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| research 16 implants 2 2016 Fig. 4a: Processing of the bone block. Fig. 4b: Intermediate storage of grafts in venous autologous blood. saidtheresultwasverygood,four(5.8%)saiditwas good. None of the patients stated any impairment of any kind. All patients would undergo bone har- vesting from the iliac crest again. Discussion The success of autologous bone for jawbone aug- mentation with its low morbidity and complication rate is well known.11–15 Not for nothing is it called the gold standard. Compared to bone created in lab- oratories, it provides more reliable results.16 Com- pared to Straumann BoneCeramic® (BoneCeramic®, StraumannAG;hydroxyapatiteandtricalciumphos- phate), BioOss® (BioOss®, Geistlich; bovine bone) and Puros® (Puros®, Zimmer Dental; allograft can- cellous particles), the vital autologous bone per- forms best and yields the best de novo bone forma- tion.17 The success rate is high as well in combination with other materials.12, 18 Thenecessitytoperformpelvissurgeryundergen- eral anaesthesia and the fact that the patient should be monitored at the hospital at least for a short time makestheharvestingofpelvicboneappearlaborious, however. In addition, there may be general medical andindividualreservationsagainstopeningasecond operating field. Besidestheeasilyaccessibleanterioriliaccrest,for which the patient does not need to be repositioned for the jawbone augmentation, there are further op- tions. When harvesting bone from the dorsal part of the iliac crest, however, repositioning of the patient causesasubstantiallossoftime.Allotherdonorsites mentioned above are associated with a limitation of available material, so that they are suited to fill only minor defects in contrast to the iliac crest, where sufficient quantities of cortical and cancellous bone are available. Within the scope of the present prospective lon- gitudinal study, the anterior iliac crest was chosen exclusivelyasthedonorsiteofautologousbone.The same experienced surgeon always harvested the graft,thusensuringastandardisedandspeedypro- cedure.Inaddition,asthepatientdidnotneedtobe repositioned, a second team could expose and pre- pare the graft site simultaneously. This can neither berealisedeffectivelybytheprocedureofintra-oral bone harvesting nor by harvesting of material from the posterior iliac crest. The timesaving is remark- able and certainly has an effect on the hygienic situation. Within the scope of this study, the jawbone situa- tion is not addressed in detail. We may remark, how- ever,thatnograftlossoccurredinthetransplantbed. This correlates with the patients’ assessment to un- dergo the surgery again. Serious intraoperative complications, secondary haemorrhage, infections, or impaired wound healing did not occur, certainly also because of the strict ex- clusion criteria like nicotine abuse and diabetes re- quiring insulin. Subjective paraesthesia and short-time tempo- rary functional impairments when standing up or climbing stairs were predominant. The evaluation ofsurgery-relatedpain,inthiscasefocusedonthe pelvic region, is difficult, as pain is an individual, subjectively-biased sensation that is usually mod- ulated by means of analgesic medication in partic- ular after surgeries. Usually and in this study, the intensity of available pain is given by the patient him-/herself on an analogue scale ranging from 1 (minimum) to 10 (maximum). This information is also a measure of the analgesic effectiveness and can therefore not be used in the strict sense (Singh et al. 2009, Fasolis et al. 2012)19,20 . Improved post- operative analgesia bears great potential after all. We drew the conclusion by administering an addi- tional long-lasting local anaesthetic at the end of the operation (Carbosthesin®, AstraZeneca; Bupivacaine). The effect is promising. Fig. 4bFig. 4a 22016