Long-term peri-implant bone level changes of non-vascularized fibula bone grafted edentulous patients

Long-term results of reconstructions and prosthetic rehabilitation of patients presenting severely atrophied edentulous ridges remains a challenge for clinicians. Among the various available augmentation materials there is evidence that avascular fibula bone grafts possess a reliable resistance against resorption and may thus provide a valuable source to reduce the loss of vertical bone height after reconstruction of the severely atrophied mandible and maxilla. The purpose of the present study was to assess long-term crestal bone level stability in avascular fibula bone grafts. 8 edentulous female patients (average age 70.6 years) with Class-VI-atrophy and less than 5 mm residual bone volume received onlay-grafting with avascular fibula bone grafts and were monitored with a mean observation time of 133.7 months (121-186). A total of 39 implants were placed in the maxilla and mandible. Three patients received immediate and five patients delayed implant placement 3 months after grafting. All patients were provided with bar-retained dentures. Postoperative evaluation included clinical implant success (Buser) and radiographic examinations (orthopantomogram) to quantify crestal bone resorption. Grafting was successfully performed in all patients with no regrafting necessary. All implants but one, lost 2 years after abutment connection, remained successfully integrated and fulfilled the Buser criteria, rendering to a success rate of 97%. Mean bone resorption after 10 years was mesial 1.4 mm and distal 1.4 mm at each implant-site. Maximum bone resorption occurred between postoperative and first year, thereafter no significant resorption was measured in re-examinations up to 15 years. Avascular fibula grafts are a reliable bone graft for augmentation procedures in atrophied edentulous ridges. Dental implants that integrated in the autogenous fibular bone grafts showed a stable crestal peri-implant bone level up to 15 years after implant placement.