Prosthodontic Rehabilitation After Fibula-Free Flap Reconstruction of the Jaws.

BACKGROUND

Prosthodontic rehabilitation (PR) after fibula-free flap (FFF) reconstruction of maxillomandibular defects remains clinically challenging, and understanding factors that enhance or detract from achieving PR is critical to improving outcomes.

PURPOSE: The purpose of this study was to estimate the incidence of PRand identify clinical factors that facilitate or impede completion of PR in subjects undergoing FFF reconstruction of the maxilla or mandible.

STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study was conducted at the University of Alabama at Birmingham and included subjects who underwent FFF reconstruction between January 2014 and July 2021, with at least 12 months of follow-up. The exclusion criteria included unresectable tumors, defects outside the oral cavity, and insufficient follow-up.

PREDICTOR VARIABLES: Predictor variables included demographic, medical, pathologic, and operative factors, including implant placement.

OUTCOME VARIABLE(S): The outcome variable was time-to-PR and was defined as the replacement of missing dentition with fixed or removable prostheses.

COVARIATES: Not applicable.

ANALYSIS: Descriptive statistics, Student's t test, χ2, Kaplan-Meier analysis, and Cox regression analyses were performed. Statistical significance was set at P < .05.

RESULTS

The sample consisted of 167 subjects with a mean age of 54.2 years (SD, 15.9), 86 (51.5%) male, and the median duration of follow-up was 39 months (interquartile range [IQR], 31). The incidence of PR at 12 months was 20%. The median time to PR was 32.5 months (95% CI, 19.9 to 45.0) and was significantly longer among subjects with malignant pathology, mandibular reconstruction, no implant placement, postoperative radiotherapy, and limited occlusal support. On multivariable analysis, mandibular reconstruction (P < .01) and absence of implant placement (P < .01) were independently associated with delayed completion of PR. A cumulative proportion of subjects who completed PR was 53.3%.

CONCLUSIONS AND RELEVANCE: PR following FFF reconstruction occurred in a minority of subjects, with a median time to completion of 32.5 months, and was independently associated with mandibular reconstruction and absence of dental implant placement.