Bone impacted fibular free flap: A novel technique to increase bone density for dental implantation in osseous reconstruction

Dziegielewski, Peter T.; Mlynarek, Alex; Harris, Jeffrey R.; Hrdlicka, Adam; Barber, Brittany; Al‐Qahtani, Khalid; Wolfaardt, Johan; Raboud, Don; Seikaly, Hadi

doi:10.1002/hed.23510

Cited by 16 publications

(24 citation statements)

References 17 publications

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“…3,5 The bone stock can be further augmented for implantation by impacting the marrow of the donor fibula with demineralized bone or morselized fibular bone, resulting in improved osseointegrated implant longevity. 46,47 The present study has certain limitations. The prospective cohort case-matched design confers level 2-3 evidence and is the best design possible with our longitudinal data.…”

Section: Discussionmentioning

confidence: 83%

“…The fibula is the most commonly used flap in the bone framework reconstruction of the head and neck, as it provides excellent bone stock, good soft tissue component, and has a long, robust pedicle . The bone stock can be further augmented for implantation by impacting the marrow of the donor fibula with demineralized bone or morselized fibular bone, resulting in improved osseointegrated implant longevity …”

Section: Discussionmentioning

confidence: 99%

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The Alberta Reconstructive Technique: An Occlusion‐Driven and Digitally Based Jaw Reconstruction

et al. 2019

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Objectives/Hypothesis The free flap reconstructive protocols of the jaws have been refined over the years and presently are based on bone‐driven approaches that generally use the lower border of the mandible or the anterior surface of the maxilla as the templates for reconstruction because these contours are deemed important to the eventual cosmetic outcomes of patients. The ultimate goal of functional jaw reconstruction, however, is the reconstruction of the dental occlusion and oral rehabilitation. The purpose of the present study was to evaluate the Alberta reconstructive technique (ART), which is a new approach of occlusion‐driven jaw reconstruction with digitally planned immediate osseointegrated implant installation. Study Design Prospective cohort study. Methods This research study considers the ART's safety, effectiveness, accuracy, timeliness of reconstruction, aesthetic appeal, and cost‐effectiveness in comparison with the standard bone‐driven and delayed osseointegrated implant installation (BDD) protocol. Results The ART procedures were as safe and more effective at achieving full occlusal reconstruction and oral rehabilitation. The ART cohort of patients achieved oral rehabilitation in 21.4 month as compared to 73.1 months for the BDD cohort. There were no differences in the aesthetic appeal the two groups. The ART cost an average of $22,004 less than BDD and we calculated the quality adjusted life years gain to be between 2.14 and 4.04 in favour of ART. Conclusions The ART is a good option for patients with jaw defects. It provides a safe, effective, accurate, aesthetic, and cost‐effective reconstruction that restores form and function in a timely manner. Level of Evidence 2b Laryngoscope, 129:S1–S14, 2019

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

The Alberta Reconstructive Technique: An Occlusion‐Driven and Digitally Based Jaw Reconstruction

et al. 2019

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“…This technique involves morselization of the remaining fibula and impaction of the pieces into the hollow marrow of the fibula bone before insetting. A previous study describing the technique demonstrated increased bone density at 6 and 12 months after BIFFF reconstruction, as assessed on CT imaging. The justification for this procedure is the desire for increased bone stock provided by the impaction that may contribute to more successful osseointegration of the surface area of the implant compared to the traditional fibular free flap, which relies on only the fibular cortical plates for osseointegration.…”

Section: Introductionmentioning

confidence: 83%

“…The BIFFF is harvested, as previously described by Dziegielewski et al The fibula bone is cut to the appropriate length necessary to reconcile the defect and hollowed, after which the remaining bone is cut into smaller pieces and morselized. The morselized bone is then rinsed with 20 cc of sterile 0.9% isotonic saline.…”

Section: Methodsmentioning

confidence: 99%

Bone‐impacted fibular free flap: Long‐term dental implant success and complications compared to traditional fibular free tissue transfer

Barber

Dziegelewski

Chuka³

et al. 2015

Head & Neck

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“…With an osseous component, osseointegrated implants for future dental rehabilitation can be pursued. 13 Several different osseous flaps have been used and include the fibular osteocutaneous flap, [13][14][15][16][17][18][19] iliac crest flaps, 20 and scapular flaps. [21][22][23] Studies on speech outcomes have shown that maxillary reconstruction results in satisfactory speech 22,24,25 and normal intelligibility.…”

Section: Introductionmentioning

confidence: 99%

Comparison of speech and resonance outcomes across three methods of treatment for maxillary defects

Papadopoulos-Nydam

Wolfaardt

Seikaly

et al. 2017

Int J Maxillofac Prosthetics

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Purpose: Treatment of maxillary defects, whether by prosthetic rehabilitation or surgical reconstruction, should aim to restore speech function and resonance balance. With the advent of technology and changing clinical practices related to maxillary defect management, speech outcomes need to be evaluated and compared in order to determine efficacy of differing approaches. Materials and Methods: One hundred and four patients across three treatment groups for maxillary defects were included: 38 patients who were treated with maxillary obturators (OBT group), 39 patients who were treated with a standard fibular free flap reconstruction that did not involve digital planning of the reconstruction (Standard group) and 27 patients who were reconstructed using a digitally planned surgical design and simulation fibular free flap reconstruction (SDS group). Speech assessments were completed to assess word and sentence intelligibility, resonance balance and aeromechanical orifice estimation among these three groups. Assessments included the Computerized Assessment of Intelligibility of Dysarthric Speech (C-AIDS), nasalance scores via the Nasometer and palatopharyngeal orifice area via the PERCI-SARS. Results: Significant differences were found in word intelligibility between the SDS and the Standard groups (p =.035) and on nasalance scores between the SDS and the OBT groups (p=.027). Conclusions: Patients treated with digital reconstruction (SDS) had better speech outcomes than the other two treatment groups, whose mean scores on certain speech variables were not within normal limits. Speech outcomes in the SDS group were consistently within the normal range across all measured speech variables.

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Bone impacted fibular free flap: A novel technique to increase bone density for dental implantation in osseous reconstruction

Abstract: BIFFF increases reconstructed bone density, initial dental implant stability, and 1-year implant success.

Cited by 16 publications

References 17 publications

The Alberta Reconstructive Technique: An Occlusion‐Driven and Digitally Based Jaw Reconstruction

The Alberta Reconstructive Technique: An Occlusion‐Driven and Digitally Based Jaw Reconstruction

Bone‐impacted fibular free flap: Long‐term dental implant success and complications compared to traditional fibular free tissue transfer

Comparison of speech and resonance outcomes across three methods of treatment for maxillary defects

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