Dental implants and free fibula flap: 23 patients

Mandibular reconstruction with a microvascular free fibula flap (MFF) is an elegant solution to restore the anatomic arch, oral functions, and facial esthetics. But the thin cutaneous tissue, the thickness of subcutaneous tissues, the absence of a pelvilingual and vestibular groove, and the fragility of soft tissues complicate dental prosthetic stabilization. Implants may restore prosthetic functionality. A lot has been published on osteointegration with a MFF, but few studies have been aimed at the prosthetic aspect, final goal of any oral reconstruction. The aim of this retrospective study was to present the results of oral reconstruction with implant supported prostheses after mandibular reconstruction with a MFF.

Twenty-three patients underwent mandibular reconstruction: 17 men and six women with a mean age of 46 years (17-66). Fourteen patients (60.8%) underwent radiotherapy before reconstruction. Mandibular osteoradionecrosis was the indication for reconstruction in seven patients. Each patient was assessed by dentascan. Implants were placed under general anesthesia. Postoperative clinical and radiographic controls were made regularly. Transmucous abutments were placed after six postoperative months and the prosthetic phase was initiated one month later. The criteria for implant and prosthetic success were assessed.

Seventy-five implants were placed, on average 3.2 per patient, with an 80% success rate. Three implants (4%) were not used for prosthesis placement. Ten permanent prostheses and 13 removable prostheses were placed. The mean delay before implant loading was 7.6 months (6-10) and the mean follow-up was 27.5 months (1-71). Occlusion was considered as "satisfactory" for 69.6% of patients. For 57% of patients, the quality of surrounding soft tissues was considered as "satisfactory". For 74% of patients, oral rehabilitation was "satisfactory".

The implant supported prosthesis after MFF mandibular reconstruction, on an irradiated site or not, gives satisfactory results despite the thickness and mobility of soft tissues, and despite scar contracture and the absence of keratinization. Implant placement must be performed after a prosthetic planning. Using radiosurgical guides, despite their cost and difficult adaptation, would certainly improve the technique greatly.