Long-term survival of implant-based oral rehabilitation following maxillofacial reconstruction with vascularized bone flap

Abstract

Aim The aim of the study was to assess the 5-year cumulative survival rate of implant-based dental rehabilitation following maxillofacial reconstruction with a vascularized bone flap and to investigate the potential risk factors which might influence the survival rate. Materials and methods A retrospective cohort study was designed. Inclusion criteria involved 18 years old or above patients with the availability of clinical and radiological data and a minimum follow-up 1 year following implant placement. The cumulative survival rate was analyzed by Kaplan–Meier curves and the influential risk factors were assessed using univariate log-rank tests and multivariable Cox-regression analysis. Results 151 implants were assessed in 40 patients with a mean age of 56.43 ± 15.28 years at the time of implantation. The mean number of implants placed per patient was 3.8 ± 1.3 with a follow-up period of 50.0 ± 32.0 months. The cumulative survival at 1-, 2- and 5-years was 96%, 87%, and 81%. Patients with systemic diseases (HR = 3.75, 95% CI 1.65–8.52; p = 0.002), irradiated flap (HR = 2.27, 95% CI 1.00–5.17; p = 0.05) and poor oral hygiene (HR = 11.67; 95% CI 4.56–29.88; p < 0.0001) were at a significantly higher risk of implant failure. Conclusion The cumulative implant survival rate was highest at 1st year followed by 2nd and 5th year, indicating that the risk of implant failure increased over time. Risk indicators that seem to be detrimental to long-term survival include poor oral hygiene, irradiated flap and systemic diseases.

Optimal Treatment Order With Fibula-Free Flap Reconstruction, Oncologic Treatment, and Dental Implants: A Systematic Review and Meta-Analysis

“…The primary oncologic diagnosis was oral squamous cell carcinoma in most studies (66.7%), followed by adenoid cystic carcinoma 8,[18][19][20] and other malignant tumors/carcinomas of the head and neck. [21][22][23][24] Primary reconstruction, defined as FFF reconstruction occurring during the tumor resection surgery, was the only reconstructive method performed in 14 studies. Secondary reconstruction, defined as the FFF reconstruction in a separate surgery after the first ablative surgery, was the sole reconstruction method performed in 5 studies.…”

“…19,[25][26][27][28][29][30] Supplemental Table 2, Supplemental Digital Content 1, http://links.lww.com/SCS/G5 provides information about the implants and RTX treatment. Eight studies described implants placed in both native bone and the flap, 8,18,[20][21][22]29,31,32 Neckel and colleagues had all implants placed in the irradiated native bone, and the remaining 11 studies described implants placed only in the fibula. Fifteen studies included patients with maxillary and mandibular implants, with the remaining 5 presenting only mandibular implants.…”

“…The remaining 2 studies consisted of cases with secondary reconstruction procedures. 8,22 Barrowman and colleagues had implant placement during reconstruction, and Ma and colleagues had implant placement after reconstruction. The pooled survival rate for post-operative RTX and secondary reconstruction implants is 81%, which is approaching significance to be lower than primary reconstruction and post-implantation RTX (Supplemental Table 3, Supplemental Digital Content 1, http://links.lww.com/SCS/G5: 81% versus 92%, P = 0.066).…”

Clinical outcomes and periodontal conditions of dental implants placed in free fibula flaps (FFF): a retrospective study with a mean follow-up of 6 years

“…These findings are comparable to those published by several authors, who registered an overall implant survival of 93.5% on average, with a range of percentages between 83 and 97% from 1 to 5 years after placement [ 1 , 21 , 34 – 49 ], and a mean 5-year survival rate of 91% [ 50 ]. Lower values of 5-year implant survival (81% [ 51 ], 85.6% [ 52 ], and 87.2% [ 53 ]) were reported in studies which underlined recurrence of tumor, soft tissue proliferation, and infection as main factors involved in implant failure. On the other hand, higher percentages of 97.2% [ 33 ] and 98% [ 48 ] were reported after a mean follow-up of even 8 years after implant loading.…”

The Survival and Success of External Type Dental Implant after Vascularized Mandibular Reconstruction

“…Lei et al reported a 93.2% cumulative survival rate of implants placed in bone flaps, with a longest follow-up of 12.9 years; 10 Wei et al reported 5-, 10-, and 20-year implant survival rates of 90.1%, 83.1%, and 69.3%, respectively; 11 Gerardo et al reported 1-, 5-, and 10-year implant survival rates of 97.2%, 86.5%, and 79.3%, respectively; 12 Sameh et al reported 1-and 11-yearcumulative survival rates of 93% and 78%, respectively;13 and Hongyang et al reported 1-, 2-and 5-year cumulative survival rates of 96%, 87%, and 81%, respectively 14. In this study, only 7 out of 100 implants failed, with 5-and 10-year implant survival rates of 95.0% and 91.5%, respectively.…”