Jaw in a Day: Immediate Dental Rehabilitation during Fibula Reconstruction of the Mandible

Abstract

Reconstructing mandibular defects presents challenges to dental rehabilitation related to altered bone and soft tissue anatomy. Dental implants are the most reliable method to restore the lost dentition. Immediate dental implants have been placed for many years but with unacceptably low rates of dental/prosthetic success. Current virtual technology allows placement of both fibulas and guided implants in restoratively driven positions that also allow immediate dental rehabilitation. Inexpensive three-dimensional printing platforms can create provisional dental prostheses placed at the time of surgery. This article reviews our digital and surgical workflow to create an immediate dental prosthesis to predictably restore the dentition during major jaw reconstruction with fibula free flaps.

Free flap jaw reconstruction with dental implantation: A single‐institution experience

“…As for the effects of radiation, adjuvant radiotherapy has not been associated with decreased rates of implant integration, with increasing evidence supporting immediate implantation in this patient group. 10,17,[24][25][26] Until recently, most centers have elected to place implants after adjuvant radiation, due to concerns about the potential for bone loss around the implants or compromise of the flap skin island needed for oral lining replacement. 27 These concerns have largely been allayed through retrospective clinical reviews focused on early dental implantation, with multiple institutions demonstrating equal or higher rates of implant survival, similar complication rates, improved quality of life, and no delays in initiation of adjuvant radiation.…”

“…27 These concerns have largely been allayed through retrospective clinical reviews focused on early dental implantation, with multiple institutions demonstrating equal or higher rates of implant survival, similar complication rates, improved quality of life, and no delays in initiation of adjuvant radiation. 14,[25][26][27] Furthermore, delaying dental implantation leads to prolonged dental rehabilitation time and risks of poor osteointegration or osteonecrosis in radiated mandible bone. The risk of placing osteointegrated implants after radiation may actually be higher than placing them in healthy, non-irradiated bone.…”

“…This "Jaw in a Day" technique, which accomplishes functional jaw and dental reconstruction within a single procedure, is made possible by leveraging emerging technologies including virtual surgical planning and in-house 3D printing. 10,17,19,24,25,28 In this series, we did not attempt "Jaw in a Day" reconstruction. The two patients that received a temporary dental prosthesis did so 12 ± 4 months after jaw reconstruction.…”

Immediate Free Fibula Flap After Maxillectomy With Simultaneous Full-arch Dental Implant-Supported Prosthetic Rehabilitation of the Midface and Mandible: The “Super Reconstruction Concept”

“…To our knowledge, there is no literature reporting immediate reconstruction of a total maxillectomy defect with free fibula flap, endosseous dental implants, and prosthesis with full arch restoration of the opposing mandible with dental implants and prosthesis. Following Hirsch's landmark report, investigators focused and streamlining the technique, reducing cost, and efficiency of digital workflows for the procedure, [18][19][20][21] Miloro et al and others added to the protocol with the addition of nerve allografting. 10,22,23 Traditional techniques involved in jaw reconstruction include resection of tumor and reconstruction.…”

Approach for Mandibular Reconstruction Using Vascularized Free Fibula Flap: A Review of the Literature

“…The use of cutting templates, 3D printing models, and prebent plates are being used to increase the efforts to improve occlusal accuracy and establish operative efficiency during mandibular reconstruction [ 18 ]. Modern virtual technology and equipment help in the placement of guided implants and fibulas in restorative positions which allows for immediate dental rehabilitation [ 19 ]. Template design and computer modeling can increase the accuracy of fibula contouring and save time, mainly for surgeons with fewer skills and experience.…”