The Treatment of Lower Jaw Defects Using Vascularized Fibula Graft and Dental Implants

Abstract

This study is based on an analysis of the results of treatment of 21 patients with mandibular defects of different localization and etiology who underwent reconstruction with fibula free flap. Postoperative clinical and radiographic controls were made regularly, the criteria for implant success were assessed. The postoperative evolution of the patients was favorable, with the integration of the fibula vascularized grafts. Complete engraftment of bone autografts and wound healing was obtained in all observations. In all 21 patients, fibula flaps provided adequate conditions for implant placement. The coefficient of osteointegration of implants 3 years after bone grafting was 97%. Using a vascularized autograft from the fibula to replace the defects of the lower jaw provides the conditions for a full rehabilitation of patients. The methods of reconstructive surgery and implantation make it possible to successfully perform the replacement of defects in the maxillofacial region, being one of the methods medical and social rehabilitation of patients with this pathology.

Systematic review and pooled analysis of survival rates, success, and outcomes of osseointegrated implants in a variety of composite free flaps

“…Individual level data were pooled from 18 included articles, 13,15,[18][19][20][21][22][23][24][25]29,32,35,37,38,41,42,44 and cumulative survival was estimated with Kaplan-Meier curves for implants placed into FFF and DCIA ( Figure 2). Other flap types were not included due to insufficient numbers.…”

“…Other flap types were not included due to insufficient numbers. A total of 1057 implants from 17 studies placed into FFF (FFF or double barreled fibula free flap [DBFFF], not bone impacted fibula free flap [BIFFF]), 13,15,[18][19][20][21][22][23][24][25]29,32,35,37,38,41,42 and 271 placed into DCIA flaps from five studies were included. 15,18,32,37,44 The cumulative 5-year survival was 94% for implants placed into both FFF and DCIA and there was no statistical difference between the survival curves ( Figure 2).…”

“…8,16,[19][20][21][22][23]25,[30][31][32][33][34][35][36][38][39][40][41][42][43] The definition for implant survival was no implants lost during follow-up period for 19 (56%) of the articles and the remaining articles gave different criteria for survival or may have given a success definition. Reasons attributed to implant failure included the following: radiation exposure, 8,18,27,32,38,39,42,44 peri-implantitis, 22,23,26,33,35,37,38,40,43 failure of osseointegration, 22,25,29,32,38,40 unable to incorporate into prosthesis, 25,26,33,40 graft fracture, …”

“…56 Two of the included articles measured primary stability using resonance frequency analysis (RFA), which gives an implant stability quotient (ISQ) as a unit of measure. 24,29 This method has been shown to be an accurate measure of implant stability in native bone. 57 The fibula has heterogeneous structure compared with native maxilla or mandible, with a cylinder of dense cortical bone and a small cancellous core.…”

Reconstruction the Postablative Lower Jaw Defects with Vascularized Free Fibula Flap with Further Endosteal Implants

“…lowing key objectives: 1) Obliteration of the defect; 2) Restoration of function; particularly speech and mastication; 3) Structural support for reconstruction of external facial features; and 4) Aesthetic reconstruction of these external facial features [2]. The goals of mandibular reconstruction are to re-establish the form of the lower third of the face and to restore the patient's ability to eat in public, be intelligible to both trained and untrained listeners, and to maintain an unencumbered airway that allows the freedom to perform all activities [3]. Loss of mucosa from the floor of mouth is critical in the assessment of whether to restore this component of the defect with non-native tissue.…”