Relationship between fibula free flap complications and dental implant outcomes: a retrospective cohort study

To clarify how fibula free flap (FFF) complications influence clinical and functional outcomes after implant-supported oral rehabilitation.

A single-center retrospective cohort of 29 patients (56.41 ± 12.74 years; 31% female, 69% male) who underwent segmental jaw resection, FFF reconstruction and subsequent implant placement (2002-2010) was analyzed. Demographic, oncologic, flap, implant-related and patient-centered functional variables were extracted; associations were tested with exact, rank and regression statistics (⍺ = 0.05).

Patients received 7.14 ± 3.06 implants each and 72% were restored with telescopic overdentures. Recipient-site wound-healing defects (WHD) occurred in 31% and were independently associated with multisegment osteotomies (p = 0.012) and longer operative time (p = 0.026); partial flap loss (PFL) was infrequent (6.9%). WHD reduced maximum inter-incisal opening (MIO) by 0.8 cm and PFL by 2.8 cm, both impairing contour ratings. Implant failure (0.59 ± 1.59) correlated with poorer speech intelligibility (p = 0.004) and lower aesthetic scores (p = 0.032). Nonetheless, 96% of patients spoke intelligibly (with or without concentration), 96% judged their dental aesthetic as good or excellent, and 75% consumed a normal diet. Ordinal regression confirmed the number of fibula segments as the sole predictor of contour (p = 0.001).

FFF reconstruction permits dependable, implant-supported rehabilitation, but multisegment osteotomies and prolonged surgery heighten soft-tissue morbidity, which in turn constrains both MIO and appearance. Failed implants further degrade speech intelligibility and aesthetics. Long-term success therefore hinges on balancing the contour gains of complex osteotomies with flap vascular resilience while safeguarding implant stability.