Mandibular Reconstruction and Rehabilitation with Vascularized Free Fibula Flap with Further Endosteal Implants

Abstract

Objectives:To evaluate of the effectiveness of rehabilitation in patients following mandibulectomy and free fibula flap reconstruction with further endosteal implants. Materials and Metods: The patient cohort consisted of 27 patients years (14 males and 13 females) with lower jaw defects due to resection for tumors, were reconstructed with fibula-free flaps in a 6-year period (2015-2020). All patients underwent a thorough clinical laboratory, radiological examination according to a generally accepted scheme. Patients were evaluated by preoperative and postoperative outcome using computed tomography scan evaluation. The surgical procedure included: Segmentar resection of the lower jaw, reconstruction with fibula free flap. The implants were evaluated with measures of Resonance Frequency Analysis (RFA) during the follow-up periods using Osstell Mentor at time of implant placement, after 3 months. The mean RFA recordings of all 134 implants were 65 ISQ at implant placement respectively 73 ISQ after 3 months. After 4-6 months of healing, 152 dental implants were placed in non-irradiated fibular bone. Dental prosthetic rehabilitation was performed after 3-4 months of submerged healing. Patients had received implant-bridge and hybrid denture that provided ideal facial balance and occlusion. Results:Postoperative clinical and radiographic controls were made regularly, the criteria for implant success were assessed.With dynamic observation, clinical and radiological indices were stable, of the 152 implants installed, 2 failed to osseointegrate and 5 after years of loading (peri-implantitis). Success rate of implants 5 years after was 96.1%. Conclusion:The reconstruction of the lower jaw defects after ablation of tumors with fibular flaps is a reliable method with good long-term results. In all 27 patients, fibula flaps provided adequate bone stock for implant placement. Implants placed in the reconstructed areas were demonstrated to integrate normally. The results showed that implant treatment is effective to improve patients‘ masticatory efficiency and an acceptable quality of life to the patient