Chapter 7. Summary and conclusions

The following main conclusions can be drawn from the results obtained in the present studies:

1. The minimally invasive surgical approach utilizing the motorized trephine used in these studies was found to be safe in harvesting bone from the anterior iliac crest in the cadaver model. Adequate quantities of bone for reconstruction of modest defects of the cranio-maxillofacial skeleton can be safely harvested using this technique. The injury of peritoneal structures is made impossible by the design of the apparatus used in this study.

2. Patients accept, tolerate and are satisfied with this minimally invasive surgical approach, which can routinely be performed on healthy patients in an outpatient setting.

3. Patients experience significantly less morbidity using a minimally invasive anterior iliac crest harvest using a motorized trephine than that experienced with a traditional open medial approach. This is characterized by lower overall pain scores, more rapid ambulation and fewer days of hospital stay with the motorized trephine group, when compared to the open iliac crest group.

4. Coral-derived granules are safe as a bone graft substitute in the cranio-maxillofacial skeleton, as long as they are placed in a subperiosteal pocket and in a well vascularized non infected graft bed. They can be used in many sites in the cranio-maxillofacial skeleton.

5. In the growing patient, coral-derived granules are most efficacious in reconstructing dento-alveolar defects for dental implant placement in the posterior maxilla or mandible. Coral-derived granules were less efficacious in the anterior maxilla, where tooth-loss was a result of trauma. There may be a difference in the nature of the wounds in these two areas that may account for this variation in treatment outcomes.