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Autologous bone grafting is a common, standard procedure in maxillofacial surgery. We investigated complications of harvesting bone from the anterior iliac crest.A retrospective analysis with a 2-year observational period included 75 patients who had undergone iliac bone grafting. Two techniques were examined: the closed osteotomy using a cylinder osteotome (Shepard) and an open procedure with a saw.One major complication, a fracture of the anterior superior iliac spine, was observed (0.7%). Regarding long-term morbidity, 3 patients (4%) suffered from persistent pain and 2 (2.7%) from persistent sensory disturbance. A correlation by gender showed greater severity of pain directly after graft harvesting in women (PWilcoxon ≤ .001). Harvesting of corticocancellous blocks caused more pain than with the cylinder osteotome (PMedian ≤ .07).The morbidity after iliac crest harvesting was found to be moderate to low, but the procedure is still necessary and frequently used.