Trends in Orthognathic Surgery: A National Survey of Orthodontists

Abstract

the remaining 22 (85%) having mandibular defects; all were reconstructed with fibula free flaps. Thirteen patients had Class I defects (50%), twelve patients had Class II defects (46%), and one patient had a Class III defect (4%). A total of 123 endosseous implants were placed, 100 of which were in the reconstructed fibula. The remaining 23 implants were placed in native bone adjacent to the fibula, to be included as part of the final restorative plan. Eighty three of the implants (67%) were immediately placed at the time of fibula reconstruction, and the remaining 40 (33%) were placed after a healing period. Ten patients received adjuvant radiation therapy after implant placement (47 implants). The overall implant success rate was 94.3%. Four implants were buried and not used, as only palliative care was sought following fibula flap and implant placement due to the development of distant metastasis during the convalescence period. There were a total of seven implant failures, all of which were immediately placed at the time of the microvascular reconstruction. One failed implant was in the native mandible adjacent to the fibula. Three (43%) of the failed implants were in the radiation category. Five implants (71%) failed in Class I defect reconstructions and two implants (29%) failed with Class II defects. All of the prosthesis were implant retained and in functional occlusion. There was a high survival rate of endosseous implants placed in fibula free flap reconstructions. This applied to implants placed immediately at the time of fibula reconstruction, as well as delayed implant placement. There was no statistical significance (p>.05) between radiation exposure and implant failure or between timing of implant placement and failure, despite the higher number of failures being in the immediate category. The reconstruction of maxillofacial defectswithfibula and endosseous implants remains a reliable option in the functional rehabilitation of patients.