Implant-borne prosthetic rehabilitation of bone-grafted cleft versus traumatic anterior maxillary defects.

PURPOSE: This study hypothesizes comparable implant success in bone-grafted cleft-alveolus versus traumatic anterior maxillary defects. Though of different pathogenesis, both defects comprise bone deficit, scarred periosteum, and soft tissues. Additional complicating factors are isolated.

PATIENTS AND

METHODS

Twenty cleft and 20 traumatic defect cases were followed-up 48 months in average. After 9 secondary and 11 tertiary cleft-osteoplasties, 25 implants were inserted; in traumatic defects following 8 two-stage and 12 one-stage osteoplasties, 37 incisor or canine implants were inserted. After secondary and tertiary cleft-osteoplasties, 57 and 13 months elapsed until implantation, 4 months in the two-stage posttraumatic osteoplasties. Implants were loaded at 6 months by single crowns.

RESULTS

Four (20%) cleft patients faced 2 failures and 2 first-year losses; 2 (10%) trauma cases faced 2 failures and 2 first-year losses; and cumulative 5-year implant success was 80% and 88%, respectively. Other parameters' 12-month results were: values for mean cleft, trauma patients (+/- standard deviation), significance of comparison in t testing at a cut-off level of alpha = 0.05; bone loss 0.3+/-0.5 mm, 0.5+/-0.7 mm, P < .2; Periotest score 1.1+/-3.1, 1.2+/-2.5, P < .7; gingival recession 2.1+/-0.3 mm, 2.2+/-0.5 mm, P < .6; periimplant probing depth 2.5+/-0.5 mm, 2.8+/-2.6 mm, P < .3.

CONCLUSION

Similar success rates without statistically significant differences were found; a multiple factor analysis discerned as positive predictive factors the following; generous transplant volume, 3 to 6 months latency, sufficient implant dimension, early adulthood. Early loading cannot be encouraged from the success rates. Negative predictive factors were spongiosa or milled-bone transplants, dehiscence, smoking, and anorexia. Intraorally harvested membranous bone transplants may prospectively amend secondary osteoplasty-associated bone resorption. Donor site morbidity, local growth, and tooth breakthrough require additional observation in a prospective study when implant insertion should directly follow the growth spurt.