Dental implants in maxillar reconstruction using osteocutaneous free fibula flap: A 10‐year follow‐up

Abstract

Background : Dental implant placement in osteofasciocutaneous free fibula flaps (OSCFFF) presents a special clinical challenge in implantology. Extensive vertical height loss caused by bone resorption, with a consequential width and height reduction of the alveolar ridge, remains a frequent problem and is often considered a major drawback. Because of the structural diversity, drilling into OSCFFF can be demanding. Often it is difficult to achieve primary stability of the implants, and therefore pre-surgical implant placement planning is necessary. As patients in need of OSCFFF represent a therapeutically demanding group of patients, even when satisfying dental implant osseointegration is achieved, it is not easy to obtain a satisfactory long-term oral rehabilitation.Aim/Hypothesis : To show advantages and the importance of pre-surgical planning in patients in need for mid-facial reconstruction using OSCFFF. We present a 10-year follow-up OSCFFF reconstruction case in which the importance of interdisciplinary cooperation between maxillofacial surgeons, oral surgeons and prosthodontists is shown.Materials and Methods : A female patient had undergone total medial maxillary reconstruction 10 years ago, due to the gingival squamous cell carcinoma. Radiotherapy had not been performed and two years after she had no signs of recurrence. Four 3.5 × 11 mm dental implants (Ankylos Dentsply Implants, Germany) were placed in the regions of the second incisors and first premolars. One year after, vestibuloplasty was performed and four osseointegrated implants were opened. Due to the absence of hard palate tissue, a bar retained reduced total prosthesis was placed. Patient was satisfied with the end-result and after 8 years she came to replace the prosthesis. A control panoramic x -ray was taken which showed no bone resorption around the implants.Results : After 10 years, satisfactory functionality and esthetics of the implant-prosthetic reconstruction in OSCFFF graft were observed. Conclusion and ClinicalImplications : OSCFFF presents a valuable technique for major facial reconstructions. After inserting dental implants in OSCFFF reconstructed jaws, the healing period should be extended from 9-12 months. Vestibuloplasty is recommended before placing the dentures. Dental implant placement in OSCFFF presents a valuable solution for major dentoalveolar defects.