Functional Outcomes with Implant-Prosthetic Rehabilitation Following Simultaneous Mandibulectomy and Mandibular Reconstruction by Fibula Graft

Khachatryan Grigor, Hovhannisyan Armen, Khachatryan Levon and Hakobyan Gagik

Department of Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, Armenia
Department of Plastic and Reconstructive Microsurgery, Erebouni Medical Center, Armenia
Department of Maxillofacial and Plastic Surgery, Modern Implant Medicine, Armenia

^*Correspondance to: Gagik Hakobyan 

 PDF  Full Text DOI: 10.25107/2474-1647.2092

Abstract

Aim: To evaluate the clinical outcomes and success rates of dental implant placement in vascularized fibula bone grafts used for the reconstruction of mandibular defects.Methods: The present study aimed at investigating the clinical treatments outcomes a 21patients (12 males and 9 females, the age was 28-63), who underwent surgical reconstruction of post-oncologic lower jaw defects with the micro vascular fibular graft and further dental implantation between 2012-2018. The mandible was resected for ameloblastoma of the mandible 13 cases, eosinophilic granuloma of the mandible in 2 case, odontogenic keratocysts of the mandible in 5 cases and low differentiation osteosarcoma in of the mandible 1 cases. Flap raising and tumour resection were always carried out simultaneously. After 5-6 months reconstruction of mandibular defects 134 implants were inserted within fibula flaps. The implants were evaluated with measures of Resonance Frequency Analysis (RFA) during the follow-up periods using Osstell Mentor at time of implant placement, after 3 months. The functional load on dental implants was performed with ISQ values above 65. Dental prosthetic rehabilitation was performed after 3-4 months of submerged healing. Postoperative clinical and radiographic controls were made regularly, the criteria for implant success were assessed.Results: The postoperative evolution of the patients was favorable, with the integration of the fibula vascularized grafts. No intra-operative or immediate post-operative complications were noted and no flap failure occurred. Free fibula flap transfer was successful in all cases. In all 21 patients, fibula flaps provided adequate bone stock for implant placement. The mean RFA recordings of all 134 implants were 65 ISQ at implant placement respectively 73 ISQ after 3 months. Implants placed in the reconstructed areas were demonstrated to integrate normally. Of the 134 implants placed in these 21 patients, 4 failed to osseointegrate. Overall, graft success rate was 100% and implant success rate was 97%.

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Cite the article

Grigor K, Armen H, Levon K, Gagik H. Functional Outcomes with Implant-Prosthetic Rehabilitation Following Simultaneous Mandibulectomy and Mandibular Reconstruction by Fibula Graft. Clin Surg. 2018; 3: 2092.