Riabilitazione implanto-protesica in pazienti con esiti di labiopalatoschisi

Objectives. This study evaluated long-term survival and success rates of implants inserted in cleft lip and palate patients previously treated with autogenous bone grafts for the correction of residual alveolar cleft. Materials and methods. Between 1993 and 2004 115 patients affected by sequelae of cleft lip and palate (previously treated with labioplasty and palatoplasty) and a residual alveolar cleft in association with a partially edentulous anterior maxilla were treated by autogenous bone grafts harvested from intraoral or extraoral sites. Among these, 30 patients (15 females and 15 males) were selected for rehabilitation with implant-supported prostheses and received a total of 51 endosseous implants in the grafted areas. Four to six months after implant placement, the prosthetic rehabilitation was started. Patients were followed from 24 to 156 months (mean: 70.4 months). The following parameters were evaluated: 1) survival and success rates according to the criteria of Albrektsson et al.; 2) clinical peri-implant parameters (plaque index, bleeding index, probing depth). Results. Two out of 51 implants were removed (survival rate 94.7%), due to loss of osseointegration. Six implants did not satisfy success criteria because of excessive peri-implant bone resorption: implant success rate was therefore 84.2%. Clinical parameters demonstrated healthy peri-implant soft tissues in all survived implants. Conclusions. Dental rehabilitation of patients affected by sequelae of cleft lip and palate treated by grafting autogenous bone in the residual cleft and inserting implants in the grafted clefts demonstrated to be a reliable procedure with implant survival rates which are consistent with those observed for implants placed in native bone. On the contrary, the success rate of implants reported in this study was lower than that reported for implants placed in native bone, because of higher peri-implant resorption, in particular within two years after the start of prosthetic loading.