Papers that provide practical answers to clinical questions have an impact, and can – if acted upon – improve clinical care. From the many papers published about implants I have chosen a few that have modified my practice and I hope will benefit your patients.Schepers RH, Slagter AP, Kaanders JH, van den Hoogen FJ, Merkx MA. Effect of postoperative radiotherapy on the functional result of implants placed during ablative surgery for oral cancer.Int J Oral Maxillofac Surg2006;35:803–8. Epub 2006, May 11.This is a retrospective evaluation of the survival of dental implants in 48 patients who had surgery alone or in combination with postoperative radiotherapy. Implants were placed during ablative surgery for resection of squamous cell carcinoma of the floor of the mouth, in the anterior part of the lower edentulous jaw in the period 1996–2003. Two to four Branemark Mk II/III 2-implants were placed in each patient (139 implants in total). Twenty-one patients (61 implants) were given postoperative radiotherapy (as 60–68Gy a boost dose on the primary tumour site, and 10–68Gy on the symphyseal area). No difference was found in the percentage of functional dentures on implants between the groups that were and were not irradiated. The survival of the implants as judged by osseointegration was 97% in the postoperative irradiated group and 100% in the non-irradiated group. Postoperative radiotherapy does not affect the osseointegration of dental implants placed during ablation of a tumour.CommentAlthough not all patients were successfully rehabilitated with an implant-supported prosthesis for other reasons including local recurrence of the tumour, the use of postoperative radiotherapy did not significantly affect the success of primary placement of the implant (in the anterior edentulous mandible) at the time that the tumour was resected. Primary placement enables earlier rehabilitation and the avoidance of a further operation.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 Res2006;17:220–8.Revascularised flaps are a valuable way of replacing tissues after resection of the jaw. Fibular bone usually gives favourable conditions for placement of implants to enable full rehabilitation of patients. The clinical outcome of fibular free flaps over an eight year period was reported in 59 patients, 16 of whom were given 71 implants for prosthetic rehabilitation of the reconstructed edentulous areas. Of the 59 fibular free flaps, three failed and had to be removed, nine partially necrosed (involving the bony segment or the skin paddle) but survived, while the remaining 47 healed uneventfully (mean (range) follow-up 55 (24–120) months). The cumulative survival of fibular free flaps was 95%. The mean follow-up of the 16 patients treated with dental implants and implant-supported prostheses was 50 months (24–96). The cumulative success of implants and their survival were 99% and 93%, respectively. The use of fibular free flaps is a reliable technique with good long-term results. Implants placed in the reconstructed areas integrated normally; their success and survival were comparable to those obtained with implants placed in native bone.Kramer FJ, Dempf R, Bremer B. Efficacy of dental implants placed into fibula-free flaps for orofacial reconstruction.Clin Oral Implants Res2005;16:80–8.This study reports a prospective study of 16 consecutive patients given free fibular grafts and 51 dental implants between 1999 and 2001. All implants were inserted secondarily after bone grafting and loaded after 3 months of submerged healing. The implant success was evaluated clinically, radiographically, and by resonance frequency analysis.