The minimal-invasive aproach in iliac crest harvesting for alveolar bone reconstruction in the context of implantprosthetic rehabilitation. Case report

Abstract

Background. The implant-prosthetic rehabilitation in conditions of bone atrophy supposes a bone augmentation surgery with biomaterials of various origins. The optimal mixture of grafting material is considered to be a mixture of 50/50% of autogenous and xenogenic bone. Often the necessary quantity of autogenous graft is difficult or impossible to harvest from intraoral sites. The iliac crest represents a very important bank of bone tissue for reconstructions, from quantitative and qualitative points of view. The classic method of iliac crest bone harvesting consists in making of an extended incision, of 5-7 cm, with its dissection and exposure, in order to harvest the cortico-cancelous blocks, used in the reconstruction itself or milled. This invasive method has an increased risk of complications such as pain, gait disturbance, sensitivity disorders, hernia of abdominal organs, hematoma, iliac crest fracture etc. Aim of the study. Evaluation of minimally- invasive method of harvesting the cortico-cancelous graft from iliac crest with using cylindrical device. Case report. The study was axed on a patient of 34 years old, who suffered an accidental fall trauma at the age of 22, resulted in avulsion of superior incisors with horizontal and vertical defect of alveolar bone. To restore the defect, a bone augmentation using GBR technique with particulated autogenic and xenogenic grafting material has been performed, in relation of 50/50%, 7 cm3 in volume. The autograft, harvested from iliac crest with minimally- invasive approach, was particulated in bone-mill. For the graft stabilization, a resorbable membrane fixed with screws was used. Results. The wound healing in receptor site took place in conventional terms, without peculiarities, but on the donor site a faster healing and an insignificant scar formation has been noticed. The clinical and radiological examination (panoramic X-ray, CBCT) at 3 month postoperative period showed a good bone volume formation, absence of complications both on the donor and receptor sites. The advantage of the used method comparatively to the classical one consists in following: the incision line reduction, limited decolation with minimal trauma of soft tissues; directed bone graft harvesting in the inter-cortical space, that has reduced the traumatic impact on iliac crest, avoided fracture, hematoma, peritoneum perforation or abdominal organs hernia. By this way, the morbidity of donor site has been significantly reduced and allowed early rehabilitation of the patient. Conclusions. The minimally- invasive method of iliac crest bone harvesting is easy and rapid, well-accepted by the patient and with good results and reduced morbidity