Immediate loading of dental implants placed in severely resorbed edentulous maxillae reconstructed with Le Fort I osteotomy and interpositional bone grafting

Background: Reconstruction and rehabilitation of atrophic maxillae with bone grafts is a lengthy and demanding procedure. This study reports the immediate loading of 50 implants placed on six extremely atrophied edentulous maxillae reconstructed with Le Fort I osteotomy and iliac bone grafting. Methods: Six patients, aged 49 to 68 years, with severely atrophied maxillae were treated with Le Fort I osteotomy and iliac bone grafting to allow for implant‐borne prosthetic rehabilitation. Four to 5 months thereafter, 50 implants (seven to 10 per patient) were placed in reconstructed maxillae and immediately functionally loaded with a screw‐retained definitive prosthesis. The patients were followed by clinical and radiographic examinations for 24 months after prosthetic loading. Results: The grafting procedure and healing period before implant placement were uneventful in all patients. Two implants were lost within 2 months after prosthesis insertion in two patients, with an overall survival rate of 96%. The prostheses success rate was 100%. At the end of the follow‐up period, all remaining implants appeared clinically healthy; crestal bone loss was >1.7 mm for six implants, resulting in a cumulative success rate of 84%. Conclusion: Immediate loading of implants placed after Le Fort I osteotomy and interpositional iliac bone grafting could be considered a viable protocol to rehabilitate extremely atrophied edentulous maxillae, considerably reducing the treatment time.     

Guided bone regeneration with autogenous block grafts applied to Le Fort I osteotomy for treatment of severely resorbed maxillae: a 4- to 6-year prospective study

Introduction: Edentulism causes progressive bone resorption of the maxillae, which can lead to altered maxillo‐mandibular relationships. The aim of the study was to evaluate the applicability of guided bone regeneration (GBR) to Le Fort I osteotomies with interpositional bone grafts for treatment of patients with severe maxillary atrophy. Materials and methods: Twenty consecutive patients characterized by severely atrophic maxillae were treated from January 2003 to January 2006 in order to resolve maxillary edentulism. All patients underwent pre‐prosthetic surgery, including a Le Fort I osteotomy associated with autologous interpositional bone grafts to move the alveolar arch forward and to resolve the maxillary atrophy. Barrier membranes were also used to cover the bone grafts and the osteotomy line, favoring the healing process according to GBR principles. Maxilla advancement and alveolar crest augmentation were measured to assess the degree of reconstruction. A total of 154 implants were inserted in reconstructed maxillae 4 months after surgery and were restored with fixed full‐arch dentures after another 4 months. Surgical and prosthetic complications were recorded and previously established implant success criteria were used to assess the success of this treatment protocol. Results: The outcome of pre‐prosthetic surgery and implant‐supported rehabilitation was prospectively evaluated every year. All Le Fort I osteotomies were successfully carried out, with a mean maxilla advancement of 4.2 cm (range: 3.1–5 cm), which appeared to be stable during the follow‐up. After a mean follow‐up of 66.4±18.4 months, only four implants failed according to the success criteria, yielding a cumulative success rate of 95.8%. Discussion and conclusions: Le Fort I osteotomies with the use of barrier membranes to cover the interpositional bone grafts can be a predictable treatment for edentulous patients with severely resorbed maxillae. The study data suggest that this approach makes it possible to compensate for both sagittal and vertical discrepancies due to maxilla atrophy, with a minimum resorption of advanced maxillae and grafted bone. A GBR‐based protocol seems to lead to high implant success rates, although further randomized controlled studies are needed to demonstrate the usefulness and advantageousness of GBR. To cite this article:
De Santis D, Trevisiol L, D'Agostino A, Cucchi A, De Gemmis A, Nocini PF. Guided bone regeneration with autogenous block grafts applied to Le Fort I osteotomy for treatment of severely resorbed maxillae: a 4‐ to 6‐year prospective study.
Clin. Oral Impl. Res. 23 , 2012; 60–69.
doi: 10.1111/j.1600‐0501.2011.02181.x     

Le Fort I osteotomy with interpositional bone grafts and implants for rehabilitation of the severely resorbed maxilla: a 2-stage procedure.

