[Augmentation of the extremely atrophied maxilla and mandible by autologous calvarial bone transplantation].

Rehabilitation in patients with severe alveolar ridge atrophy of the maxilla or mandible is problematic and can often only be achieved by long-term treatment. In most cases, autologous bone grafting with iliac crest bone has been used to augment severely atrophied upper jaws. In our experience, iliac bone grafts are less useful, since iliac bone appears to be of inferior quality; in elderly osteoporotic women, the bone is soft, indentable, and of poor osteogenic potency. In our department, we have been using only autologous calvarial bone grafts for augmentation of alveolar ridge atrophy since 1993. The bone is removed from the outer table of the skull only, trimmed to the alveolar ridge, und fixed with titanium lag scews. The skull defect created is covered with crushed bone or a titanium mesh to avoid aesthetic problems. Insertion of dental implants follows after a healing period of the bone grafts of 5-6 months. A total of 63 patients underwent calvarial split-graft augmentation; augmentation of the maxilla and mandible was carried out in 15 of these patients, of the maxilla only in eight, and of the mandible only in 40. The investigations 1 year later showed a resorption rate of approximately 10%. This is lower than when using iliac bone grafting. The resorption results were stable between 6 and 12 months after augmentation. Using dental implants (12 patients with 32 implants), the resorption rate was low and constant. We have never seen total loss of bone grafts or intracranial complications. All patients were pleased with the treatment. In our opinion, severe alveolar atrophy of the maxilla or mandible should be compensated for by augmentation with autologous calvarial bone grafts to obtain good long-term results.