Outcomes and influencing factors of dental implants in fibula, iliac crest, and scapula free flaps: a retrospective case-control study.
Dental implants
Head and neck cancer
Implant success
Implant survival
Oral rehabilitation
Vascularized free flaps
Journal
International journal of implant dentistry
ISSN: 2198-4034
Titre abrégé: Int J Implant Dent
Pays: Germany
ID NLM: 101676532
Informations de publication
Date de publication:
09 Feb 2024
09 Feb 2024
Historique:
received:
22
09
2023
accepted:
11
01
2024
medline:
9
2
2024
pubmed:
9
2
2024
entrez:
9
2
2024
Statut:
epublish
Résumé
Reconstruction with vascularized bone grafts after ablative surgery and subsequent dental rehabilitation with implants is often challenging; however, it helps improve the patient's quality of life. This retrospective case-control study aimed to determine the implant survival/success rates in different vascularized bone grafts and potential risk factors. Only patients who received implants in free vascularized bone grafts between 2012 and 2020 were included. The free flap donor sites were the fibula, iliac crest, and scapula. The prosthetic restoration had to be completed, and the observation period had to be over one year after implantation. Implant success was defined according to the Health Scale for Dental Implants criteria. Sixty-two patients with 227 implants were included. The implant survival rate was 86.3% after an average of 48.7 months. The causes of implant loss were peri-implantitis (n = 24), insufficient osseointegration (n = 1), removal due to tumor recurrence (n = 1), and osteoradionecrosis (n = 5). Of all implants, 52.4% were classified as successful, 19.8% as compromised, and 27.8% as failed. Removal of osteosynthesis material prior to or concurrent with implant placement resulted in significantly better implant success than material not removed (p = 0.035). Localization of the graft in the mandibular region was associated with a significantly better implant survival (p = 0.034) and success (p = 0.002), also a higher Karnofsky Performance Status Scale score with better implant survival (p = 0.014). Implants placed in vascularized grafts showed acceptable survival rates despite the potential risk factors often present in these patient groups. However, peri-implantitis remains a challenge.
Identifiants
pubmed: 38334913
doi: 10.1186/s40729-024-00522-5
pii: 10.1186/s40729-024-00522-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
8Subventions
Organisme : Universitätsklinikum Hamburg-Eppendorf
ID : Open Access Publication Fund of UKE - Universitätsklinikum Hamburg-Eppendorf
Organisme : Universitätsklinikum Hamburg-Eppendorf
ID : DFG - German Research Foundation
Informations de copyright
© 2024. The Author(s).
Références
Ch’ng S, Skoracki RJ, Selber JC, Yu P, Martin JW, Hofstede TM, Chambers MS, Liu J, Hanasono MM. Osseointegrated implant-based dental rehabilitation in head and neck reconstruction patients. Head Neck. 2016;38(Suppl 1):E321–7.
pubmed: 25546139
Fenlon MR, Lyons A, Farrell S, Bavisha K, Banerjee A, Palmer RM. Factors affecting survival and usefulness of implants placed in vascularized free composite grafts used in post-head and neck cancer reconstruction. Clin Implant Dent Relat Res. 2012;14:266–72. https://doi.org/10.1111/j.1708-8208.2009.00250.x .
doi: 10.1111/j.1708-8208.2009.00250.x
pubmed: 19843102
Laverty DP, Addison O, Wubie BA, Heo G, Parmar S, Martin T, Praveen P, Pearson D, Newsum D, Murphy M, Bateman G. Outcomes of implant-based oral rehabilitation in head and neck oncology patients-a retrospective evaluation of a large, single regional service cohort. Int J Implant Dent. 2019;5:8.
pubmed: 30834461
pmcid: 6399356
doi: 10.1186/s40729-019-0161-y
Parbo N, Murra NT, Andersen K, Buhl J, Kiil B, Nørholt SE. Outcome of partial mandibular reconstruction with fibula grafts and implant-supported prostheses. Int J Oral Maxillofac Surg. 2013;42:1403–8.