A surgical procedure for the rehabilitation of severely resorbed maxillae is described. Twenty-five patients, made up of a development group of 5 and a routine group of 20, were treated with Le Fort I osteotomy using interpositional bone grafts from the iliac crest and, in a second stage, titanium implants. Altogether, 181 Br?nemark implants were placed, and the patients were followed for up to 5 years. The implant survival rate for the development group was 60.0% after 5 years. Life table analysis for the routine group showed a 5-year survival rate of 85.6%. Twenty-two patients received fixed prostheses and 2 received overdentures. One patient lost all implants and was rehabilitated with a prong denture.     

Segmental Le Fort I osteotomy with bone grafting in unilateral severely atrophied maxilla

This study describes the use of a segmental Le Fort I osteotomy for interpositional autogenous iliac bone grafts in 5 patients with severe unilateral atrophy of the maxilla. Unilateral pterygomaxillary disjunction and osteotomy of the lateral and medial walls of the maxillary sinus were performed. The mucosa of the maxillary sinus was preserved and lifted cranially. It was stabilized with autogenous cancellous bone grafts. One side of the maxilla was gently downfractured until it replaced the original morphology of the alveolar crest. The inter-arch space was therefore reduced to the ideal level for placing implants. Lateral widening of the alveolar crest was obtained with on-lay bone grafts. Segmental osteotomy with bone grafting is a modification of Le Fort I swing osteotomy that has several advantages. The in-lay graft was not resorbed because it was rapidly revascularized and implant placement was delayed. This article presents a surgical technique for the reduction of vertical inter-arch space for the correct positioning of osseointegrated implants.     

Monitoring of implant stability in grafted bone using resonance frequency analysis. A clinical study from implant placement to 6 months of loading

The aim of this prospective study was to compare implants placed in grafted and normal non-grafted maxilla by means of resonance frequency analysis (RFA), clinical stability and implant failure.Twenty-nine patients with severe atrophy of the edentulous maxilla were treated with autogenous bone grafts as onlay (24 patients) or as interpositional grafts in conjunction with a Le Fort I osteotomy (five patients) 6 months prior to placement of 222 implants. Ten non-grafted patients treated with 75 Brånemark implants in the edentulous maxillae served as a control group. RFA was performed at implant placement, abutment connection and after 6 months of bridge loading.Seventeen (8%) implants were lost in the grafted bone and one (1%) in normal bone. RFA revealed a similar pattern in both grafted and normal maxillae, i.e. increasing resonance frequency (RF) with time (Wilcoxon Signed Rank test for paired data). Twenty implants that were rotation mobile (low primary stability) at the time of insertion showed a significantly lower value at implant placement according to RFA (Mann–Whitney U-test, P=0.020). The RF for the failed implants revealed a tendency towards lower values (Mann–Whitney U-test, P=0.072), compared to the successful implants.It is concluded that implants placed in grafted bone when using a two-stage technique achieve a stability similar to that of implants placed in normal non-grafted bone.     

Immediate loading of dental implants placed in revascularized fibula free flaps: a clinical report on 2 consecutive patients

PURPOSE: The objective of this study was to report the clinical outcome of dental implants placed in revascularized fibula flaps for the reconstruction of severely atrophied edentulous maxillae and immediately loaded with full-arch implant-supported prostheses. MATERIALS AND METHODS: Two patients, a 55-year-old woman and a 59-year-old woman, who presented with severely atrophied edentulous maxillae and local anatomy incompatible with rehabilitation with conventional complete removable dentures and insufficient bone volume for placement of implants of adequate dimensions were selected for reconstruction with revascularized fibula free flaps. Three months after the reconstructive procedure, Br?nemark System dental implants (8 in the 55-year-old patient, 7 in the 59-year-old patient) were placed in the reconstructed areas and immediately loaded with implant-supported full-arch prostheses. The mean follow-up period of implants after the start of prosthetic loading was 24 months. Radiographic peri-implant bone level changes and peri-implant clinical parameters (Plaque Index, Bleeding Index, and probing depth) were evaluated. RESULTS: No implants were lost during the follow-up period. Implant survival and success rates were 100% and 93.3%, respectively. Peri-implant clinical parameters presented values consistent with those obtained for implants placed in native nonreconstructed bone and allowed to heal before loading. DISCUSSION: To the authors' knowledge, this is the first time that the successful immediate loading of implants placed in fibula free flaps for the rehabilitation of totally edentulous patients with severely resorbed maxillae or mandibles has been described. CONCLUSION: Despite the limited number of patients and the short follow-up period, immediate loading of implants placed in revascularized fibula free flaps appears to be a reliable method for the dental rehabilitation of these patients.     

