Assessment of functional improvement with implant-supported prosthetic rehabilitation after mandibular reconstruction with a microvascular free fibula flap: A study of 25 patients.

STATEMENT OF PROBLEM: Mandibular reconstruction with a microvascular free fibula flap is widely used after oncologic resection because it allows functional and esthetic restoration of the mandibular arch and implant-retained prostheses.

PURPOSE: The purpose of this study was to highlight the results that can be expected from an implant-supported prosthesis on a free fibula flap.

MATERIAL AND

METHODS

Patients treated with a microvascular free fibula flap and rehabilitated prosthetically were included. The number of osteotomies, number of implants, type of prosthesis, follow-up after placement of the prosthesis, preimplant surgery, and periimplant complications were reported. Subjective criteria, including patient satisfaction and improvement of masticatory function, were collected by means of a questionnaire that covered the type of diet, restrictions when eating, intelligibility of speech, and communication levels.

RESULTS

Twenty-six patients were included: 11 patients had implant-supported dentures, and 15 had fixed prostheses. Prosthetic follow-up was over 5 years for 15 patients and less than 1 year for 2 patients. Hyperplasia was a periimplant complication for 7 patients. Overall, satisfaction was good for 24 patients (score greater than 5/10; mean score, 7.3/10). Esthetics were improved for 20 patients. Speech was improved for 6 patients, and diet improved for 9 patients.

CONCLUSIONS

Implant-retained dentures seem preferable for patients, with notable esthetic alteration, although a screw-retained fixed resin-bonded prosthesis remains a good alternative. Improved mastication is more notable with patients who are completely edentulous and with large reconstructions but nevertheless remains disappointing. Whether dental restoration is necessary in treatments with short lateral flaps is worth questioning.