Long-term stability of atrophic ridges reconstructed with hydroxylapatite: a prospective study

This article reports the results of an investigation of the long-term efficacy and stability of reconstructive surgery of atrophic ridges using dense hydroxylapatite (HA).

Subperiosteal HA was used as a first stage of reconstruction in 678 ridges, 645 mandibular and 35 maxillary, followed after 4 to 5 weeks by a total lowering of the floor of the mouth, vestibuloplasty, and skin graft in the mandible: a same-stage submucous vestibuloplasty was done in the maxilla. Patients were followed for an average of 5.3 +/- 2.7 years by the same surgical and prosthodontic team. The presence of severe or moderate radiographic change was analyzed in relation to gender, age, severity of atrophy, postoperative complications, clinical changes, patient satisfaction, and type of HA particles used alone or with a binder.

Seventy-seven percent of cases had no observable radiographic changes, 13% had moderate changes, and 10% had severe changes, of which fewer than half also had severe clinical changes. Relationships were established between the presence of radiographic change and certain parameters, especially postoperative delay in healing, severe or moderate clinical changes, and type of HA particles used.

Hydroxylapatite, when used alone or with binding agents, and in association with basic techniques of reconstructive surgery and soft tissue handling, is a predictable and stable biomaterial for ridge reconstruction.