Oral Rehabilitation With Osseointegrated Implants in Oncologic Patients

Abstract

The esthetic and functional rehabilitation of oncologic patients subjected to major resection surgery constitutes one of the greatest challenges for the head and neck surgeon. Immediate bone reconstruction with microsurgical free tissue transfer and dental implants has constituted a genuine revolution in the management of such patients. We present a series of 111 oncologic patients, involving a total of 706 implants, who underwent reconstruction with pedicled or free microsurgical flaps. The osseointegration success rate was 92.9%, with a global failure rate (malpositioning or failed osseointegration or loading) of 15%. Failure particularly affected the group of irradiated patients and those subjected to lateral osseomyocutaneous trapezial pedicled flap reconstruction. Excellent results were obtained with the fibular and iliac crest free flaps and osseointegrated dental implants. The difficulties of prosthetic rehabilitation are discussed, along with the individualized solutions applied, the repercussions on the temporomandibular joint, and the management protocol adopted by our service.