Implant Dental Rehabilitation of Fibula-Free Flap Reconstructed Jaws

Zavattero, Emanuele; Ramieri, Guglielmo; Agrò, Giovanni; Fasolis, Massimo; Garzino-Demo, Paolo; Borbon, Claudia

doi:10.1097/scs.0000000000006874

Cited by 8 publications

(15 citation statements)

References 22 publications

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“…Free flaps represent the gold standard for post-oncological mandibular reconstruction and the fibula flap, with its reliable vascular pedicle and its reduced donor site morbidity, provides an adequate quantity of bicortical bone that is suitable for dental rehabilitation [ 6 , 10 , 11 , 12 , 13 , 14 , 22 , 23 , 24 , 25 , 26 , 27 ]. While “ free-hand ” techniques are characterized by operator-dependent outcomes and by less accuracy in condylar repositioning and individual occlusion restoration [ 14 , 22 ], the introduction of Computer-Assisted Surgery (CAS) techniques led to more accurate reconstructions and to a shorter length of surgery [ 14 , 17 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The osteocutaneous fibula free flap with titanium implants fixation currently represents one of the best reconstructive options for mandibular defects because of its versatility, the massive portion of bone available and the possibility of being prosthetically rehabilitated [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. A fundamental requirement in order to obtain a good morphological reconstruction is represented by the respect of individual dental occlusion and condyle-glenoid relationship through the accurate shaping of fixation plate that will keep the bone in the correct position.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol

Sozzi

Filippi

Canzi

et al. 2022

JCM

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Aim: the purpose of this work is to present an innovative protocol for virtual planning and surgical navigation in post-oncological mandibular reconstruction through fibula free flap. In order to analyze its applicability, an evaluation of accuracy for the surgical protocol has been performed. Methods: 21 patients surgically treated for mandibular neoplasm have been included in the analysis. The Brainlab Vector Vision 3.0® software for surgical navigation has been used for preoperative surgical planning and intra-operative navigation. A post-operative accuracy evaluation has been performed matching the position of mandibular landmarks between pre-operative and post-operative CT scans. Results: the maximal discrepancy observed was included between −3.4 mm and +3.2 mm, assuming negative values for under correction and positive values for overcorrection. An average grade of accuracy included between 0.06 ± 0.58 mm and 0.43 ± 0.68 mm has been observed for every mandibular landmark examined, except for mandibular angles that showed a mean discrepancy value included between 1.36 ± 1.73 mm and 1.46 ± 1.02 mm when compared to preoperative measurements. Conclusion: a satisfying level of accuracy has been observed in the protocol presented, which appears to be more versatile if compared to closed custom-made systems. The technique described may represent a valid option for selected patients, but it cannot be considered for routine activity because of the complexity of the method, the mobility of the jaw, the necessity of surgical navigator and the long surgical learning curve that is required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol

Sozzi

Filippi

Canzi

et al. 2022

JCM

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show abstract

“…Bone quality can be classified into four categories, based on its radiographic appearance and the resistance to drilling [ 43 ]: (1) “type 1 bone”, homogenous compact bone; (2) “type 2 bone”, dense trabecular bone surrounded by a thick cortical bone; (3) “type 3 bone”, in which a dense trabecular bone is surrounded by a thin layer of cortical bone; (4) “type 4 bone”, characterized by a core of low-density trabecular bone and a thin layer of cortical bone. Dental implants placed in grafted bone/free bone flaps bone can be considered as well performing as those placed in regular bone, as also described in the literature [ 44 , 45 , 46 ]. Figure 2 and Figure 3 present an example of free fibula flap (FFF) reconstruction and dental rehabilitation.…”

