was minimal disruption to her daily activities. Implant placement and prosthodontic treatment concluded to the patient's satisfaction. It may be advisable to include the possibility of occurrence of heterotopic ossification and resultant pain as a specific preoperative warning when iliac crest bone harvesting is planned to prepare patients for this potentially serious complication and to avoid litigation. Keywords: bone transplantation, dental implants, heterotopic ossification, iliac crest, myositis ossificans, preprosthetic surgery