pubmed: 23773236
doi: 10.1016/j.ijom.2013.05.007
Nooh N. Dental implant survival in irradiated oral cancer patients: a systematic review of the literature. Int J Oral Maxillofac Implants. 2013;28:1233–42.
pubmed: 24066313
doi: 10.11607/jomi.3045
Kniha K, Möhlhenrich SC, Foldenauer AC, Peters F, Ayoub N, Goloborodko E, Hölzle F, Modabber A. Evaluation of bone resorption in fibula and deep circumflex iliac artery flaps following dental implantation: a three-year follow-up study. J Craniomaxillofac Surg. 2017;45:474–8.
pubmed: 28258918
doi: 10.1016/j.jcms.2017.01.014
Laverty DP, Kelly R, Addison O. Survival of dental implants placed in autogenous bone grafts and bone flaps in head and neck oncology patients: a systematic review. Int J Implant Dent. 2018;4:19.
pubmed: 29971513
pmcid: 6029983
doi: 10.1186/s40729-018-0131-9
Panchal H, Shamsunder MG, Petrovic I, Rosen EB, Allen RJ, Hernandez M, Ganly I, Boyle JO, Matros E, Nelson JA. Dental implant survival in vascularized bone flaps: a systematic review and meta-analysis. Plast Reconstr Surg. 2020;146:637–48. https://doi.org/10.1097/PRS.0000000000007077 .
doi: 10.1097/PRS.0000000000007077
pubmed: 32459736
pmcid: 8435212
Pellegrino G, Tarsitano A, Ferri A, Corinaldesi G, Bianchi A, Marchetti C. Long-term results of osseointegrated implant-based dental rehabilitation in oncology patients reconstructed with a fibula free flap. Clin Implant Dent Relat Res. 2018;20:852–9.
pubmed: 30144257
doi: 10.1111/cid.12658
Ma H, van Dessel J, Shujaat S, Bila M, Sun Y, Politis C, Jacobs R. Long-term survival of implant-based oral rehabilitation following maxillofacial reconstruction with vascularized bone flap. Int J Implant Dent. 2022;8:15. https://doi.org/10.1186/s40729-022-00413-7 .
doi: 10.1186/s40729-022-00413-7
pubmed: 35378661
pmcid: 8980171
Howe M-S, Keys W, Richards D. Long-term (10-year) dental implant survival: a systematic review and sensitivity meta-analysis. J Dent. 2019;84:9–21.
pubmed: 30904559
doi: 10.1016/j.jdent.2019.03.008
Burgess M, Leung M, Chellapah A, Clark JR, Batstone MD. Osseointegrated implants into a variety of composite free flaps: a comparative analysis. Head Neck. 2017;39:443–7.
pubmed: 27880030
doi: 10.1002/hed.24609
Watanabe T, Kawahara D, Inoue R, Kato T, Ishihara N, Kamiya H, Bessho K. Squamous cell carcinoma around a subperiosteal implant in the maxilla and the association of chronic mechanical irritation and peri-implantitis: a case report. Int J Implant Dent. 2022;8:10.
pubmed: 35235079
pmcid: 8891407
doi: 10.1186/s40729-022-00409-3
Schwarz F, Derks J, Monje A, Wang H-L. Peri-implantitis. J Periodontol. 2018;89(Suppl 1):S267–90.
pubmed: 29926957
Attia S, Wiltfang J, Pons-Kühnemann J, Wilbrand J-F, Streckbein P, Kähling C, Howaldt H-P, Schaaf H. Survival of dental implants placed in vascularised fibula free flaps after jaw reconstruction. J Craniomaxillofac Surg. 2018;46:1205–10.
pubmed: 29884312
doi: 10.1016/j.jcms.2018.05.008
Brito C, Tenenbaum HC, Wong BKC, Schmitt C, Nogueira-Filho G. Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature. J Biomed Mater Res B Appl Biomater. 2014;102:643–50.
