Bone Graft Solutions in the Treatment of Severe Maxillary Atrophy: Advantages of Combined Therapy

Objectives: The aim of the present study was to evaluate the effectiveness of combined therapy as a treatment for severe maxillary atrophy. The long term survival rate of dental implants placed in autologous onlay bone block grafts (AOBG) augmentation areas, harvested from intraoral origin using combined surgical therapy, was evaluated.

Methods: A retrospective study was conducted on 108 patients who received a total of 272 dental implants placed in 109 maxillary augmentations sites using AOBG in combination with Platelet Rich Plasma (PRP) and Bio-Oss, covered with Platelet Poor Plasma (PPP). As part of the combined surgical therapy, 29 sinus and 16 subnasal elevations procedures were performed simultaneously with maxillary bone augmentation. In 26 patients a subepithelial connective tissue graft procedure was performed as well.

Results: Of the total AOBG performed during 2000-2010, 108 (99.1%) were diagnosed as successful. Of the total implants, the majority were defined as survived (94.5%). The total cumulative 10 years survival rate, using Kaplan Meier life table analysis, was 89%, compare to 99% in the anterior maxillary area. Complications following implant placement were observed in 11.8% of the total implants, when the inflammation/infection (5.9%) and spontaneous premature exposed implant (3%) were the most common. Total marginal bone loss ≤1.5 mm accompanied by inflammation, occurred only in 2.6% of the cases during the follow-up period (mean follow up time 43.6±32.5 months).


Conclusions: We suggest that the combine therapy that we described heir should be considered a reliable, safe and very effective method to obtain high bone graft survival rate following high long-term implants' survival rate and good esthetic outcome. Moreover, we believe that PRP as an autologous source of growth factors mixed with osteoconductive bone substitute and covered with PPP as a biological membrane may offer a novel therapy with greater efficacy than single augmentation technique for bone regeneration.