Long-term Results of Osseointegrated Implant-based Dental Rehabilitation in Oncology Patients Reconstructed with a Fibula Free Flap

Background: Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation.

Purpose: This retrospective study evaluated the long-term outcomes of patients who underwent jaws reconstruction with a fibula free flap and subsequent rehabilitation with implant-supported prostheses.

Materials And Methods: In total, 21 patients were enrolled; 108 osseointegrated dental implants, positioned on 21 fibular free flaps were assessed. Follow-up examinations were performed according to a standardized protocol, including clinical and radiological evaluations. The mean follow-up after implant insertion was 90.2 (range, 20-204) months.

Results: The overall implant survival rate was 97.2% at the 12-month follow-up, 86.5% at 60 months, and 79.3% at 120 months. The rate of overall implant success was 95.4% at the 12-month follow-up, 73.5% at 60 months, and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy. Peri-implantitis and mucositis were identified in 14.8% and 20.3% of surviving implants, respectively, at the 5- and 10-year follow-up. The risk of developing peri-implantitis was estimated to be higher (odds ratio = 1.5) for patients without connective tissue or skin grafts versus patients with one of them (18.2% vs 9.5%).

Conclusions: Long-term implant-related outcomes show that the survival rate of implants placed into the fibula is acceptable. Radiotherapy negatively impacts survival and success, in particular in the short and medium-term follow-up. Moreover, a relevant peri-implant bone resorption does occur over time and ultimately influences implants success, and it is mainly related to peri-implant gingival mucositis. In this regard skin or connective tissue grafts seem to offer an aid to manage this problem.