S.M. Meloni

Delayed Iliac Abscess as An Unusual Complication of an Iliac Bone Graft in an Orthognathic Case

The reconstruction of large maxillofacial defects generally requires harvesting bone from extra-oral sites. The main source of autogenous bone is the iliac crest. This donor site is used to obtain bone for augmentation in orthopaedic surgery, neurosurgery, and oral and maxillofacial surgery, where the main indications are secondary and tertiary osteoplasty in patients with cleft-lip and palate, reconstruction of bony defects after operations for tumours, and augmentation of severe atrophy of the alveolar crest in preprosthetic surgery. A review of the literature on complications following bone harvesting from the anterior iliac crest reveals persistent pain, nerve injury, haemorrhage, limping, persistent gait abnormalities, conspicuous scarring, bone contour alteration, infection, fracture, meralgia paraesthetica, peritonitis, and herniation. The authors report an unusual complication: a huge iliac abscess that appeared 4 years after bimaxillary surgery involving iliac bone grafts.

Computer assisted dental rehabilitation in free flaps reconstructed jaws: one year follow-up of a prospective clinical study

Continuity defects in bone after resection of the jaw may cause problems, and osseo-myocutaneous free flaps are the gold standard for their reconstruction. Implant-supported prosthetic rehabilitation is reliable with these microvascular options, although it is still a serious challenge. The aim of this prospective clinical study was to describe the advantages of implants restored according to a computer-assisted surgical protocol. A group of 10 consecutive patients (both sexes) had already been treated and followed up for at least 1 year after prosthetic loading. The NobelGuide protocol had to be modified to adapt the technique for these patients who had had reconstructions. A total of 56 fixtures were installed and, when possible, immediately loaded (overall survival of implants 95%). Every patient was given correct provisional prosthetic rehabilitation, which was most satisfactory as far as chewing, social functioning, and overall quality of life were concerned. Three-dimensional computed tomographic (CT) examination showed a mean (SD) marginal bone loss of 1.06 (0.5)mm. We used a modified technique of computer-assisted implant surgery in jaws that had been reconstructed with free flaps; from these preliminary findings this approach seems valid when it comes to function, improving prosthetic restoration, and aesthetics.

Grafting after sinus lift with anorganic bovine bone alone compared with 50:50 anorganic bovine bone and autologous bone: results of a pilot randomised trial at one year

Our aim was to compare the outcome of implants inserted in maxillary sinuses augmented with anorganic bovine bone grafts compared with those augmented with mixed 50:50 bovine and autologous bone grafts. Twenty sinuses with 1-4mm of residual crestal height below the maxillary sinuses were randomised into two groups according to a parallel group design (n=10 in each). Sinuses were grafted using a lateral approach. In one group the grafts were 50:50 anorganic bovine bone and autologous bone and in the other anorganic bovine bone alone. After 7 months, 32 implants had been inserted. Outcome measures were survival of implants, complications, marginal changes in the height of the bone, and soft tissue variables (pocket probing depth and bleeding on probing). Probabilities of less than 0.05 were accepted as significant. No patient failed to complete the trial and no implant had failed at 1 year. There were some minor complications. After 12 months, the mean (SD) marginal bone loss (mm) was 1.06 (0.61) in the 50:50 group and 1.19 (0.53) in the anorganic bovine group. The mean (SD) values for pocket probing depth (mm) and bleeding on probing (score) were 2.49 (0.38) and 1.59 (0.82) in the 50:50 group and 2.31 (0.64) and 1.36 (0.87) in the anorganic bovine group (neither difference was significant). The present data are consistent with the hypothesis that the outcome of implants inserted in sinuses grafted with either material is comparable.