Behavior of implants in bone grafts or free flaps after tumor resection

Abstract

The authors compared bone resorption of autogenous bone grafts and revascularized free flaps used for the reconstruction of mandibular continuity defects following resection for tumors, before and after the placement of endosseous implants. Ten patients (group 1) were treated with autogenous bone grafts taken from the fibula or the anterior iliac crest; 8 patients (group 2) were treated with iliac or fibula revascularized flaps. Four to 8 months later, 72 endosseous implants were placed in the reconstructed areas. After a further healing period of 4-6 months, patients were rehabilitated with implant-borne prostheses. The following parameters were evaluated and compared between the two groups: 1) bone resorption of grafts and free flaps before and after implant placement; 2) peri-implant bone resorption mesial and distal to each implant, immediately after prosthetic rehabilitation and then during yearly follow-ups. Bone resorption before implant placement showed mean values of 3.53 mm in group 1, and 0.96 mm in group 2. Peri-implant bone resorption was: 0.49 mm (39 implants) in group 1, and 0.45 mm (30 implants) in group 2, at time of prosthetic rehabilitation; 0.78 mm (39 implants) in group 1, and 0.89 mm (30 implants) in group 2, 12 months after prosthetic load; 1.16 mm (24 implants) in group 1, and 1.02 mm (13 implants) in group 2, 24 months after the prosthetic load. A significant difference in bone resorption before implant placement was found between the two groups, whereas it was not found after implant placement and prosthetic load. The failure rate according to Albrektsson criteria was 4.9% (2/41 implants) in group 1, and was 3.2% (1/31) in group 2.

Clinical and Functional Outcomes of Implant Prostheses in Fibula Free Flaps

“…The fibula has a biomechanical advantage in that it can favorably withstand masticatory loads. 11,13,17,19,23,24 The morbidity in relation with the donor site was acceptable with limited pain and gait disturbances. Reconstruction of surgical jaw defects with fibula free flaps is not without problems.…”

“…31 Implant survival rate in our study was 100%, which was higher than previous studies and implant success rate in our study was 94%, which was lower than previous studies. 10,19,23,24,26 Data regarding the usefulness of implant prosthodontic treatment in the functional rehabilitation of patients with jaw defects reconstructed with fibula free flaps are lacking. 20 In this study, 80% of the patients could not chew properly on both sides although only one patient had limitations in the consistency of food she could consume.…”

“…[11][12][13][14] Fibular bone presents favorable conditions for implant placement, and subsequent implant supported prosthetic rehabilitation, due to its diameter and the good quality of its cortical bone. 11,[15][16][17][18][19] There are few studies focusing on the success rate of such treatment and the proportion of patients who are able to wear a functioning dental prosthesis after surgical reconstruction. Furthermore, patient perception about the functional outcome of such treatment has rarely been reported in studies.…”

Beneficial Role of Periosteum in Distraction Osteogenesis of Mandible: Its Preservation Prevents the External Bone Resorption

“…Weight bearing may also protect against resorption, because functional pressure promotes the bone remodeling (Chiba 1976). Many reports point out that implant placement protects against bone resorption of the alveolar crest on the grafted (Chiapasco et al 2000) or distracted (Nosaka et al 2000) mandible. According to Radomisli et al (2001), weight bearing alerts the expression of collagen I and II, BMP, and osteocalcin to affect early healing in DO.…”

Does Evidence Support Prosthetic or Surgical Rehabilitation for Patients With Maxillary Defect Regarding the Quality of Life? Systematic Review.

“…[20][21][22][23][24][25] The application of dental implants has been found to be advantageous for the oral rehabilitation of patients who have undergone intraoral resections, as dental implants in bone grafts or free flaps after tumor resection was providing satisfactory results despite the thickness and mobility of soft tissues and scar contracture,as well as, the use of dental implants in the zygoma or in premaxilla improved obturator retention and stability. [26][27][28] Quality of life is an important consideration in philosophy, medicine, religion ,ecomomics and politics. In general, the term ‗quality of life' is used to describe factors that influence the living conditions of a society or of the society's individuals.The WHO defines quality of life as ‗the individual's perception of their position in life in the context of the culture and value systems inwhich they live and in relation to their goals, expectations, standards and concerns.…”