Non-vascularised bone grafts: pushing beyond boundaries

Maxillofacial reconstruction is inherently challenging due to its critical role in mastication, speech, and aesthetics. While non-vascularised bone grafts (NVBGs) are considered suitable for small defects, their success in larger defects remains debated. This study was performed to evaluate the effectiveness of rib and iliac crest NVBGs in repairing segmental mandibular defects >6 cm versus ≤6 cm, and their ability to support dental implants. A retrospective observational study was conducted on 20 patients who underwent segmental mandibulectomy for benign pathology followed by immediate reconstruction with rib or anterior iliac crest NVBGs. Patients were stratified by defect length (≤6 cm and >6 cm). Dental rehabilitation with endosseous implants was performed either immediately or after a healing period of 9-18 months, when feasible. Procedural success at 1 year, complications, and implant survival were evaluated. Iliac crest NVBGs were used in nine cases and rib NVBGs in 11 cases, with graft lengths ranging from 4 to 10 cm. Radiographic graft integration was observed in 16 cases. Two cases in the ≤6 cm group showed late graft resorption. Graft failure requiring removal occurred in two cases, one in each group. A total of 18 delayed implants placed in eight patients showed 100% survival regardless of graft length, whereas only one of four immediately placed implants survived in a single ≤6 cm case. At 1-year follow up, NVBGs >6 cm showed reliable integration, with procedural success rates of 87.5% (7/8 cases) for defects >6 cm and 91.67% (11/12 cases) for defects ≤6 cm and supported predictable delayed implant placement in designated cases.