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Methods : Patient experience following iliac crest-derived alveolar bone grafting and implant placement [1]

Methods : Patient experience following iliac crest-derived alveolar bone grafting and implant placement [1]

author: Cecilie G Gjerde, Siddharth Shanbhag, Evelyn Neppelberg, Kamal Mustafa, Harald Gjengedal | publisher: drg. Andreas Tjandra, Sp. Perio, FISID

This cross-sectional retrospective cohort study was based on records from all patients (n = 69) who underwent advanced alveolar augmentation with autologous iliac bone grafts at the Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway, over 10 years (2002–2012). These patients were orally compromised with severe chewing problems as well as speech difficulties and had previously undergone several unsuccessful rehabilitation methods, prior to referral. At the time of this survey, seven patients had passed away, two had moved to unknown addresses, and one was hospitalized in a psychiatric institution. Thus, the study sample included 59 patients: 29 women and 30 men.

The Norwegian Committee for Medical Research Ethics (“REK,” Health Region West), acknowledged this study as a treatment quality control study.

Bone graft surgeries were performed under general anesthesia and sterile conditions. Cortico-cancellous bone blocks were harvested from the anterior superior iliac crest. Reconstructions in the maxilla (N = 57) or mandible (N = 2) were performed in one operation by two teams using an onlay bone graft fixated with titanium micro-screws (1.5 mm Ø). The surgical procedure was performed according to the protocol commonly used at Haukeland University Hospital. In brief, the harvesting of autogenous bones from the anterior iliac crests started with a skin incision following the skin lines in a posterolateral direction starting from 3 to 4 cm medial to the iliac crests. The superior surfaces of the iliac crests are exposed after a sharp dissection through the periosteum following the crests. The dissections are performed with great attention to avoid laceration of the fascia lata. Both cortical and spongious bone are harvested. The donor sites are closed in layers with special attention to the first layer—the fascia lata. This layer is sutured close to avoid marrowbone bleeding. Activated vacuum drainages are positioned between the fascia lata and the muscles until the patients are mobilized. The skin incisions are closed with continuous intracutaneous resorbable sutures. All patients included in the study were hospitalized 2–3 days postoperatively. Patients received phenoxymethylpenicillin (1 g × 3) or clindamycin (300 mg × 3) for 5 days following the operation. Vacuum drainage at the donor site was used until the patient was mobilized the morning after surgery. Analgesics (paracetamol or non-steroid anti-inflammatory drugs) were prescribed 7–10 days postoperatively.

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