Immediate dental rehabilitation in fibula free flaps for malignancy: Is it feasible?
dental implants
fibula free flap
immediate teeth
jaw reconstruction
malignancy
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
10 May 2024
10 May 2024
Historique:
revised:
29
04
2024
received:
12
02
2024
accepted:
30
04
2024
medline:
10
5
2024
pubmed:
10
5
2024
entrez:
10
5
2024
Statut:
aheadofprint
Résumé
Fibula free flap reconstruction has revolutionized maxillofacial reconstruction. While immediate dental rehabilitation with dental implants and teeth has shown benefits, it remains uncommon, especially for patients with malignancy. A retrospective cohort study at a single institution explored immediate dental rehabilitation in fibula flaps for patients with malignant disease. Thirteen patients with malignancies that underwent immediate fibula free flap reconstruction with dental implants and dental prosthesis were included with a minimum of 3-month follow-up. Forty eight implants replaced 90 teeth in 13 patients. All implants were integrated at 3 months, with an overall success rate of 87.5%. Two patients experienced delayed (>3 months postoperatively) implant loss due to osteoradionecrosis and infection. Peri-mucositis occurred in three patients which resolved with treatment. Skin paddles were used in 11 patients and radiation therapy was not delayed for any patient. With proper patient selection, diagnosis of malignancy and the need for osteocutaneous flap reconstruction does not exclude the ability to place immediate implants and deliver an immediate dental prosthesis in head and neck reconstruction.
Sections du résumé
BACKGROUND
BACKGROUND
Fibula free flap reconstruction has revolutionized maxillofacial reconstruction. While immediate dental rehabilitation with dental implants and teeth has shown benefits, it remains uncommon, especially for patients with malignancy.
METHODS
METHODS
A retrospective cohort study at a single institution explored immediate dental rehabilitation in fibula flaps for patients with malignant disease. Thirteen patients with malignancies that underwent immediate fibula free flap reconstruction with dental implants and dental prosthesis were included with a minimum of 3-month follow-up.
RESULTS
RESULTS
Forty eight implants replaced 90 teeth in 13 patients. All implants were integrated at 3 months, with an overall success rate of 87.5%. Two patients experienced delayed (>3 months postoperatively) implant loss due to osteoradionecrosis and infection. Peri-mucositis occurred in three patients which resolved with treatment. Skin paddles were used in 11 patients and radiation therapy was not delayed for any patient.
CONCLUSION
CONCLUSIONS
With proper patient selection, diagnosis of malignancy and the need for osteocutaneous flap reconstruction does not exclude the ability to place immediate implants and deliver an immediate dental prosthesis in head and neck reconstruction.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;84:71‐79.
Lilly GL, Petrisor D, Wax MK. Mandibular rehabilitation: from the Andy Gump deformity to jaw‐in‐a‐day. Laryngoscope Investig Otolaryngol. 2021;6(4):708‐720.
Landes CA, Kovacs AF. Comparison of early telescope loading of non‐submerged ITI implants in irradiated and non‐irradiated oral cancer patients. Clin Oral Implants Res. 2006;17(4):367‐374.
Garrett N, Roumanas ED, Blackwell KE, et al. Efficacy of conventional and implant‐supported mandibular resection prostheses: study overview and treatment outcomes. J Prosthet Dent. 2006;96(1):13‐24.
Adell R, Svensson B, Bagenholm T. Dental rehabilitation in 101 primarily reconstructed jaws after segmental resections—possibilities and problems. An 18‐year study. J Craniomaxillofac Surg. 2008;36(7):395‐402.
Hundepool AC, Dumans AG, Hofer SOP, et al. Rehabilitation after mandibular reconstruction with fibula free‐flap: clinical outcome and quality of life assessment. Int J Oral Maxillofac Surg. 2008;37(11):1009‐1013.
Ch'ng S, Skoracki RJ, Selber JC, et al. Osseointegrated implant‐based dental rehabilitation in head and neck reconstruction patients. Head Neck. 2016;38(Suppl 1):E321‐E327.
Gurlek A, Miller MJ, Jacob RF, et al. Functional results of dental restoration with Osseointegrated implants after mandible reconstruction. Plast Reconstr Surg. 1998;101(3):650‐655.