Reconstruction of an atrophic maxilla: comparison of two methods

We have evaluated the survival of dental implants in extremely atrophic edentulous maxillas after autogenous bone grafting. We compared two techniques: the Le Fort I down-grafting procedure and conventional raising of the sinus floor with onlay bone grafting.Twenty-seven consecutive patients had their atrophic maxillas reconstructed, 10 of whom were treated with a Le Fort I osteotomy with down-grafting and interpositioning of bone, and 17 by raising the sinus floor and onlay grafts. All implants were placed 5–6 months after grafting. There was no difference in the survival of implants between the two groups. The choice of grafting technique will therefore be based primarily on the interarch relations and the need for soft tissue support.     

A histomorphometric comparison of the bone graft-titanium interface between interpositional and onlay/inlay bone grafting techniques

PURPOSE: To analyze the bone graft-implant interface of titanium microimplants (MIs) placed at the time of bone grafting or after a healing period of 6 months and retrieved after another 6 to 14 months of healing. Integration of MIs placed in interpositional bone grafts (IBGs) in conjunction with a Le Fort I osteotomy was compared with the integration of those placed in onlay/inlay bone grafts (OBGs). MATERIALS AND METHODS: The severely atrophied edentulous maxillae of 23 patients (14 women, 9 men) were restored with autogenous bone grafts (either IBG [n=8] or OBG [n=15]) and titanium implants. Six-month periods were allowed between grafting, implant placement, and abutment connection. The bone-implant interface was studied histologically with the use of unloaded titanium MIs. RESULTS: Sixty-eight MIs were either (1) placed simultaneously with grafting and retrieved after 6, 12, or 14 months or (2) placed after 6 months of healing and retrieved after another 6 to 8 months. Histomorphometry indicated equal degrees of osseointegration for the 2 intraoral reconstruction techniques when looking at bone-implant contact, bone area in threads, and newly formed bone (NFB) (Student t test for unpaired observations). There was a significant difference between simultaneous and delayed implant placement with respect to BIC and NFB (Student t test for paired observations). Three additional MIs placed in the nongrafted residual alveolar ridge and retrieved after 6 months showed significantly more bone in threads and NFB (Student t test for paired observations; P = .003 and P = .009, respectively) compared to MIs placed at graft placement (6 months' healing). DISCUSSION: Timing of implant placement appeared more important than healing time or surgical technique. The delayed approach resulted in better implant integration, probably because of the initial revascularization of the graft. CONCLUSIONS: Implant integration was similar in the IBG and OBG groups. Placement of MIs after an initial healing period of 6 months resulted in better integration than placement simultaneously with grafting.     

Interpositional bone grafting and Le Fort I osteotomy for reconstruction of the atrophic edentulous maxilla: A two-stage technique

This study presents the results from ten consecutive patients who, because of insufficient bone volume for conventional implant placement in the maxilla, were treated with an interpositional bone graft and Le Fort I osteotomy. The endosteal implants were placed six months after the osteotomy. A total of 60 screw-shaped titanium implants (Brånemark^®) were placed, of which three failed to integrate during the six-month healing period. No further implants were lost during the follow-up period, ranging from 15 to 39 months after placement of the implants. All patients received fixed bridges and all have continued to function efficiently.     

Implant stability measurements using resonance frequency analysis in the grafted maxilla: a cross-sectional pilot study

Background: High failure rates have been presented for implants placed in grafted bone. The bone graft-implant interface constitutes a most complex healing situation, where the time scale for osseointegration and development of implant stability currently is not known. Purpose: The aim of the study was to measure the stability of implants placed in grafted bone after various follow-up periods. Methods: Implant stability measurements by means of resonance frequency analysis were performed in 10 patients previously treated with a Le Fort I osteotomy and interpositional bone grafts. The implants were placed 3 to 4 months after the grafting procedure. Sixty-seven Brånemark implants were subjected to resonance frequency analysis measurements at fixture placement and up to 5.5 years after implant surgery. Periapical radiographs were used for assessment of marginal bone levels. Results: The radiographic examinations showed marginal bone loss with time during the 5.5-year follow-up. The resonance frequencies varied from 5860 to 8440 Hz. When accounting for abutment length and marginal bone level, there was a tendency of increasing resonance frequency with time. Two implants with low resonance frequencies failed during the prosthetic phase. Conclusion: The results indicate an increased implant stability with time, which may reflect bone formation, remodeling, and maturation at the implant interface.     

