Long-term results of osseointegrated implant-based dental rehabilitation in oncology patients reconstructed with a fibula free flap

BackgroundDental 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. PurposeThis 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 MethodsIn 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. ResultsThe overall implant survival rate was 97.2% at the 12-month follow-up, 86.5% at 60months, and 79.3% at 120months. The rate of overall implant success was 95.4% at the 12-month follow-up, 73.5% at 60months, and 64.7% at 120months. 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%). ConclusionsLong-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.