Le Fort I osteotomy with interpositional bone grafts and delayed oral implants for the rehabilitation of extremely atrophied maxillae: a 1-9-year clinical follow-up study on humans

AIM: The purpose of this clinical follow-up study was to report the clinical outcome of osseointegrated implants placed in extremely atrophied edentulous maxillae after Le Fort I osteotomy and interpositional autogenous iliac bone grafts. PATIENTS AND METHODS: In a 10-year period (1995-2004), 39 patients, 18 males and 21 females, aged from 32 to 76 years, presenting with severely atrophied edentulous maxillae were treated with Le Fort I osteotomy and interpositional iliac bone grafts. Four to 8 months after the reconstructive procedure, 281 osseointegrated implants were placed in the reconstructed maxillae. Four to 8 months afterwards, abutments were connected and the prosthetic rehabilitation started. The mean follow-up period of implants after the start of prosthetic loading was 45.9 months (range: 12-108 months). RESULTS: The reconstructive procedure was successful in 38 of 39 patients. In one patient, partial loss of the inlay graft occurred before implant placement. Six patients (42 implants) dropped out of the study. Fifteen implants were removed during the follow-up period, due to loss of integration. Thirty-two implants, although integrated, presented with peri-implant bone-level changes higher than those proposed for successful implants. Cumulative survival and success rates of implants were 94.5% and 82.9%, respectively. CONCLUSION: Results from this study showed that Le Fort I osteotomy with interpositional bone grafts followed by delayed implant placement is an acceptable means to rehabilitate edentulous patients affected by extremely atrophied edentulous maxillae. Survival rates of implants are consistent with those related to implants placed in native, non-reconstructed bone. Conversely, the success rate of implants resulted to be lower as compared with those obtained for implants placed in native bone.