Rehabilitation of oral functions following surgery on the jaws is a goal that is often difficult to achieve. Removable dentures supported by remaining teeth or gum are often unstable and seldom satisfactory. On the other hand, endosseous (dental) implants offer a mechanism to provide stability to the dentures. This review, discusses factors related to the tumor, patient, treatment, and physicians which impact upon the feasibility and success of dental implants in patients with oral cancer.

Background: Maxillofacial reconstruction with vascularized bone restores facial contour and provides structural support and a foundation for dental rehabilitation. Routine implant placement in such cases, however, remains uncommon. This study aims to determine dental implant survival in patients undergoing vascularized maxillary or mandibular reconstruction through a systematic review of the literature. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature was queried for implant placement in reconstructed jaws using Medical Subject Headings terms on PubMed, Embase, and Cochrane platforms. Weighted implant survivals were calculated for the entire cohort and subcohorts stratified by radiotherapy. Meta-analyses were performed to estimate effect of radiation on implant osseointegration. Results: Of 3965 publications identified, 42 were reviewed, including 1084 patients with 3636 dental implants. Weighted implant survival was 92.2 percent at a median follow-up of 36 months. Survival was 97.0 percent in 269 implants placed immediately in 60 patients versus 89.9 percent in 1897 delayed implants placed in 597 patients, with follow-up of 14 and 40 months, respectively. Dental implants without radiotherapy exposure had better survival than those exposed to radiation (95.3 versus 84.6 percent; p < 0.01) at a median follow-up of 36 months. Meta-analyses showed that radiation significantly increased the risk of implant failure (risk ratio, 4.74; p < 0.01) and suggested that implants placed before radiotherapy trended toward better survival (88.9 percent versus 83.4 percent, p = 0.07; risk ratio, 0.52; p = 0.14). Conclusions: Overall implant survival was 92.2 percent; however, radiotherapy adversely impacted outcomes. Implants placed before radiotherapy may demonstrate superior survival than implants placed after.

Background: Segmental mandibulectomy impairs health-related quality of life(QoL), by altering speech, mastication, swallowing, and facial esthetics. Fibula free-flap(FFF), used for mandible reconstruction is known to improve outcomes; however, minimal information exists in the literature regarding patient-reported outcomes (PRO). We aim to assess how current studies evaluate patient perception following segmental mandibulectomy and FFF mandible reconstruction. Methods: Following PRISMA guidelines, a search was conducted for publications involving FFF mandible reconstruction between 2005–2017 using PubMed, Cochrane, EMBASE, Web of Science, and PsychInfo. Results: Of 2,212 articles identified initially, only seven studies were deemed suitable. Six studies used UWQoL questionnaire; three OHIP, and one used EORTC-H&N35. Conclusions: There is a paucity of information in published reports on QoL outcomes following mandible reconstruction with FFF. In the era of patient-centered healthcare, observations warrant attention from researchers for physician-assessed patient-reported measures to factor in QoL expectation during surgical decision-making about the choice of reconstruction.

Background: The goal of this study is to report functional and esthetic outcomes, after fibula free flap (FFF) reconstruction of the mandible for oral cancer, assessed by physicians, nonclinicians, and patients. Methods: Twenty-five long-term survivors from oral cancer after FFF reconstruction were recalled for head and neck examination by surgeons, for photographs and patient-reported outcomes, using EORTC, QLQ-C30, H&N35, and FACE-Q questionnaires. Results: Physicians reported 64% restoration of functionality compared to normal. Patients reported high scores on QLQ-C30 but lower scores on H&N35. Esthetic scores were reported higher by clinicians than nonclinicians. The decline in function and appearance was attributed to loss of lower dentition, trismus, malocclusion, xerostomia, and tissue atrophy. Conclusion: To minimize the decline in function and appearance, immediate dental implants in FFF, better reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia and oral exercises to prevent trismus should be considered. K E Y W O R D S esthetic outcomes, FACE-Q, fibula free flap, functional outcomes, head and neck cancer, long-term survivors, malocclusion, oral cancer, patient-reported outcomes, QLQ C30, QLQ HN-35, quality of life, trismus, xerostomia

Statement of problem.-Treatment and timing considerations for patients seeking oral rehabilitation after marginal or segmental mandibulectomy (with osseous reconstruction) are not well understood. Purpose.-The purpose of this retrospective review study was to report the type and timing of oral rehabilitation for mandibular defects without discontinuity and describe additional treatment considerations for rehabilitation. Material and methods.-The records were reviewed of all patients who had a mandibular resection prosthesis after marginal mandibulectomy, marginal mandibulectomy with fasciocutaneous free flap reconstruction, and segmental mandibulectomy with fibula free flap