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Maxillary sinus augmentation with iliac autograft: a health-economic analysis
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
2012 (English)In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 24, no 10, p. 1088-1093Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To estimate and compare the costs of maxillary sinus augmentation performed with autologous bone graft either from the iliac crest or from local bone harvested from the mandibula. To evaluate post-operative health-related quality-of-life parameters for patients subjected to sinus augmentation and iliac bone surgery. MATERIAL AND METHODS: The hospital records of 14 patients subjected to sinus augmentation with iliac autograft, and 14 patients treated with local autograft, were analysed with regard to costs related to surgery, hospitalization and sick leave. Post-operative health parameters were assessed with a questionnaire. RESULTS: Mean hospital costs, administration excluded, for sinus augmentation with iliac autograft was €3447. Policlinic treatment alternatives e.g. local bone autograft with or without bone substitutes, rendered costs of approximately 42% thereof. The loss of production for a worker was 41% of the total cost (€9285). With regard to health-related quality-of-life and post-operative morbidity, most of the patients had recovered 14 days after the iliac graft surgery. CONCLUSION: The cost for a sinus augmentation with iliac surgery exceeds that of a policlinic procedure manifold. Provided that a policlinic operation with local bone, with or without bone substitute, renders an adequate end result, the economic gain would be substantial and post-operative morbidity would be greatly reduced.

Place, publisher, year, edition, pages
John Wiley & Sons, 2012. Vol. 24, no 10, p. 1088-1093
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-5868DOI: 10.1111/j.1600-0501.2012.02515.xISI: 000323838400004PubMedID: 22697486Scopus ID: 2-s2.0-84883554088Local ID: 16824OAI: oai:DiVA.org:mau-5868DiVA, id: diva2:1402737
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
In thesis
1. An injectable biphasic bone substitute in sinus augmentation
Open this publication in new window or tab >>An injectable biphasic bone substitute in sinus augmentation
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis concerns a new synthetic, injectable bone substitute, Cerament™, primarily developed for treatment of vertebral fractures. The purpose of the thesis was to investigate the properties of the newbone substitute, that is, whether it can contribute to the generation of new bone formation needed for placement of future dental implants. When the amount of bone in the upper jaw is insufficient, primary stability of dental implants cannot be achieved. Sinus augmentationis a well-established method for increasing the bone volume. This technique can be performed with autologous bone graft and/or bone substitute. Autologous bone graft can be harvested either from a local source in the oral cavity or from an extra oral source. The iliac crest is a common donor site for bone grafts when large quantities are needed, but bone harvesting from the iliac crest require surgery under general anesthesia resulting in an increased morbidity and higher costs.The thesis is based on study I-IV, both animal experimental studies and clinical applications. The question is what gains can be achievedwith the use of a bone substitute. Therefore, to start with, study I analyzed and compared the costs of local bone grafts from the oral cavity and extra-oral bone grafts from the iliac crest. In addition, post-operative health parameters were analyzed for those patients who underwent sinus augmentation, performed under general anesthesia, with bone graft from the iliac crest. Finally, the total cost of sinus augmentation, performed under general anesthesia, with iliac bone graft was calculated and analyzed with respect to the cost of surgery, anesthesia, hospitalization and sick leave. To achieve a broader understanding of the properties of the bone substitute study II and III were performed. Firstly, an animal experimental study in rats, with the intention to investigate if and to what extent Cerament™ onlay is able to stimulate new bone growth on a cortical bone surface. Secondly, an animal experimental rat study that analyzed and estimated to what extent Cerament™, in an onlay application, adds strength to the osseointegration of a titanium screw, measured as removal torque resistance. Further, to investigate the effect of a titanium screw without any bone substitute on a corticalbone surface analyzed with regard to bone remodeling. Finally, as a clinical application (study IV), sinus augmentation with Cerament™ was performed in four patients. The patients received either pure Cerament™ or Cerament™ mixed with autologous bone chips. The studies resulted in the following: Costs for sinus augmentation with iliac graft are several times larger than those for policlinic procedures. Most patients, who received iliac graft surgery, had recovered after 14 days. LoP (loss of production) constituted 41% of the total cost for sinus augmentation with iliac bone graft. Cerament™ guided bone generation from a cortical surface on rats’ tibia. The second animal study displayed no difference in torque resistance between screws embedded in Cerament™ and controls. Sinus augmentation in a mixture of bone chips and 50-75% Cerament™ rendered new bone formation after 6-11 months. Conclusion: There are gains to be made, in both economic and morbidity terms, by using Cerament™. When applied as an onlay, Cerament™ is capable of guiding and generating new bone formationon rats’ tibia. In sinus augmentation, Cerament™ has been proven to generate new bone without any adverse reactions. Future research should clarify how the clinical findings made in this thesis can be applied in the orofacial environment.

Place, publisher, year, edition, pages
Malmö University, Faculty of Odontology, 2014. p. 84
Series
Doctoral Dissertation in Odontology
Keywords
Dentala implantat, Dental Implants, Bone transplantation, Bone substitutes
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7706 (URN)17698 (Local ID)9789171043993 (ISBN)9789171044006 (ISBN)17698 (Archive number)17698 (OAI)
Note

Note: The papers are not included in the fulltext online.

Paper III in dissertation as manuscript.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-14Bibliographically approved

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Truedsson, AnnaWarfvinge, Gunnar

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