Académique Documents
Professionnel Documents
Culture Documents
HARVEST SITES
Many sites are available for graft harvest, including
local and distant sites (Table 1). Consideration as
Department of Oral and Maxillofacial Surgery, Loma Linda University, 11092 Anderson Street, Loma Linda,
CA 92350, USA
* Corresponding author. Department of Oral and Maxillofacial Surgery, Loma Linda University School
of Dentistry, Room 3306, 11092 Anderson Street, Loma Linda CA 92350.
E-mail address: aherford@llu.edu
Oral Maxillofacial Surg Clin N Am 23 (2011) 433442
doi:10.1016/j.coms.2011.04.004
1042-3699/11/$ see front matter 2011 Elsevier Inc. All rights reserved.
oralmaxsurgery.theclinics.com
434
Table 1
Harvest sites
Donor Site
Type of Graft
Volume Available
Possible Complications
Ascending Ramus
Cortical
510 cc
Symphysis
Corticocancellous
510 cc
Tuberosity
Tibia
Cancellous
Cancellous
2 cc
2040 cc
Cranium
Anterior Iliac Crest
Cortical
Corticocancellous
2040 cc
5070 cc
Corticocancellous
80140 cc
eliminates the possible complications from an extraoral site, such as scarring, gait disturbance, or
need for hospitalization. The grafts also provide
bone with similar architecture as the bone at the
recipient site. A disadvantage is the limited amount
of bone available compared with other extraoral
sites.
Maxillary tuberosity
Bone harvested from the maxillary tuberosity has
limited use as a donor graft because of the small
volume available. The graft material is cancellous
and can be harvested with simultaneous third
molar removal. Complications associated with
this site include oral/antral communication and
hematoma formation from disruption pterygoid
venous plexus.
Ascending ramus
The anterior portion of the ascending ramus has
been used for grafting in a variety of clinical applications (Fig. 2). Bone harvested from the ascending
ramus provides mainly a cortical graft with a volume
of approximately 5 to 10 cc. The bone obtained
from the ramus is a good option for horizontal
defects requiring onlay grafting. These grafts heal
quickly, exhibit minimal resorption, and maintain
their dense quality. Possible complications of
mandibular ramus graft site include damage to
Fig. 2. (A) Outline of graft to be harvested. (B) Use of a chisel to harvest ramus bone. The chisel should not be
directed toward the neurovascular bundle. (C) The uninjured neurovascular bundle is visualized after harvest
of the graft. (D) Thickness of the graft. (E) Bone graft secured into place with screws. (F) Bone graft is well
integrated with surrounding bone.
damage during suturing. Misch8 compared intraoral donor sites for onlay grafting before implant
placement and found that the ramus was associated with fewer complications than the symphysis
graft as a donor site (Fig. 3). Silva and colleagues9
found that 8.3% of patients who had had bone
435
436
437
438
Fig. 10. (A) Radiograph showing failed implants and inadequate bone. (B) Harvest of an iliac crest bone graft from
and anterior approach. (C) The grafts are secured with screws to prevent mobility of the graft. (D) Radiograph
showing the grafted bone in place.
439
440
Fig. 11. (A) Placement of graft harvested from the ascending ramus. (B) Exposure of the graft postoperatively. (C)
Complete loss of the graft.
14.
15.
16.
17.
REFERENCES
1. Herford AS, Brown BR. Outpatient harvest of bone
grafts. Selected Readings in Oral and Maxillofacial
Surgery 2007;15:114.
2. Zouhary KJ. Bone graft harvesting from distant sites:
concepts and techniques. Oral Maxillofac Surg Clin
North Am 2010;22:30116.
3. Raghoebar GM, Louwerse C, Kalk WW, et al.
Morbidity of chin bone harvesting. Clin Oral Implants
Res 2001;12:5037.
4. Beirne JC, Barry HJ, Brady FA, et al. Donor site
morbidity of the anterior iliac crest following cancellous bone harvest. Int J Oral Maxillofac Surg 1996;
25:26871.
5. Sittitavornwong S, Rajesh G. Bone graft harvesting
from regional sites. Oral Maxillofac Surg Clin North
Am 2010;22:31730.
6. Larson PE. Morbidity associated with calvarial bone
graft harvest. J Oral Maxillofac Surg 1989;47(8):
1101.
7. Marx R. Bone and bone graft healing. Oral Maxillofac Surg Clin North Am 2007;19:45566.
8. Misch CM. Comparison of intraoral donor site for onlay grafting prior to implant placement. Int J Oral
Maxillofac Implants 1997;12:76776.
9. Silva FM, Cortez AL, Morekira RW, et al. Complications of intraoral donor site for bone grafting prior
to implant placement. Implant Dent 2006;15:4206.
10. Gapski R, Wang HL, Misch CE. Management of
incision design in symphysis graft procedures:
a review of the literature. J Oral Implantol 2001;27:
13442.
11. Weibull L, Widmark G, Ivanoff CJ, et al. Morbidity
after chin bone harvestinga retrospective longterm follow-up study. Clin Implant Dent Relat Res
2009;11:14957.
12. Chaushu G, Blinder D, Taicher S, et al. The effect of
precise reattachment of the mentalis muscle on the
soft tissue response to genioplasty. J Oral Maxillofac
Surg 2001;59:5106.
13. Calvero J, Lundgren S. Ramus or chin grafts for
maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
441
442