title: Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants -- a prospective study.
abstract: The fibular flap can be used for a variety of indications. Recently, the treatment of four patients with severely atrophied upper jaws using a method to prefabricate the vascularized fibular graft has been published. This technique consists of a two-stage operation procedure that allows simultaneous prosthodontic rehabilitation and immediate placement of dental implants. In this paper eight patients with 29 ITI implants (Straumann AG, Waldenburg, Switzerland) who had reconstruction of either the upper or lower jaw are presented. The aim of the study was (i) to evaluate the behavior of the newly formed soft tissue around implants inserted in the fibula by applying periodontal parameters, (ii) to monitor prospectively the integration of the implants in the fibular graft, and (iii) to assess the osseous integration of the fibular graft used for reconstruction of the upper or lower jaw. Two implants failed during the observation time because of avascular bone at the distal end of the fibular graft. Stabilization of the graft, however, was never compromised. Due to the prefabrication firmly attached gingiva-like soft tissue could be provided preventing periimplant soft tissue inflammation and facilitating oral hygiene. After 1 year of observation the mean attachment level was similar to implants placed in original bone whereas vertical bone loss measured radiographically was lower in the present study. This may indicate that the remodeling of a bicortical bone requires a longer period of time compared with the bone of the alveolar crest. The prospective 1-year results are promising but long-term evaluation of periodontal and radiological parameters are required.
authors.affiliation: Department of Reconstructive Surgery, University Hospital Basel, Basle, Switzerland. cjaquiery@uhbs.ch
authors.forename: Claude
authors.initials: C
authors.lastname: Jaquiéry
authors.forename: Dennis
authors.initials: D
authors.lastname: Rohner
authors.forename: Christoph
authors.initials: C
authors.lastname: Kunz
authors.forename: Peter
authors.initials: P
authors.lastname: Bucher
authors.forename: Françoise
authors.initials: F
authors.lastname: Peters
authors.forename: Robert K
authors.initials: RK
authors.lastname: Schenk
authors.forename: Beat
authors.initials: B
authors.lastname: Hammer
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000145:classification; D016723:Bone Remodeling / Q000502:physiology; D016025:Bone Transplantation / Q000000981:diagnostic imaging / Q000379:methods* / Q000473:pathology; D000044:Dental Abutments; D015921:Dental Implants; D019232:Dental Restoration Failure; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008439:Maxillary Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology; D017622:Periodontal Attachment Loss / Q000145:classification; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D011446:Prospective Studies; D011859:Radiography
chemical_list: D015921:Dental Implants