Microsurgical Reconstruction of the Jaw With Fibular Grafts and Implants

Abstract

Reconstructive treatments for jaw defects are complex procedures that can combine multiple techniques including fibula free flap (FFF) grafting. The purpose of this retrospective study was to document and share our experience on mandibular and maxillar reconstruction with FFF followed by secondary dental rehabilitation using implant insertion.We reviewed 198 patients treated by FFF grafting for mandibular and/or maxillary defects in our department during the past 11 years (1996-2007). A selection of 30 patients (18 males and 12 females, mean age of 46 y) with adequate criteria (hygiene, motivation, and prognosis) received secondary placement of osseointegrated implants. The implant success was clinically and radiographically evaluated.A total of 105 osseointegrated implants were placed in the grafted fibulas 5 months to 3 years after the reconstruction surgery. Only 4 implants were lost because of peri-implantitis (3 patients) and fibular fracture (1 patient); this corresponds to a 96.2% implant success rate.During the mean follow-up of 76 months, patient's satisfaction and functional and aesthetic results were evaluated. Radiologic findings indicated a low crest resorption around the implants despite an unfavorable crown-to-root ratio.The main difficulties in the reconstructions were lack of FFF height, absence of a vestibular groove, limitation of mouth opening, skin paddle thickness, and the reconstruction of surrounding tissues including the lip. Our management strategy is discussed.Prosthetic choice is fundamental to achieving patient-specific solutions. The prostheses used included sealed or screwed bridge, resin-bonded bridge, tooled bar, implant-borne denture, or implant-stabilized dentures. Dental implants may be used even in situations involving an unfavorable crown-to-root ratio and implant position by using milled bar and overdenture. The FFF provides a consistent bone graft that allows a reliable and predictable restoration with dental implants, leading to a satisfactory functional and aesthetic restoration.

The Jugaad Technique for Jaw Reconstruction: Denture Based Inverse Planning

“…Various reviews have shown that only about 15-25 % of patients who have been reconstructed end up with dental rehabilitation, the remainder of patients staying functionally crippled [5,6]. One of the causes for such a low rate of rehabilitation is that the reconstructed bone is in a poor relation to support implants.…”

Ingénierie du tissu osseux oro-maxillofacial par combinaison de biomatériaux, cellules souches, thérapie génique

“…Les techniques actuelles de réparation privilégient l'apport de tissu osseux autologue, sous forme de greffes osseuses non vascularisées [1,2] ou de lambeaux libres micro-anastomosés [3], car l'utilisation de ces greffons autologues permet de réduire les phénomènes de rejet immunitaire. Ces techniques permettent ainsi l'apport conjoint d'un support (ou matrice) et de cellules osseuses, fonctionnelles et actives, ainsi qu'une éventuelle suppléance vasculaire en fonction de la technique chirurgicale et du volume greffé.…”

Mandibular Reconstruction with Vascularized Osseous Free Flaps: a Review of the Literature

“…However, Raoul et al suggested that implant placement should be avoided in areas that have received radiotherapy doses of more than 50 Gy (Raoul et al, 2009 Raoul et al reported that implant loss occurred only in 1 irradiated vascularized fibula flap among a total of 18 implants placed in 6 patients, representing a success rate of 94% (Raoul et al, 2009). Salinas et al reported a 72.5% osseointegration rate for 51 implants placed in 22 patients (Salinas et al, 2010).…”