Is mandibular reconstruction using vascularized fibula flaps and dental implants a reasonable treatment?

Purpose: this study retrospectively analyzed the rate of screwed implant insertion and risk factors in patients undergoing mandibular reconstruction with microsurgical revascularized fibula flaps.

Methods: This study retrospectively analyzed all patients with microvascularized fibula grafts between 1997 and 2005. Collected data included general data and risk factors (e.g., smoking, alcohol use), and irradiation was the main predictor variable. The number of patients rehabilitated with dental implants and the implant success rate were evaluated, possible influencing factors were identified, and the results were compared with previously published data.

Results: The sample included 33 patients (17 men, 16 women; mean age: 52 years); 76% were smokers, 42% drank alcohol regularly, and 73% had undergone mandible irradiation. Twenty-three patients received 140 screw-retained implants for dental rehabilitation. Twenty-three implants were lost. Overall 1- and 5-year implant survival rates were 94% and 83%, respectively. Implant survival rates were 86% in non-irradiated mandibular bone, 86% in non-irradiated grafted fibular bone, 82% in irradiated mandibular bone, and 38% in irradiated grafted fibular bone.

Conclusion: This study showed that the use of dental implants in patients with fibula flaps is an appropriate and successful option for dental rehabilitation, even in those with risk factors such as smoking, alcohol use, and irradiation. Implant placement in irradiated grafted bone seems to be a high-risk procedure.