Panchal H, Shamsunder MG, Petrovic I, et al. Dental implant survival in vascularized bone flaps: a systematic review and meta‐analysis. Plast Reconstr Surg. 2020;146(3):637‐648.
Sandoval ML, Rosen EB, Robert AJ, Nelson JA, Matros E, Gelblum DY. Immediate dental implants in fibula free flaps to reconstruct the mandible: a pilot study of the short‐term effects on radiotherapy for patients with head and neck cancer. Clin Implant Dent Relat Res. 2020;22(1):91‐95.
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(3):201‐206.
Ma H, van Dessel J, Shujaat S, et al. Long‐term survival of implant‐based oral rehabilitation following maxillofacial reconstruction with vascularized bone flap. Int J Implant Dent. 2022;8(1):15.
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(1):e3.
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(5):852‐859.
Levine JP, Bae JS, Soares M, et al. Jaw in a day: total maxillofacial reconstruction using digital technology. Plast Reconstr Surg. 2013;131(6):1386‐1391.
Patel A, Harrison P, Cheng A, Bray B, Bell RB. Fibular reconstruction of the maxilla and mandible with immediate implant‐supported prosthetic rehabilitation: jaw in a day. Oral Maxillofac Surg Clin North Am. 2019;31(3):369‐386.
Williams FC, Hammer DA, Wentland TR, Kim RY. Immediate teeth in fibulas: planning and digital workflow with point‐of‐care 3D printing. J Oral Maxillofac Surg. 2020;78(8):1320‐1327.
Williams FC, Hammer DA, Wentland TR, Kim RY. Immediate teeth in fibulas: expanded clinical applications and surgical technique. J Oral Maxillofac Surg. 2021;79(9):1944‐1953.
Greenstein G, Cavallaro J. The clinical significance of keratinized gingiva around dental implants. Compen Contin Educ Dent. 2011;32(8):24‐31.
Zigdon H, Machtei EE. The dimensions of keratinized mucosa around implants affect clinical and immunological parameters. Clin Oral Implants Res. 2008;19(4):387‐392.
Boynuegri D, Nemli SK, Kasko YA. Significance of keratinized mucosa around dental implants: a prospective study. Clin Oral Implants Res. 2013;24(8):928‐933.
Li BH, Byun SH, Kim SM, Lee JH. The clinical outcome of dental implants placed through skin flaps. Otolaryngol Head Neck Surg. 2014;151(6):945‐951.
Wang M, Abdelrehem A, Qu X, Zhang C. Thinned‐out skin paddle versus collagen matrix as an optimized peri‐implant soft tissue following fibula osteoseptocutaneous free flap: 3‐year retrospective study. Int J Oral Maxillofac Surg. 2021;50(3):391‐397.
Qaisi M, Kolodney H, Swedenburg G, Chandran R, Caloss R. Fibula jaw in a day: state of the art in maxillofacial reconstruction. J Oral Maxillofac Surg. 2016;74(6):1284 e1.
Hutchison IL, Dawood A, Tanner S. Immediate implant supported bridgework simultaneous with jaw reconstruction for a patient with mandibular osteosarcoma. Br Dent J. 2009;206(3):143‐146.
Allen RJ Jr, Shenaq DS, Rosen EB, et al. Immediate dental implantation in oncologic jaw reconstruction: workflow optimization to decrease time to full dental rehabilitation. Plast Reconstr Surg Glob Open. 2019;7(1):e2100.
Anolik RA, Nelson JA, Rosen EB, Disa J, Matros E, Allen RJ. Immediate dental implant placement in the oncologic setting: a conceptual framework. Plast Reconstr Surg Glob Open. 2021;9(9):e3671.
Kumar VV, Ebenezer S, Kämmerer PW, et al. Implants in free fibula flap supporting dental rehabilitation—implant and peri‐implant related outcomes of a randomized clinical trial. J Craniomaxillofac Surg. 2016;44(11):1849‐1858.
Walia A, Mendoza J, Bollig CA, et al. A comprehensive analysis of complications of free flaps for Oromandibular reconstruction. Laryngoscope. 2021;131(9):1997‐2005.
Yamashita J, Akashi M, Takeda D, Kusumoto J, Hasegawa T, Hashikawa K. Occurrence and treatment outcome of late complications after free fibula flap reconstruction for mandibular osteoradionecrosis. Cureus. 2021;13(3):e13833.