Long-term outcomes of implant-based dental rehabilitation in head and neck cancer patients after reconstruction with the free vascularized fibula flap

Lodders, Johannes N.; Leusink, Frank K.J.; Ridwan-Pramana, Angela; Winters, H.A.H.; Karagozoglu, K.H.; Dekker, Hannah; Forouzanfar, Tymour; Schulten, E.A.J.M.

doi:10.1016/j.jcms.2021.03.002

Cited by 27 publications

(51 citation statements)

References 26 publications

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“…Free flaps represent the gold standard for post-oncological mandibular reconstruction and the fibula flap, with its reliable vascular pedicle and its reduced donor site morbidity, provides an adequate quantity of bicortical bone that is suitable for dental rehabilitation [ 6 , 10 , 11 , 12 , 13 , 14 , 22 , 23 , 24 , 25 , 26 , 27 ]. While “ free-hand ” techniques are characterized by operator-dependent outcomes and by less accuracy in condylar repositioning and individual occlusion restoration [ 14 , 22 ], the introduction of Computer-Assisted Surgery (CAS) techniques led to more accurate reconstructions and to a shorter length of surgery [ 14 , 17 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The osteocutaneous fibula free flap with titanium implants fixation currently represents one of the best reconstructive options for mandibular defects because of its versatility, the massive portion of bone available and the possibility of being prosthetically rehabilitated [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. A fundamental requirement in order to obtain a good morphological reconstruction is represented by the respect of individual dental occlusion and condyle-glenoid relationship through the accurate shaping of fixation plate that will keep the bone in the correct position.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol

Sozzi

Filippi

Canzi

et al. 2022

JCM

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Aim: the purpose of this work is to present an innovative protocol for virtual planning and surgical navigation in post-oncological mandibular reconstruction through fibula free flap. In order to analyze its applicability, an evaluation of accuracy for the surgical protocol has been performed. Methods: 21 patients surgically treated for mandibular neoplasm have been included in the analysis. The Brainlab Vector Vision 3.0® software for surgical navigation has been used for preoperative surgical planning and intra-operative navigation. A post-operative accuracy evaluation has been performed matching the position of mandibular landmarks between pre-operative and post-operative CT scans. Results: the maximal discrepancy observed was included between −3.4 mm and +3.2 mm, assuming negative values for under correction and positive values for overcorrection. An average grade of accuracy included between 0.06 ± 0.58 mm and 0.43 ± 0.68 mm has been observed for every mandibular landmark examined, except for mandibular angles that showed a mean discrepancy value included between 1.36 ± 1.73 mm and 1.46 ± 1.02 mm when compared to preoperative measurements. Conclusion: a satisfying level of accuracy has been observed in the protocol presented, which appears to be more versatile if compared to closed custom-made systems. The technique described may represent a valid option for selected patients, but it cannot be considered for routine activity because of the complexity of the method, the mobility of the jaw, the necessity of surgical navigator and the long surgical learning curve that is required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol

Sozzi

Filippi

Canzi

et al. 2022

JCM

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show abstract

“…The principle of separating the anatomical units prior to IPS implant placement has to be strictly followed. As well as in alternative procedures, a history of irradiation leads to a higher rate of complications (27,28).…”

Section: Discussionmentioning

confidence: 99%

A New Strategy for Patient-Specific Implant-Borne Dental Rehabilitation in Patients With Extended Maxillary Defects

et al. 2021

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Purpose of the StudyPatients undergoing ablative tumor surgery of the midface are faced with functional and esthetic issues. Various reconstructive strategies, such as implant-borne obturator prostheses or microvascular tissue transfer, are currently available for dental rehabilitation. The present study shows the first follow-up of patients treated with patient-specific implants (IPS Implants® Preprosthetic) for the rehabilitation of extended maxillary defects following ablative surgery.Patients and MethodsAll patients treated with patient specific implants due to postablative maxillary defects were included. 20 implants were placed in the 19 patients (bilateral implants were placed in one of the cases). In 65.75% of the cases, resection was performed due to squamous cell carcinoma. In addition to the primary stability, the clinical implant stability, soft tissue management, successful prosthodontic restoration, and complications were evaluated at a mean follow-up period of 26 months.ResultsAll patient-specific implants showed primary stability and were clinically stable throughout the observation period. Definitive prosthodontic restorations were performed in all patients. No implant loosening was observed. Major complications occurred only in previously irradiated patients with insufficient soft tissue conditions (p = 0.058). Minor complications such as exposure of the underlying framework or mucositis were observed, but they never led to failure of restorations or implant loss.ConclusionsTreatment of postablative maxillary defects with patient-specific implants offers a safe alternative with predictable results for full and rapid dental rehabilitation, avoiding time-consuming augmentation procedures and additional donor-site morbidity.

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“…There are multiple surgical options available for the reconstruction of composite oral and maxillofacial defects (Torroni et al, 2015;Yao et al, 2020). The most commonly used donor sites include the iliac crest, the radial forearm, the scapula and the fibula (Disa et al, 2000;Valentini et al, 2009;Myeroff et al, 2011;Lodders et al, 2021). The radial free flap has the advantage of a long vascular pedicle, but its clinical vertical bone gain is expected to be only 4e6mm.…”

Section: Discussionmentioning

confidence: 99%

“…It is free of the risks of GTR, and it allows considerable bone gain (Cope et al, 2000;Ow et al, 2008;Andrade et al, 2011), therefore a closer to optimal implant-to-crown ratio may be achieved -a key factor of proper function over a long period of time. Peri-implant soft tissues can also be managed a lot easier with this approach, which reduces the risk of periimplantitis (Lodders et al, 2021). On the negative side, it is time-consuming and may be uncomfortable for the patient.…”

Section: Discussionmentioning

confidence: 99%

Vertical mandibular bone augmentation by the osteodistraction of the transplanted fibula free flap: A case series with long-term follow-up

Sass

Piffkò

Oberna

2021

Journal of Cranio-Maxillofacial Surgery

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Long-term outcomes of implant-based dental rehabilitation in head and neck cancer patients after reconstruction with the free vascularized fibula flap

Cited by 27 publications

References 26 publications

Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol

Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol

A New Strategy for Patient-Specific Implant-Borne Dental Rehabilitation in Patients With Extended Maxillary Defects

Vertical mandibular bone augmentation by the osteodistraction of the transplanted fibula free flap: A case series with long-term follow-up

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