Interpositional bone grafts in the posterior mandibular region: a report on six patients

The purpose of this study was to evaluate treatment of resorbed posterior mandibles with interpositional bone grafts (the "sandwich" technique) and implant-supported prostheses. Six consecutive patients with resorbed posterior mandibles (seven sites) were 4reated by the sandwich osteotomy technique with an interpositional bone graft harvested from the iliac crest. Vertical bone height was measured before surgery and 3 to 4 months later, prior to implant placement, on computed tomography scans to evaluate the augmentation obtained. In all the treated sites it was possible to place implants. None of the 21 implants placed failed, and minimal bone resorption was present 14 to 16 months after the prosthetic loading. If confirmed by long-term follow-up studies and more cases, these findings suggest that interpositional bone grafting in the posterior mandible could be a viable alternative to other surgical techniques.     

Implant reconstruction of the bone-grafted maxilla: review of the literature and presentation of 8 cases.

PURPOSE: This study prospectively investigates the long-term success of iliac crest bone grafting and the secondary placement of osseointegrated implants in reconstructing maxillae with severely reduced bone mass. MATERIALS AND METHODS: Eight consecutive patients (7 women, 1 man), aged 18 to 69 (mean, 49.6), were treated by augmentation of their maxillae with corticocancellous autogenous iliac bone blocks. Forty-one Branemark implants of 7 to 15 mm in length and 3.75 mm in diameter were placed after a minimum delay of 6 months. Bone healing, maintenance of bone height, and implant stability were measured by clinical examination and radiographic control. RESULTS: One patient was lost to follow-up at 24 months after delivery of the prosthesis and one was lost at 75 months. The average duration of follow-up after loading of the implants was 90.5 months, and the longest was 154 months. Thirty-four of 41 (83%) of the implants survived to the end of the observation period. Four of 6 implants that failed were 7 mm in length and the other 2 were 10 mm in length. One 10-mm implant was "slept" because of poor positioning. All prostheses survived. There was one significant gingival infection that resulted in loss of 1.5 mm of bone after which the implant remained stable. None of the other implants were associated with crestal bone loss of more than 0.5 mm for the duration of this study. CONCLUSIONS: Delayed placement of osseointegrated implants in maxillae augmented by iliac bone grafts is predictable and successful in the long term.     

Immediate loading of dental implants placed in severely resorbed edentulous mandibles reconstructed with autogenous calvarial grafts

OBJECTIVE: The aim of this prospective study was to present the clinical outcome of immediately loaded dental implants placed in edentulous, severely atrophied mandibles, after reconstruction with autogenous multilayered calvarial grafts. MATERIALS AND METHODS: Six patients, two males and four females, aged 40-67 years (mean: 56 years) presenting with severely atrophied edentulous mandibles (Cawood and Howell class VI), were reconstructed with multilayered calvarial bone grafts placed in the intraforaminal area of the mandible. Five to 8 months afterwards, 23 dental implants were placed in the reconstructed areas (three to four implants per patient) and immediately loaded with implant-supported overdentures. Patients were followed with clinical and radiographic controls annually. RESULTS: Recovery after the reconstruction was uneventful in all patients. All 23 implants were osseointegrated 1-3 years after the start of immediate loading. The survival and success rates of implants were 100% and 95.7%, respectively. CONCLUSION: Results from this study showed that immediate loading of dental implants placed in severely atrophied edentulous mandibles reconstructed with calvarial bone grafts is a predictable procedure, which permits a successful dental rehabilitation with a shortening of treatment times.     

A new method of inserting endosseous implants in totally atrophic maxillae

A new method is described (Sailer, 1988) whereby endosseous implants are inserted in the totally atrophic maxilla, the intermaxillary relationship and vertical dimension corrected and a vestibuloplasty performed during one surgical procedure. The method can also be used to treat minor degrees of maxillary alveolar atrophy. The procedure enables 20 mm-long Titanium screws to be used in totally atrophic maxillae. The following surgical procedures are carried out during one operation: A Le Fort I osteotomy, removal of the mucous membrane of the sinus floor, obturation of the denuded maxillary sinus floor by autologous bone grafts from the iliac crest, simultaneous insertion of Titanium screws, fixation of the down-fractured maxilla by miniplates, and a modified submucous vestibuloplasty. Intermaxillary relationship and vertical dimension can be normalized, and the aesthetic results are excellent. To date 35 implants of which none has been lost, have been placed in 5 patients.     

Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study

OBJECTIVE: The aim of this study was to determine the long-term outcome of implant insertion in the augmented severely atrophied maxilla. STUDY DESIGN: Three hundred and twenty-four implants were inserted in 35 patients (eight males, 27 females, average age 57.6 years) in extremely atrophied maxillae after osteotomy and interposition of iliac crest bone. One hundred implants were installed in 12 patients simultaneously with the osteotomy and grafting; 224 implants were placed in 23 patients in a second procedure 6-12 months later. Implant parameters like osseointegration and peri-implant bone loss; peri-implant tissue parameters like bleeding, gingival and plaque index; and patients' satisfaction were evaluated. RESULTS: Of 324 implants, 29 (8.9%) were lost during the entire follow-up: 14 in six patients of the one-step and 15 in 11 patients of the two-step group. The overall input-output survival in 141.1 months was 91.1%. The overall 2-year failure-free fraction of implants was 95.5%; the 5-year failure-free fraction was 89.3%. In the one-step group, the 2 (5)-year failure-free fraction was 95.9% (86.9%), and in the two-step group 95% (91.3%) (log-rank test P=0.57). Marginal peri-implant bone loss was 1.7+/-1.3 mm mesial and 1.8+/-1.3 mm distal. CONCLUSION: Implant insertion after osteotomy and iliac bone grafting is a reliable operation method for the dental rehabilitation of the severely atrophied maxilla showing good long-term results.     

Fractures of the atrophic, edentulous maxilla during Le Fort I osteotomy

The incidence of unfavorable fractures of the maxilla during Le Fort I osteotomy was compared between patients with atrophic, edentulous maxillae and patients with normal dentate maxillae. Unfavorable fractures frequently occurred in atrophic, edentulous maxillae. The most common maxillary fracture involved the junction of the horizontal plate of the palatine bone and posterior part of the maxilla. Prevention strategies and treatment options are discussed.     

Dental implants placed in expanded narrow edentulous ridges with the Extension Crest device. A 1-3-year multicenter follow-up study

OBJECTIVE: This study has been designed to evaluate the capability of a new surgical device (Extension Crest) to widen narrow edentulous alveolar ridges and to allow a correct placement of endosseous implants in horizontally atrophied sites. MATERIAL AND METHODS: Forty-five patients, 20 males and 25 females, aged 20-66 years, affected by edentulism associated to horizontal resorption of the ridges, were treated by means of a sagittal osteotomy and expansion of the ridge with a new surgical device (Extension Crest) to obtain a wider bony base for ideal implant placement. In the same procedure in 33 patients, and 1 week afterwards in 12 patients, 110 endosseous titanium implants (ITI TE) were placed. Three to four months later, the patients were rehabilitated with implant-supported prostheses. RESULTS: The success rate of the expansion technique was 97.8%. A total of 110 implants were inserted in the expanded ridges. The mean follow-up after the start of prosthetic loading was 20.4 months. Three implants were removed before the start of prosthetic loading, because of non-integration, while no other implants failed after the completion of the prosthetic rehabilitation. Three implants, although integrated and in function, did not fulfill success criteria: cumulative success and survival rates at the end of the observation period were 95.4% and 97.3%, respectively. CONCLUSION: Within the limits of this study, this technique appeared to be reliable and simple, with reduction of morbidity and times of dental rehabilitation as compared with other techniques such as autogenous bone grafts and guided bone regeneration. Survival and success rates of implants placed in the treated areas are consistent with those placed in native bone.     