pubmed: 24124021
doi: 10.1002/jbm.b.33042
Curi MM, Condezo AFB, Ribeiro KDCB, Cardoso CL. Long-term success of dental implants in patients with head and neck cancer after radiation therapy. Int J Oral Maxillofac Surg. 2018;47:783–8.
pubmed: 29426738
doi: 10.1016/j.ijom.2018.01.012
Mombelli A, Müller N, Cionca N. The epidemiology of peri-implantitis. Clin Oral Implants Res. 2012;23(Suppl 6):67–76.
pubmed: 23062130
doi: 10.1111/j.1600-0501.2012.02541.x
Chrcanovic BR, Albrektsson T, Wennerberg A. Smoking and dental implants: a systematic review and meta-analysis. J Dent. 2015;43:487–98.
pubmed: 25778741
doi: 10.1016/j.jdent.2015.03.003
Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A. Factors influencing early dental implant failures. J Dent Res. 2016;95:995–1002.
pubmed: 27146701
doi: 10.1177/0022034516646098
Khaleghi G, Mahdavi H, Mahdavi SR, Khajetash B, Nikoofar A, Hosntalab M, Sadeghi M, Reiazi R. Investigating dose homogeneity in radiotherapy of oral cancers in the presence of a dental implant system: an in vitro phantom study. Int J Implant Dent. 2021;7:90.
pubmed: 34486092
pmcid: 8419140
doi: 10.1186/s40729-021-00372-5
Misch CE, Perel ML, Wang H-L, Sammartino G, Galindo-Moreno P, Trisi P, Steigmann M, Rebaudi A, Palti A, Pikos MA, Schwartz-Arad D, Choukroun J, Gutierrez-Perez J-L, Marenzi G, Valavanis DK. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent. 2008;17:5–15.
pubmed: 18332753
doi: 10.1097/ID.0b013e3181676059
Brierley JD. TNM classification of malignant tumours. 8th ed. Chichester: Wiley Blackwell; 2017.
Bruggenkate ten CM, van der Kwast WA, Oosterbeek HS. Success criteria in oral implantology. A review of the literature. Int J Oral Implantol. 1990;7:45–51.
Khadembaschi D, Russell P, Beech N, Batstone MD. Osseointegrated implant survival, success and prosthodontic outcomes in composite free flaps: a 10-year retrospective cohort study. Clin Oral Implants Res. 2021;32:1251–61.
pubmed: 34352129
doi: 10.1111/clr.13822
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1:11–25.
pubmed: 3527955
Chiapasco M, Biglioli F, Autelitano L, Romeo E, Brusati R. Clinical outcome of dental implants placed in fibula-free flaps used for the reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis. Clin Oral Implants Res. 2006;17:220–8.
pubmed: 16584419
doi: 10.1111/j.1600-0501.2005.01212.x
Gangwani P, Almana M, Barmak B, Kolokythas A. What is the success of implants placed in fibula flap? A systematic review and meta-analysis. J Oral Maxillofac Res. 2022;13: e3.
pubmed: 35574211
pmcid: 9069636
doi: 10.5037/jomr.2022.13103
Lodders JN, Leusink FKJ, Ridwan-Pramana A, Winters HAH, Karagozoglu KH, Dekker H, Forouzanfar T, Schulten EAJM. Long-term outcomes of implant-based dental rehabilitation in head and neck cancer patients after reconstruction with the free vascularized fibula flap. J Craniomaxillofac Surg. 2021;49:845–54.
pubmed: 33985871
doi: 10.1016/j.jcms.2021.03.002
Chiapasco M, Romeo E, Coggiola A, Brusati R. Long-term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo-mandibular defects due to extreme atrophy. Clin Oral Implants Res. 2011;22:83–91.
pubmed: 20868451
doi: 10.1111/j.1600-0501.2010.01999.x
Fang W, Liu Y-P, Ma Q, Liu B-L, Zhao Y. Long-term results of mandibular reconstruction of continuity defects with fibula free flap and implant-borne dental rehabilitation. Int J Oral Maxillofac Implants. 2015;30:169–78.
