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Implant-borne prosthetic rehabilitation of bone-grafted cleft versus traumatic anterior maxillary defects.

Landes CA

Maxillofacial and Plastic Facial Surgery Department, The J.-W. Goethe University Medical Centre, Frankfurt, Germany. c.landes@lycos.com

PURPOSE: This study hypothesizes comparable implant success in bone-grafted cleft-alveolus versus traumatic anterior maxillary defects. Though of different pathogenesis, both defects comprise bone deficit, scarred periosteum, and soft tissues. Additional complicating factors are isolated. PATIENTS AND METHODS: Twenty cleft and 20 traumatic defect cases were followed-up 48 months in average. After 9 secondary and 11 tertiary cleft-osteoplasties, 25 implants were inserted; in traumatic defects following 8 two-stage and 12 one-stage osteoplasties, 37 incisor or canine implants were inserted. After secondary and tertiary cleft-osteoplasties, 57 and 13 months elapsed until implantation, 4 months in the two-stage posttraumatic osteoplasties. Implants were loaded at 6 months by single crowns. RESULTS: Four (20%) cleft patients faced 2 failures and 2 first-year losses; 2 (10%) trauma cases faced 2 failures and 2 first-year losses; and cumulative 5-year implant success was 80% and 88%, respectively. Other parameters' 12-month results were: values for mean cleft, trauma patients (+/- standard deviation), significance of comparison in t testing at a cut-off level of alpha = 0.05; bone loss 0.3+/-0.5 mm, 0.5+/-0.7 mm, P < .2; Periotest score 1.1+/-3.1, 1.2+/-2.5, P < .7; gingival recession 2.1+/-0.3 mm, 2.2+/-0.5 mm, P < .6; periimplant probing depth 2.5+/-0.5 mm, 2.8+/-2.6 mm, P < .3. CONCLUSION: Similar success rates without statistically significant differences were found; a multiple factor analysis discerned as positive predictive factors the following; generous transplant volume, 3 to 6 months latency, sufficient implant dimension, early adulthood. Early loading cannot be encouraged from the success rates. Negative predictive factors were spongiosa or milled-bone transplants, dehiscence, smoking, and anorexia. Intraorally harvested membranous bone transplants may prospectively amend secondary osteoplasty-associated bone resorption. Donor site morbidity, local growth, and tooth breakthrough require additional observation in a prospective study when implant insertion should directly follow the growth spurt.

Published 17 January 2006 in J Oral Maxillofac Surg, 64(2): 297-307.
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