Long-Term Results of Mandibular Reconstruction of Continuity Defects with Fibula Free Flap and Implant-Borne Dental Rehabilitation.

PURPOSE: This study evaluated the retrospective outcomes of implant-borne dental rehabilitation in patients with mandibular defects reconstructed with a fibula free flap.

MATERIALS AND

METHODS

Patients with segmental mandibular defects were enrolled in this cohort study. Defects in these patients were caused by oral neoplasm, trauma, and osteoradionecrosis. The patients were treated with a fibula free flap procedure and dental implant-borne prostheses between 1988 and 2010. Clinical and radiographic data were evaluated; Kaplan-Meier survival analysis and Poisson regression analysis were used to evaluate implant survival parameters. The statistical significance (α = .05) of the results was determined.

RESULTS

Seventy-four patients were selected in this study. All patients were available for continuous follow-up. Nine patients (12.1%) developed fibular graft complications postoperatively: 3 in donor sites and 6 in recipient sites. One hundred ninety-two implants were inserted, and 18 implants failed (9.3%). Overall implant survival in patients was 90.1%, 83.1%, and 69.3% after 5, 10, and 20 years, respectively. In 152 implants, probing depth (PD) ranged from 2 to 3 mm. In 31 implants, PD was greater than 5 mm. In 9 implants, PD was greater than 7 mm. The highest implant failure rates were expected for men (odds ratio [OR] = 2.948; 95% confidence interval [CI], 1.10 to 7.85; P = .031), patients receiving primary fibula free flap reconstruction (OR = 3.696; 95% CI, 1.16 to 11.73; P = .027), and patients receiving radiotherapy (OR = 5.269; 95% CI, 1.40 to 19.7; P = .014).

CONCLUSION

Fibula free flap procedures and implant-borne prostheses proved to be reliable approaches for rehabilitation of mandibular defects and oral function. The overall postoperative fibula free flap and peri-implant complication rates proved to be low. Regular follow-up visits and proper oral hygiene maintenance contributed to the long-term successful treatments.