# Evaluating Bone Grafting Success in Maxillofacial Surgery Among Patients With Oral Mucosal Diseases: A Prospective Cohort Study

## TL;DR

This study found that patients with oral mucosal diseases have lower bone graft success rates and more complications compared to those without these conditions.

## Contribution

The study is the first to prospectively evaluate bone grafting outcomes in patients with immune-mediated oral mucosal diseases.

## Key findings

- Patients with oral mucosal diseases had significantly lower graft success rates (71.1% vs. 91.6%).
- Immunosuppressive therapy and poor glycemic control were strongly associated with graft failure in OMD patients.
- Wound healing complications were more common in the OMD group (28.9% vs. 10.4%).

## Abstract

Background: In maxillofacial surgery, bone grafting plays a critical role in alveolar defect reconstruction and dental bone grafts. Oral mucosal diseases (OMDs), including oral lichen planus and mucous membrane pemphigoid, may impair the local epithelial integrity and immune reactions. The objective of this research was to compare six-month graft integration between immune-mediated OMDs and those without and evaluate wound healing complications, surgical site infections, and factors of graft failure (immunosuppressive therapy, glycemic control, and smoking).

Materials and methods: A total of 86 patients who underwent autogenous or alloplastic bone grafting at a tertiary care hospital were studied between June 2023 and December 2023 as part of a prospective cohort study, with outcomes assessed at six months. The participants were divided into two groups: those with clinically and histopathologically proven OMDs (n = 38) and those without mucosa pathology (n = 48). The chart reviews and standardized follow-up exams (six months) were used to gather data on graft integration, wound healing, infection rates, immunosuppressive therapy, glycemic control, and smoking status. All statistical analyses were performed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.), and a significance level of p = 0.05 was applied.

Results: OMD patients showed significantly reduced graft success rates, 27 (71.1%) vs. 44 (91.6%), p = 0.018, and an elevated incidence of wound healing complications, 11 (28.9%) vs. 5 (10.4%), p = 0.031, compared to the control group. Strong associations were found between immunosuppressive therapy (OR: 4.87, CI: 1.39-17.1, p = 0.013) and poor glycemic control (OR: 3.24, CI: 1.11-9.52, p = 0.031), as well as graft failure in the OMD group, with smoking showing a non-significant trend.

Conclusions: The prevalence of underlying OMDs was found to be associated with reduced success of bone grafts; after adjustment, failure was primarily linked to the use of immunosuppressive therapy and poor glycemic control. Successful perioperative screening, optimized metabolic management, and immunosuppressive management contribute to better outcomes.