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Clinical Oral Investigations

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01.03.2015 | Original Article

Masticatory rehabilitation following upper and lower jaw reconstruction using vascularised free fibula flap and enossal implants—19 years of experience with a comprehensive concept

verfasst von: Samer George Hakim, Harald Kimmerle, Thomas Trenkle, Peter Sieg, Hans-Christian Jacobsen

Erschienen in: Clinical Oral Investigations | Ausgabe 2/2015

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Abstract

Objectives

Conventional prosthesis is generally inapplicable following reconstruction with free fibula flaps (FFF) due to impaired bone and soft tissue conditions, and rehabilitation via enossal implants in FFF is relatively novel. This retrospective study aimed to document the surgical aspects of this option and to describe related supplementary procedures that can help optimise the definitive outcome.

Material and methods

One hundred nineteen implants were inserted within FFFs in 37 patients (mean age 51.8 ± 10.6 years), who underwent ablative surgery of the maxilla (3) and mandible (34). In a cross-sectional study design with a follow-up period of 3–172 months, we analysed types and configurations of graft design, patterns of implant insertion and methods for prosthetic rehabilitation as well as primary stability and survival rate.

Results

Most patients underwent jaw reconstruction using a mono-barrel FFF (14 osseous and 18 osteocutaneous/osteomyocutaneous); three patients received double-barrel reconstruction of the mandible. Three patients with maxillary defects were reconstructed using mono-barrel grafts (one osteocutaneous and two prefabricated grafts). Pre-prosthetic procedures were required in 23 patients to optimise conditions in the peri-implant soft tissue. Iliac bone onlay graft was used in six patients to achieve appropriate vertical height in mono-barrel grafts. A total of 10 implants in eight patients (five irradiated) could not be loaded. All other implants showed stable osseous integration and satisfactory peri-implant soft tissue conditions.

Conclusion

Masticatory rehabilitation can be achieved using enossal implants inserted in FFF. Special requirements can be met through selection of an appropriate graft configuration and optimal implant positioning. Supplementary pre-prosthetic procedures are usually required as they improve long-term survival.

Clinical relevance

This overview provides a reliable and comprehensive algorithm for standard implant-borne rehabilitation of patients with fibula grafts.

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Titel: Masticatory rehabilitation following upper and lower jaw reconstruction using vascularised free fibula flap and enossal implants—19 years of experience with a comprehensive concept
verfasst von: Samer George Hakim
Harald Kimmerle
Thomas Trenkle
Peter Sieg
Hans-Christian Jacobsen
Publikationsdatum: 01.03.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Oral Investigations / Ausgabe 2/2015
Print ISSN: 1432-6981
Elektronische ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-014-1247-9

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Masticatory rehabilitation following upper and lower jaw reconstruction using vascularised free fibula flap and enossal implants—19 years of experience with a comprehensive concept

Abstract

Objectives

Material and methods

Results

Conclusion

Clinical relevance

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Springer Medizin

Abstract

Objectives

Material and methods

Results

Conclusion

Clinical relevance

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