Mandibular Reconstruction With Iliac Crest Free Flap, Nasolabial Flap, and Osseointegrated Implants

Cuéllar, Carlos Navarro; Caicoya, Santiago Ochandiano; Acero, Julio; Cuéllar, Ignacio Navarro; Muela, Cristina Maza; Vila, Carlos Navarro

doi:10.1016/j.joms.2014.02.031

Cited by 31 publications

(16 citation statements)

References 24 publications

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“…Thus, autogenous bone blocks are still considered the gold standard, especially when large volume is required [ 3 ]. Iliac or calvarial grafts have been proposed by various studies with varying rates of complications, including infection, mobility impairment and hernia [ 4 , 5 ]. Furthermore, remarkable surface resorption of the transferred lilac bone graft on the recipient alveolar bone has been reported in many interventions [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the autogenous bone block transfer for dental implant placement: Symphysal or ramus harvesting?

2016

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BackgroundThe absence of sufficient bone volume is the most relevant problem in implant dentistry. Grafting from exogenous sources may provide a limited gain but exhibits poor performance in large bone defects. Autogenous bone block transfer (ABBT) from the mandibular symphysis and ramus has been used with varying rates of success. The aim of this study was to compare the efficacy of symphysal and ramus ABBT for the restoration of lost horizontal alveolar bone volume in the anterior maxilla. Implants placed in the augmented areas were also evaluated.MethodsThe maxillary alveolar bone deficits of 32 patients were treated by similar-sized autogenous bone blocks (7 × 7 × 4 mm) harvested from the symphysis or ramus area. After 4 to 5 months of healing, implants were inserted. At the end of the osseointegration period, the implants were restored by fixed prostheses. Baseline bone thickness was determined by Cone beam computed tomography and was compared to post-op and one-year post-loading bone thickness values where the implants were inserted. Any complications or consequences were noted. The success and survival of the 45 implants were evaluated. The results were analyzed using the Student t-test and Fisher’s exact test (p < 0.05).ResultsPost-op complications were frequent in both groups. Baseline bone thickness values were similar at the beginning of the study (p = 0.71) and exhibited a significant increase after the ABBT surgery (6.29 (SD 0.86) and 6.01 (SD 0.92) mm in the symphysis and ramus groups, respectively). The amount of bone thickness gain was 4.34 mm (SD: 0.92) and 4.36 mm (SD: 1.01) in the symphysis and ramus groups, respectively. After one year, the mean surface resorption was 0.6 mm (SD: 0.78) and 0.80 mm (SD: 0.56) for the symphysis and ramus groups, respectively (p = 0.089). The success and survival rates of the implants were 94.11 and 96.42 %, respectively. No graft failures were observed.ConclusionsBoth symphysal and ramus ABBT procedures were successful for the restoration of a horizontal bone defect in the anterior maxilla. Ramus harvesting may be advisable due to fewer complications. Implants placed in the grafted regions exhibited a high success and survival rate within the one-year follow-up period.

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Section: Introductionmentioning

confidence: 99%

Evaluation of the autogenous bone block transfer for dental implant placement: Symphysal or ramus harvesting?

2016

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“…Extensive resection of tumor often results in bone and soft tissue defects that cause functional and esthetic consequences (Navarro Cuellar et al, 2014). Regarding treatment of jaw neoplasms, the success was defined as maintenance of bone continuity and stability, and absence of infection 1 year after reconstruction upon clinical and radiographic examination (van Gemert et al).…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Mandibular Ameloblastoma and Immediate Reconstruction with Nonvascularized Bone Graft and Hyperbaric Oxygen Therapy

Pastore

Martins

Goulart

et al. 2016

Int. J. Odontostomat.

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MARTINS, I. S.; GOULART, D. R.; PRATI, A. J.; DE MORAES M.; PASTORE, P. R. & DE TOLEDO, M. C.Surgical management of mandibular ameloblastoma and immediate reconstruction with nonvascularized bone graft and hyperbaric oxygen therapy. Int. J. Odontostomat., 10(3):409-417, 2016.ABSTRACT: Extensive resection of tumor often results in bone and soft tissue defects that cause functional and esthetic consequences. The reconstructive surgery is extremely important for the rehabilitation of these patients. The purpose of this study is to report on the use of Hyperbaric Oxygen therapy (HBO) in the case of a large ameloblastoma treated with segmental resection and reconstructed immediately with nonvascularized bone graft (NVBGs) from iliac crest. A 41-year-old woman was referred to our department because of paresthesia of the inferior alveolar nerve and history of swelling in the molar and ramus region of the left mandible. Panoramic radiograph depicting well-defined multilocular radiolucency extending from second premolar region to the left ramus region. An incisional biopsy confirms the diagnosis of solid ameloblastoma. The treatment of choice was segmental mandibular resection and immediate mandibular reconstruction using NVBGs from iliac crest, followed by removal of internal fixation and placement of dental implants with immediate loading. The patient received preoperative HBO (a 90-min session at 2.2-2.4 atmospheres, five times per week for two weeks, for a total of up to 10 sessions). Postoperative HBO (10 further 90-min sessions) was administered within 2 weeks. The patient received rehabilitation with a mandibular implant-supported fixed complete dental prosthesis. The present study showed successful management of mandibular ameloblastoma that associated extensive surgery, immediate reconstruction with NVBGs from iliac crest, hyperbaric oxygen therapy and dental implants. These combined procedures allowed removal of lesion and reestablishment of mandibular contour and function.

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“…Mandibular dental implants are widely used, but their placement in non-vascularized grafts is avoided when bone continuity has been disrupted. On the other hand, the placement of dental implants in vascularized iliac crest grafts has a high success rate, reaching according to some authors 95.2% [ 9 ]. In the case of the patients included in this study, the osseointegration rate of dental implants was 100%, but it should not be overlooked that a limitation of the study is the small number of patients and implicitly, the relatively small number of implants used.…”

Section: Discussionmentioning

confidence: 99%

Mandibular reconstruction using free vascularized iliac crest grafts and dental implants

Moldovan

Juncar

Dinu

et al. 2015

Medicine and Pharmacy Reports

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Background and aimThe mandible is frequently affected by tumor masses present in the oral cavity and is included in the tumor ablation procedure, with major functional and esthetic consequences for the patient. A method of high current interest in mandibular reconstruction is based on the use of free vascularized iliac crest grafts, followed by reconstruction using dental implants.MethodsThis study presents the case of four patients benefiting from this treatment method, and monitors the treatment stages and their clinical evolution after mandibular reconstruction and dental implant placement.ResultsThe postoperative evolution of the patients was favorable, with the integration of the iliac crest grafts and dental implants. After prosthetic loading, the masticatory as well as the esthetic function of the patients was restored to a standard close to the initial one.ConclusionsThis mandibular reconstruction method proved to be effective, with a high degree of reliability and a significant improvement of the patients’ quality of life.

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Mandibular Reconstruction With Iliac Crest Free Flap, Nasolabial Flap, and Osseointegrated Implants

Cited by 31 publications

References 24 publications

Evaluation of the autogenous bone block transfer for dental implant placement: Symphysal or ramus harvesting?

Evaluation of the autogenous bone block transfer for dental implant placement: Symphysal or ramus harvesting?

Surgical Management of Mandibular Ameloblastoma and Immediate Reconstruction with Nonvascularized Bone Graft and Hyperbaric Oxygen Therapy

Mandibular reconstruction using free vascularized iliac crest grafts and dental implants

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