A clinical study of the outcomes and complications associated with zygomatic buttress block bone graft for limited preimplant augmentation procedures

Purpose: The aim of this study was to evaluate the possibility of using the zygomatic buttress as an intraoral bone harvesting donor site and determine the safety of this harvesting procedure for later optimal positioning of dental implants in accordance with prosthodontic and functional principles. Material and methods: A consecutive retrospective study was conducted on patients who had been treated at the Department of Oral and Maxillofacial Surgery of Ulm military and academic hospital, over a 3-year period (January 2008 to December 2010). Medical history, smoking status, area of surgery, and complications were recorded. The need for bone grafting was defined by the impossibility of installing implants of adequate length or diameter to fulfill prosthdtic requirements, or for esthetic reasons. The patients were treated using a 2-stage technique. During the first operation, bone blocks harvested from the zygomatic buttress region were placed as lateral onlay grafts and fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After 3-6 months of healing, the flap was reopened, the screws removed and the implants placed. Results: A total of 113 zygomatic buttress bone block grafts in 112 patients were performed. Graft loss and graft removal were defined as failure; swelling, wound dehiscence, infection with pus, temporary paresthesia, and perforations of the maxillary sinus membrane were defined as complications. According to our criteria, 4 (3.5%) of the patients presented postoperative complications of the donor site and 20 (17.8%) of the recipient site. Throughout, 93 (82.3%) of the bone grafts were successful and 20 (17.6%) had complications, regardless of the final success of the implant procedure. Smoking was associated with a high rate of complications and graft failure. Early graft exposure appeared to compromise the results, whereas pain and swelling were comparable to usual dentoalveolar procedures. However, in 1.7% of all cases, concerning 2 patients, the final rehabilitation with dental implants was not possible. Conclusions: The zygomatic buttress block bone graft is a safe intraoral donor site for the reconstruction of small- to medium-sized alveolar defects, providing the greatest surgical access with minimal postoperative complications. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.