Reconstruction of the extremely atrophied mandible with iliac crest onlay grafts followed by two endosteal implants: a retrospective study with long-term follow-up.

Treatment outcomes of implant-retained lower dentures on two endosseous implants placed in severely atrophied mandibles after reconstruction with iliac crest onlay grafts were assessed in a retrospective observational study. All consecutive patients treated between 2000 and 2007 were recalled in 2012 (n=40). Survival of the implants, the condition of hard and soft peri-implant tissues, and patient satisfaction were scored. One implant was lost after 5.5 years. The mean mandibular symphysis height was 8.9+/-2.2, 16.4+/-2.7, 15.7+/-2.7, and 15.4+/-2.5mm at intake, after augmentation, after implantation, and at the last recall visit, respectively. Mean radiographic peri-implant bone loss was 0.6+/-0.7mm. Mean clinical index scores were very low. Patient satisfaction was high. Surgical complications related to the donor site were seroma (n=1), haematoma (n=2), and sensory disturbance of the lateral femoral cutaneous nerve (n=1); all had resolved before placement of the implants. Eleven patients reported postsurgical sensory disturbances of the mental nerve, of whom five still experienced some sensory disturbance at the last recall visit. Augmentation of the extremely resorbed mandible with an iliac crest onlay graft followed by placement of two implants 4 months later provides a solid basis for a bar-retained overdenture with favourable clinical and radiographic results.