Reconstruction of the resorbed maxilla with iliac crest or calvarial bone grafts: a comparison

Patients in need for an implant retained denture due to severe resorption of the edentulous jaw, often require bone reconstruction for reliable implant placement. For years, anterior iliac crest has been widely used to perform these reconstructions. However, anterior iliac crest harvesting is associated with postoperative pain and gait disturbances. Also, bone grafts derived from the iliac crest exhibit high resorption rates. Calvarial bone grafts form a potential alternative here, because of presumed low morbidity as well as favorable bone regeneration properties demonstrated by this bone type. The research described in this thesis aimed to compare patient reported outcomes, morbidity, microradiography, and histology of anterior iliac crest and calvarial bone graft harvesting. The results of the various studies show that calvarial and anterior iliac crest harvesting for reconstruction of the severely resorbed edentulous jaw prior to implant placement are both associated with high patient appreciation. With regards to morbidity and complications, harvesting bone grafts from either of the sites is safe. However, a slight favor is seen for calvarial grafts with regards to postoperative pain and gait disturbances. Calvarial and anterior iliac crest bone both provides a reliable and stable basis for implant placement four months after grafting. However, mineral density, porosity and resorption rate are in slight favor for calvarial bone. When extensive augmentation is needed in severely resorbed maxilla to allow for future preimplant surgery, the choice between crista iliac anterior or the calvarium as donor site depends on several factors, boldness, gait problems and preference of the patient. The choice between both bone graft types should therefore be based on patient specific factors.