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Surgical-prosthodontic reconstruction of advanced maxillary bone compromise with autogenous onlay block bone grafts and osseointegrated endosseous implants: a 12-year study of 32 consecutive patients.

During a 12-year period (1984 to 1997), 32 consecutive patients with advanced maxillary bone compromise received surgical-prosthodontic rehabilitation. The most frequent procedure used was maxillary augmentation with a free nonvascularized autogenous onlay block bone graft, and the average time of prosthesis function was 67 months. Twenty-eight patients underwent a 1-stage procedure, in which endosseous implants were placed simultaneously for internal rigid skeletal fixation of the onlay bone graft, and 4 patients underwent a 2-stage procedure, in which endosseous implants were placed secondarily 6 months after complete healing of the previously placed onlay bone graft, which initially was stabilized by titanium miniplates and lag screws. Treatment success was evaluated separately for the first 7 consecutively treated patients (developmental group) and for the next 25 consecutive patients (routine group). Assessment was made of implant survival relative to etiology of bone loss, implant type and length, type of prosthesis, type of opposing occlusion, type of surgical procedure, and presence of discontinuity. The implant survival rate was 91% in the 25 routine patients and 65% in the 7 developmental patients. Implant type and length, prosthesis type, opposing occlusion, and the presence or absence of discontinuity significantly impacted treatment outcome. Onlay block bone graft success (96%) in all 32 treated patients and prosthetic success (96%) in the last 25 patients was recorded.