pubmed: 25265128
doi: 10.11607/jomi.3606
Papaspyridakos P, Chen C-J, Singh M, Weber H-P, Gallucci GO. Success criteria in implant dentistry: a systematic review. J Dent Res. 2012;91:242–8.
pubmed: 22157097
doi: 10.1177/0022034511431252
Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer. 1948;1:634–56.
doi: 10.1002/1097-0142(194811)1:4<634::AID-CNCR2820010410>3.0.CO;2-L
Wilkman T, Husso A, Lassus P. Clinical comparison of scapular, fibular, and iliac crest osseal free flaps in maxillofacial reconstructions. Scand J Surg. 2019;108:76–82.
pubmed: 29732952
doi: 10.1177/1457496918772365
Möhlhenrich SC, Kniha K, Elvers D, Ayoub N, Goloborodko E, Hölzle F, Modabber A. Intraosseous stability of dental implants in free revascularized fibula and iliac crest bone flaps. J Craniomaxillofac Surg. 2016;44:1935–9.
pubmed: 27769721
doi: 10.1016/j.jcms.2016.09.011
Akkocaoglu M, Cehreli MC, Tekdemir I, Comert A, Güzel E, Dağdeviren A, Akca K. Primary stability of simultaneously placed dental implants in extraoral donor graft sites: a human cadaver study. J Oral Maxillofac Surgery. 2007;65:400–7.
doi: 10.1016/j.joms.2005.12.073
Haas R, Haimböck W, Mailath G, Watzek G. The relationship of smoking on peri-implant tissue: a retrospective study. J Prosthet Dent. 1996;76:592–6.
pubmed: 8957783
doi: 10.1016/S0022-3913(96)90435-7
Kasat V, Ladda R. Smoking and dental implants. J Int Soc Prev Community Dent. 2012;2:38–41.
pubmed: 24478965
pmcid: 3894084
doi: 10.4103/2231-0762.109358
Twito D, Sade P. The effect of cigarette smoking habits on the outcome of dental implant treatment. PeerJ. 2014;2: e546.
pubmed: 25237600
pmcid: 4157230
doi: 10.7717/peerj.546
Naseri R, Yaghini J, Feizi A. Levels of smoking and dental implants failure: a systematic review and meta-analysis. J Clin Periodontol. 2020;47:518–28.
pubmed: 31955453
doi: 10.1111/jcpe.13257
Neves J, Araújo Nobre de M, Oliveira P, Martins Dos Santos J, Malo P. Risk factors for implant failure and peri-implant pathology in systemic compromised patients. J prosthodont. 2018;27:409–15.
pubmed: 27348845
doi: 10.1111/jopr.12508
Jackson RS, Price DL, Arce K, Moore EJ. Evaluation of clinical outcomes of osseointegrated dental implantation of fibula free flaps for mandibular reconstruction. JAMA Facial Plast Surg. 2016;18:201–6.
pubmed: 26868226
doi: 10.1001/jamafacial.2015.2271
Schiegnitz E, Müller LK, Sagheb K, Theis L, Cagiran V, Kämmerer PW, Wegener J, Wagner W, Al-Nawas B. Clinical long-term and patient-reported outcomes of dental implants in oral cancer patients. Int J Implant Dent. 2021;7:93.
pubmed: 34255187
pmcid: 8276905
doi: 10.1186/s40729-021-00373-4
Chrcanovic BR, Albrektsson T, Wennerberg A. Dental implants in irradiated versus nonirradiated patients: a meta-analysis. Head Neck. 2016;38:448–81.
pubmed: 25242560
doi: 10.1002/hed.23875
Chen H, Liu N, Xu X, Qu X, Lu E. Smoking, radiotherapy, diabetes and osteoporosis as risk factors for dental implant failure: a meta-analysis. PLoS ONE. 2013;8: e71955.
pubmed: 23940794
pmcid: 3733795
doi: 10.1371/journal.pone.0071955
ZenFilho EV, Tolentino EDS, Santos PSS. Viability of dental implants in head and neck irradiated patients: a systematic review. Head Neck. 2016;38(Suppl 1):E2229–40.
