Primary Placement of Osseointegrated Implants in Microvascular Mandibular Reconstruction

Abstract

The goal of mandibular reconstruction is to rehabilitate the patient by restoring occlusal relationships, lower facial contour, oral continence, and a denture-bearing surface. One of the major advantages of the use of vascularized bone over all other methods of mandibular reconstruction is its ability to achieve dental rehabilitation rapidly. The use of osseointegrated dental implants is a valuable adjunct in oral rehabilitation. It provides the most rigid form of stabilization to withstand the forces of mastication. In situations in which soft tissue reconstruction or the height of the alveolar ridge is not sufficient for a tissue-borne denture, implants offer the most suitable alternative. Mandibular reconstruction with free tissue transfer techniques is ideally suited for the placement of implants. These can be inserted at the time of mandibular reconstruction. Four months after surgery, when the integration process has occurred, the implants are unroofed, loaded, and ready for prosthetic placement. We will present several representative patients who underwent mandibular reconstruction with microvascular free bone transfer who have been successfully rehabilitated by osseointegrated implants. The process of osseointegration, different types of dental implants, and issues regarding radiation and implants are discussed. This is the first report of dental rehabilitation by primary placement of dental implants in patients undergoing microvascular mandibular reconstruction.

Microsurgical Reconstruction of Maxillary Defects

“…The use of osseointegrated implants for dental rehabilitation has previously been much more extensively discussed in the context of mandibular reconstruction than that of maxillary reconstruction. [95] Some fundamental concepts of functional dental restoration with prosthetics should be understood. The reconstruction should provide for retention, support, and stabilization of the denture.…”

“…[96] Three to 8 months after placement, the osseointegrated implants are uncovered and prepared for final prosthetic reconstruction by a prosthodontist. [95] The use of free tissue transfer techniques in combination with osseointegrated implants for maxillary reconstruction has been reported by various authors. [97] Holle et al [98] described a two-stage procedure for the reconstruction of maxillectomy defects.…”

Head and Neck Reconstructive Surgery

“…The fibula also has a low profile relative to the height of the native mandible in dentulous patients. In patients in whom osseointegrated implants are planned as either a primary or a secondary procedure, the fibula should be placed about 0.5 to 1 cm above the inferior border of the native mandible, closer to the superior alveolar edge, to facilitate the placement of implants; alternatively, a double-barrel fibula can be used (Chang et al, 1998;Urken ML et al, 1989 ;Sclaroff A, 1994). However, this requires an adequate skin paddle because more soft tissue is often needed to accommodate the extra bony volume.…”

Rehabilitation of Partial Mandibulectomy Using Implant-Supported Removable Prosthesis in an Irradiated Patient: Case Report

“…16 The placement of implants before and after radiotherapy has been reported and a period of 6 weeks between reconstruction and radiation therapy was recommended. 17 On the other hand, it was also reported that postoperative radiation increases the risk of loosening of implants and osteoradionecrosis. 18,19 Placement of implants after radiotherapy prevents loosening of implants.…”