Maxillary reconstruction to enable implant insertion: a retrospective study of 181 patients

BACKGROUND: The purpose of the present study was to evaluate different types of maxillary pre-prosthetic surgery using autogenous bone graft and suggest a guideline for maxillary reconstruction to place implant. METHODS: 181 patients (125 females and 56 males), age range from 16 to 76 years old, were operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri). Different techniques were used, but always with autogenous bone grafting. 21 patients underwent a Lefort 1 procedure, 139 underwent sinus graft with or without vestibular onlay graft and 21 underwent onlay graft. This surgical procedure was made to allow the insertion of 685 implants. RESULTS: The patients were evaluated by clinical and radiological assessment. In the cases of Lefort 1, the rate of successful osteointegration was higher when the implants were placed in the second part of a two stages procedure: 92%, against 81% for one stage. In cases of sinus lift procedure, the rate of implant success was 98%. The infection rate was 3.5%. There was no significant resorption and the type of prosthesis used was a denture retained by a bar or fixed bridge. In cases of onlay graft, the implant insertion success was 97% and there was no infection. The amount of resorption was more significant in the pre-maxilla than in the other areas and the type of prosthesis used was fixed dentures. CONCLUSION: These observations demonstrate that: the aetiology of the bone defect indicate the type and number of the surgical procedures to re-established good jaws relationship and give the bone conditions to implant insertion successful. CLINICAL RELEVANCE: A guideline for surgical decision in the maxillary reconstruction for oral rehabilitation by implants may help to prevent failures of osseous resorption disorders and to foresee the investment of the bone in quality and necessary quantity.