Claudy MP, Miguens SAQ, Celeste RK, Camara Parente R, Hernandez PAG, da Silva AN. Time interval after radiotherapy and dental implant failure: systematic review of observational studies and meta-analysis. Clin Implant Dent Relat Res. 2015;17:402–11.
pubmed: 23742098
doi: 10.1111/cid.12096
Jacobsson MG, et al. Short- and long-term effects of irradiation on bone regeneration. Plast Reconstr Surg. 1985;76(6):848–841.
doi: 10.1097/00006534-198512000-00006
Marx RE, Johnson RP. Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol. 1987;64(4):379–90.
pubmed: 3477756
doi: 10.1016/0030-4220(87)90136-8
Schoen PJ, Reintsema H, Raghoebar GM, Vissink A, Roodenburg JLN. The use of implant retained mandibular prostheses in the oral rehabilitation of head and neck cancer patients. A review and rationale for treatment planning. Oral Oncol. 2004;40:862–71. https://doi.org/10.1016/j.oraloncology.2003.08.024 .
doi: 10.1016/j.oraloncology.2003.08.024
pubmed: 15380163
Moore P, Grinsell D, Lyons B, Hewson I. Outcomes of dental and craniofacial osseointegrated implantation in head and neck cancer patients. Head Neck. 2019;41:3290–8.
pubmed: 31215724
doi: 10.1002/hed.25845
Zavattero E, Ramieri G, Agrò G, Fasolis M, Garzino-Demo P, Borbon C. Implant dental rehabilitation of fibula-free flap reconstructed jaws. J Craniofac Surg. 2021;32:e134–6.
pubmed: 33705050
doi: 10.1097/SCS.0000000000006874
Goker F, Baj A, Bolzoni AR, Maiorana C, Racco P, Taschieri S, Beretta P, Beltramini G, Gianni AB, Del Fabbro M. Effectiveness of dental implants placed into microvascular free flaps. Oral Dis. 2020;26:1532–6.
pubmed: 32475068
doi: 10.1111/odi.13451
Hidalgo DA. Titanium miniplate fixation in free flap mandible reconstruction. Ann Plast Surg. 1989;23:498–507.
pubmed: 2624393
doi: 10.1097/00000637-198912000-00005
Chiodo AA, Gur E, Pang CY, Neligan PC, Boyd JB, Binhammer PM, Forrest CR. The vascularized pig fibula bone flap model: effect of segmental osteotomies and internal fixation on blood flow. Plast Reconstr Surg. 2000;105:1004–12.
pubmed: 10724261
doi: 10.1097/00006534-200003000-00025
Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;84:71–9.
pubmed: 2734406
doi: 10.1097/00006534-198907000-00014
Rhinelander FW. Tibial blood supply in relation to fracture healing. Clin Orthop Relat Res. 1974;105:34–81.
doi: 10.1097/00003086-197411000-00005
Jain R, Podworny N, Hearn T, Anderson GI, Schemitsch EH. Effect of stainless steel and titanium low-contact dynamic compression plate application on the vascularity and mechanical properties of cortical bone after fracture. J Orthop Trauma. 1997;11:490–5.
pubmed: 9334950
doi: 10.1097/00005131-199710000-00006
Kregor PJ, Senft D, Parvin D, Campbell C, Toomey S, Parker C, Gillespy T, Swiontkowski MF. Cortical bone perfusion in plated fractured sheep tibiae. J Orthop Res. 1995;13:715–24.
pubmed: 7472750
doi: 10.1002/jor.1100130511
Uhthoff HK, Finnegan M. The effects of metal plates on post-traumatic remodelling and bone mass. J Bone Joint Surg Br. 1983;65:66–71.
pubmed: 6822605
doi: 10.1302/0301-620X.65B1.6822605