Journal of Dental Sciences (Jul 2024)
The dental implant survival rate in 18 patients with post-operation revolutionary jaw reconstruction using free fibular flap, dental implants, and overdentures
Abstract
Background/purpose: This retrospective study assessed the risks and complications associated with dental implants after jaw surgery and radiotherapy for large defects, highlighting challenges for reconstructive surgeons and prosthetic dentists. Materials and methods: From 2002 to 2008, National Taiwan University's Department of Maxillofacial Surgery used preoperative stereolithographic models and microvascular flaps for mandibular reconstruction in 18 patients with defects from ameloblastoma or advanced gingival cancer. They received free fibular flap grafts, followed by 46 osseointegrated dental implants. Patient outcomes, monitored for up to 60 months, were assessed through clinical and radiographic evaluations of implant success. Results: The overall survival rate of dental implants following tumor surgery and radiotherapy was 84.8%. Seven implants failed due to peri-implantitis (3), tumor recurrence (2), and osteoradionecrosis (ORN) (2). The ameloblastoma group did not contribute to implant failure, with 4 implant failures in the stage III gingival cancer group, and 3 implant failures in the stage IV gingival cancer group. Conclusion: Following segmental mandibulectomy for mandible lesions, free fibular bone graft reconstruction restored mandible continuity, while subsequent dental implantation and overdenture fabrication restored occlusion and aesthetics for patients. Besides considering treatment strategies for ameloblastoma groups, similar approaches can be extended to oral cancer patients undergoing post-operative reconstruction. However, additional considerations (peri-implant soft tissue condition, tumor recurrence, ORN, etc.) are necessary for oral cancer patients predisposed to dental implant failure post-surgery.
