Autogenous bone harvesting and grafting in advanced jaw resorption: morbidity, resorption and implant survival.

AIM To analyse the morbidity arising from autogenous bone graft harvesting, graft resorption and implant survival in grafted sites. MATERIALS AND METHODS Only comparative clinical trials on the harvest of autogenous bone grafts were selected. Studies were excluded if they compared autogenous bone grafts to bone substitutes or vascularised free bone grafts. RESULTS A total of 24 studies were included in the review. Six intraoral or distant donor sites were identified. The highest level of evidence was reached by a randomised controlled trial. The mandibular ramus was the source of bone that was preferred by the patients. From this intraoral donor site bone was harvested under local anaesthesia on an outpatient basis. Patients' acceptance of chin bone harvesting was low. It led to a considerable morbidity that included pain, superficial skin sensitivity disorders and wound healing problems at the donor site. Patients even preferred iliac crest bone harvesting over bone harvesting from the chin, although this distant donor site required general anaesthesia and a hospital stay. The harvest of posterior iliac crest block led to less morbidity than the harvest of anterior iliac crest block grafts. When only cancellous bone was needed, percutaneous bone harvesting from the iliac crest led to less morbidity than an open approach to the iliac crest. CONCLUSIONS Dependent on the required graft structure and amount of bone needed, ramus grafts, block bone grafts from the posterior iliac crest and cancellous bone grafts harvested with a trephine from the anterior iliac crest should be chosen.