A 9-14 year follow-up of onlay bone grafting in the atrophic maxilla

Treatment of the atrophic edentulous maxilla is challenging especially when bone graft procedures are necessary. In this study an onlay bone graft, a saddle or veneer, with or without maxillary sinus floor inlay graft, harvested from the anterior iliac crest, in combination with implants was used in the reconstruction of patients with extreme atrophy in their maxillae. The aim was to investigate treatment outcome, and the impact of gender and smoking, in 44 patients in a prospective, long-term, follow-up study concerning implant survival rate and marginal bone loss adjacent to the surfaces of the implant. Mean follow-up time was 11 years. Of 334 inserted Brånemark implants, with machined surface, 27 failed. Estimated implant survival rate was 90%. Marginal bone loss was 1.8 mm 1 year after implant surgery; 2.3 mm after 5 years; and 2.4 mm after 10 years. There was a significant difference between genders in implant survival. Marginal bone loss differed significantly between smokers and non-smokers up to the 5-year examination and between genders after the 4-year examination. The onlay bone graft, with or without a maxillary inlay graft, results in high implant survival rate, good oral function and stabilised marginal bone. All patients are still wearing their original fixed bridges.