Section: Methodsmentioning

confidence: 99%

Dental Implant Failure Risk in Post Oncological Patients, a Retrospective Study and Sapienza Head and Neck Unit Decisional Protocol- 7 Years of Follow-Up

et al. 2022

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(1) Background: Patients with head and neck cancer are treated by ablative surgery, radiotherapy, chemotherapy, or a combination of these. The side effects of cancer therapies can compromise conventional prosthesis rehabilitation; therefore, dental implants can result in a more effective solution. The aim of the study is to explain how to rehabilitate a patient that underwent head and neck cancer therapy. (2) Methods: This retrospective study conducted from 2015 to 2021 included 223 postoncological patients, aged between 32 and 80 years old. Eighteen patients did not proceed with any treatment, and two died. Therefore, 203 patients have been analyzed and rehabilitated following our decisional protocol, with a mean period of follow-up of 4 years. The implant placement was considered successful when a mean bone loss of 1.6 mm for the first year and a mean of 0.13 mm in subsequent years occurred (3) Results: A total of 161 patients were rehabilitated with a conventional prosthesis, 42 patients (F:M ratio 19:23) with an implant-supported prosthesis and a total of 200 implants were placed; 9 implants were lost (4.5% of 200 implants). Conclusions: The results confirmed that by following our protocol it is possible to obtain an acceptable rate of implant survival, considering the delicacy and complexity of post-oncological patients.

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“…In the other cohort, RTX was administered after ablative surgery, and all implants were placed after reconstruction. 25,27,28,31,32,[34][35][36] Six focused on primary reconstruction cases, 1 on secondary reconstruction cases, 28 and the remaining study by Dholam et al 31 included both primary and secondary reconstruction cases with secondary implant insertion. The 170 implants had a 91.1% rate of osseointegration, which was significantly higher than the pooled survival rate for implants with RTX before ablative surgery (Supplemental Table 3, Supplemental Digital Content 1, http://links.lww.com/SCS/G5: 91.1% versus 74.8%; P < 0.001, 95% CI, 8%-25%).…”

Section: Implant Survival With Radiotherapymentioning

confidence: 99%

Optimal Treatment Order With Fibula-Free Flap Reconstruction, Oncologic Treatment, and Dental Implants: A Systematic Review and Meta-Analysis

Sriram,

Njoroge,

Lopez

et al. 2024

Journal of Craniofacial Surgery

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Head and neck cancer (HNC) patients benefit from craniofacial reconstruction, but no clear guidance exists for rehabilitation timing. This meta-analysis aims to clarify the impact of oncologic treatment order on implant survival. An algorithm to guide placement sequence is also proposed in this paper. PubMed, Embase, and Web of Science were searched for studies on HNC patients with ablative and fibula-free flap (FFF) reconstruction surgeries and radiotherapy (RTX). Primary outcomes included treatment sequence, implant survival rates, and RTX dose. Of 661 studies, 20 studies (617 implants, 199 patients) were included. Pooled survival rates for implants receiving >60 Gy RTX were significantly lower than implants receiving < 60 Gy (82.8% versus 90.1%, P=0.035). Placement >1 year after RTX completion improved implant survival rates (96.8% versus 82.5%, P=0.001). Implants receiving pre-placement RTX had increased survival with RTX postablation versus before (91.2% versus 74.8%, P<0.001). One hundred seventy-seven implants were placed only in FFF with higher survival than implants placed in FFF or native bone (90.4% versus 83.5%, P=0.035). Radiotherapy is detrimental to implant survival rates when administered too soon, in high doses, and before tumor resection. A novel evidence-based clinical decision-making algorithm was presented for utilization when determining the optimal treatment order for HNC patients. The overall survival of dental prostheses is acceptable, reaffirming their role as a key component in rehabilitating HNC patients. Considerations must be made regarding RTX dosage, timing, and implant location to optimize survival rates and patient outcomes for improved functionality, aesthetics, and comfort.

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Implant Dental Rehabilitation of Fibula-Free Flap Reconstructed Jaws

Abstract: Combined use of resorbable poly-L-lactic acid-polyglycolic acid implant and bone cement for treating large orbital floor fractures.

Cited by 8 publications

References 22 publications

Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol

Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol

Dental Implant Failure Risk in Post Oncological Patients, a Retrospective Study and Sapienza Head and Neck Unit Decisional Protocol- 7 Years of Follow-Up

Optimal Treatment Order With Fibula-Free Flap Reconstruction, Oncologic Treatment, and Dental Implants: A Systematic Review and Meta-Analysis

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