中国无牙颌患者种植修复的特殊性：回顾性研究

背景与目的：中国老年人群中无牙颌患者比较常见。在中国,有越来越多的有一定经济承受能力的无牙颌患者选择种植修复。本研究通过对大量北京大学口腔医院无牙颌种植修复患者的回顾性研究,探讨中国无牙颌患者种植修复的特殊性及存在的问题。材料、方法：从1997年5月-2009年10月,共192位无牙颌或余留牙无保留价值的患者（平均年龄66岁）,接受了种植修复,其中上颌87例、下颌135例。所有患者修复完成后3个月、6个月、1年以及每年进行常规复查,拍曲面断层片。结果：所有患者在种植体植入前或同时进行了不同的颌面外科手术,包括117个上颌窦提升植骨手术（67例）,髂骨植骨重建重度萎缩的牙槽嵴（21例）,血管化腓骨瓣颌骨功能性重建后行髂骨移植onlay植骨手术（5例）,牵引成骨术重建牙槽骨垂直骨缺损（6例）,Le-Fort1型截骨和双侧升支矢状劈开手术（11例）,下颌前部根尖下截骨手术（13例）;另外有79位无牙颌患者（其中下颌61例）直接种植、未行任何植骨手术。总计192例无牙颌患者,共植入899颗种植体。平均随访时间为62个月（4月-144月）。种植体存留率为96.99%,共有27颗种植体失败,2颗种植体在修复前失败,3颗种植体修复后1年失败,14颗种植体修复后2-10年时失败;采用All-on-four即刻负重修复方式的患者,8颗种植体在负重2个月内失败,其余164颗种植体在即刻负重并完成永久修复后6-8个月时仍骨结合良好。结论：对于解剖条件不良的中国无牙颌患者,应该采取更为简单、性价比更高的种植修复方式。目前需要大量的有经验的外科医师来满足这类患者的治疗需求。     

A Retrospective Study on 287 Implants Installed in Resorbed Maxillae Grafted with Fresh Frozen Allogenous Bone

Background: Several studies have been performed to evaluate the clinical outcome of implants inserted into maxillae grafted with autogenous bone but few reports have focused on maxillae grafted with fresh‐frozen allogenous bone (FFAB). Purpose: The purpose of this study is to retrospectively evaluate the clinical outcome of implants installed in resorbed maxillae augmented with FFAB. Materials and Methods: A total of 69 patients whom had been treated with FFAB grafts to their maxillae and implant placement 4 to 6 months later were retrospectively evaluated. Edentulism was total and partial in 22 and 47 cases, respectively. A total of 287 implants of various systems had been used. A life table analysis was performed. Marginal bone loss was calculated in radiographs. Results: Five of the 287 implants were lost, giving a survival rate (SVR) of 98.3% over a mean follow‐up time of 26 months. The marginal bone resorption at the implants was 1.68 mm (SD = 0.44) after 1 year and 1.85 mm (SD = 0.98) after 4 years. The cumulative success rate based on defined criteria was 96% in the first year but decreased to 40% at 4 years because of marginal bone loss. The Kaplan–Meier algorithm demonstrated a better outcome for female patients, removable dentures, and total edentulism. No differences were detected among diameters, lengths, and implant site. Conclusion: Implants placed in FFAB showed a high SVR similar to that reported in previous studies on maxillae grafted with autogenous iliac crest bone. Although our data point to more marginal bone loss in partially edentulous patients and for fixed prosthetic restorations, the use of FFAB for reconstruction of the atrophic jaw prior to implant placement can be considered as a reliable alternative to autogenous bone.     

Autogenous onlay bone grafts vs. alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: a 2-4-year prospective study on humans

OBJECTIVES: The purposes of this study were to compare: (a) autogenous bone grafts (ABG) and distraction osteogenesis (DO) for their ability in correcting vertically deficient mandibular ridges and their capability in maintaining over time the vertical bone gain obtained before and after implant placement; and (b) the survival and success rates of implants placed in the reconstructed or distracted areas. MATERIAL AND METHODS: In a 2-year period (2001-2002), 17 patients presenting with vertically atrophied partially edentulous mandibles requiring implant-supported prosthetic rehabilitation, were included in this study. Patients were randomly assigned to two groups. Eight patients (group 1) were treated with ABG harvested from the mandibular ramus, while nine patients (group 2) were treated by means of DO. In group 1, patients received implants 4-5 months after the reconstructive procedure, while in group 2 implants were placed at the time of distraction device removal (approximately 3 months after the completion of distraction). A total of 19 endosseous implants were placed in group 1, and 21 implants were placed in group 2 patients. For both groups, after an additional 3-5-month period, prosthetic rehabilitation was started. RESULTS: Bone resorption before implant placement was significantly higher in group 1 (P=0.01), while no statistically significant differences were found between the two groups as far as survival and success rates of implants and peri-implant bone resorption after the start of prosthetic loading were concerned. CONCLUSION: The results suggested that: (a) both techniques may effectively improve the deficit of vertically resorbed edentulous ridges; (b) survival and success rates of implants placed in the reconstructed/distracted areas are consistent with those of implants placed in native bone.