Bone grafts for jaw augmentation procedures: anterior versus posterior iliac crest.
Cortico-cancellous bone graft is considered the material of choice for jaw augmentation because of its rich cellularity, its rapid revascularization, and its potential to induce new bone formation. Several donor sites have been advocated, but the iliac crest is still considered the golden standard for the procedure. However, the choice between the anterior and posterior iliac crest as the preferred site for harvesting has been a subject of debate. NKENKE et al. in a recent issue of the journal compared the morbidity of harvesting of bone grafts from anterior iliac crest with that of posterior iliac crest for preprosthetic augmentation procedures. The authors and others have reported that the posterior approach yields a larger graft volume and has a lower post operative morbidity rate. In addition, the authors reported that by post-operative day thirty, there was no statistically significant difference in pain and thermal sensitivity test (PATH test), and visual analogue scale (VAS) between the anterior or posterior approaches; and also no gait disturbance could be observed in both groups of patients. Based on these findings, they concluded that the posterior iliac crest should be taken into account even for less extensive augmentation procedures. I feel that these findings, however, do not justify their conclusion.