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Inlay versus Onlay Iliac Bone Grafting in Atrophic Posterior Mandible: A Prospective Controlled Clinical Trial for the Comparison of Two Techniques
Clinical Implant Dentistry and Related Research, 08/07/09

Felice P et al. – Inlay results in less bone resorption and more predictable outcomes, but requires an experienced surgeon. In contrast, onlay results in greater bone resorption and requires a bone block graft oversized in height, but involves a shorter learning curve. Once implant placement has been carried out, the outcomes are similar for both procedures.

Exclusive Author Commentary
Dr. Pietro Felice, 08/08/09

This comparative study suggests that the inlay and onlay techniques provide adequate correction of vertical deficits in atrophic posterior mandibles, producing implant results that are similar to those obtained in native bone, and both show acceptable complication rates. Demonstrating whether one technique is better than the other is difficult as each technique has advantages and disadvantages. The increase in bone gain in the onlay compared to the inlay group may reflect the fact that the onlay procedure allows clinicians to apply a higher bone block, while taking care not to cause excessive soft tissue strain. In the inlay technique, the presence of the upper transport segment and the necessity of maintaining the integrity of the lingual periosteum may limit vertical augmentation. Notably, we observed significantly greater bone resorption in the onlay group than in the inlay group. Of note, however, was the observation that the two techniques were comparable in terms of final vertical augmentation (subtracting bone resorption from bone gain values for each group).Considering the lack of published data, we believe that the personal experience of the surgeon should dictate which technique is to be used in the posterior mandible.

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