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ePaper created 2016-05-19, 12:42:25 | version 1.38.0
| research 14 implants 2 2016 graft from the anterior iliac crest bone between 2002 and 2010 participated in the study. The surgery was indicated on the grounds of the di- mension of the available jawbone deficit (Figs. 1 & 2), considering its localisation as well. Criteria for exclusion were heavy nicotine (more than ten cigarettes/day) and drug abuse, diabetes mellitus requiring insulin, coagulation disorders, and bone diseases. All interventions were executed under short-term antibiotic prophylaxis (Cefotiam [Spizef®], Grünen- thal GmbH or Clindamycin [Sobelin®], Pfizer) under general anaesthesia by the same surgeon, exposing at first the donor site of the anterior iliac crest bone in a minimally invasive procedure, i.e. by making a 3to4 cmlongskinincisionalongtheLangerlinesand subcutaneously,ifpossiblewithoutcuttingmuscles, nerves,andvessels.Bycreatingtwoperiostealflaps, the periosteum was pushed aside over the iliac crest bone. Using a micro-oscillating saw, cortico-cancel- lousboneblockswereremovedor,bymeansofahol- low drill, cylinders from the cancellous bone. The periosteumwasthoroughlyadaptedandclosed;the wound was sutured in layers. A continuous subcu taneous suture was made (Fig. 3). Suction drainage wasobstainedfromregularly.Beforethefinaltrans- plantation, the cortico-cancellous bone was mod- elledtofitthegraftbedandstoredintermediatelyin venous autologous blood; amorphous cancellous bonewashomogenisedandstoredintermediatelyin venous autologous blood as well until fitted in the graft bed (Fig. 4). According to the specified follow-up schedule, check-ups took place the following day, after one, two, and three postoperative weeks and in the courseoftheprosthetictreatment,atthelatestafter six months. Then, further follow-ups took place withintheboundsofthesemi-annualimplantexam- inations. The results were recorded in writing. They were analysed by means of a checklist comprising intraoperativeinjuriessuchashaemorrhages,injury of nerves (e.g. genitofemoral nerve, lateral cutane- ous nerve, iliohypogastric nerve), and peritoneal perforation. Possibly persisting sensibility disorders like complete failure of sensibility or paraesthesia (e.g. burning sensation) were grouped with intra operative complications. In addition, infections, im- paired wound healing, secondary haemorrhages, possibly available pains, their intensity (analogue scalebetween1and10)anddurationaswellasmo- tor function limitations were registered. Finally, the quality of the scar was assessed and the subjective opinion of the patient on the result of the treatment obtained. Results Intraoperative complications like heavy vascular bleeding requiring ligature did not appear in any of thecasesandwerenotexpectedbecauseofthepa- tientsanatomy.Almostregularly,however,postop- erative suffusions in various intensities occurred, albeit with no clinical relevance. Transections of Fig. 2a Fig. 2b Fig. 2c Fig. 2a: Bilaterally advanced atrophy of the alveolar ridge in the lower jaw with an insufficient prosthetic bed. – Fig. 2b: St. p. nerve lateralisation and onlay osteoplasty with cortical/cancellous bone flakes from the iliac crest bilaterally in the lower jaw, fixation of bone flakes with implants 35, 37, 45, 47, implant insertion 33, imme- diate implant insertion after extraction 43. – Fig. 2c: St. p. osseous consolidation and prosthetic supply. 22016