Long-term results of jaw reconstruction with microsurgical fibula grafts and dental implants.
OBJECTIVE
The aim of this retrospective study was to evaluate the long-term utility of the free fibula flap for the reconstruction of the maxilla and mandible and to investigate its suitability for prosthetic rehabilitation with dental implants focusing on implant survival and implant-related morbidity.


METHODS
Thirty patients who underwent microsurgical reconstruction of the upper or lower jaw after resection from 1992 to 1994 and were available for follow-up examination were included in the investigation. The primary afflictions were malignant tumors, alveolar atrophy, or osteomyelitis. Clinical and radiologic findings were gathered and evaluated with emphasis on the radiologic follow-up as well as clinical investigations disclosing implant-related complications.


RESULTS
The fibula proved very suitable for the reconstruction of the upper and lower jaw, allowing rehabilitation with dental implants in all cases. Additionally, the peri-implant bone resorption and the overall complication rate proved to be low. In 93 of 128 implants, probing depths ranged from 2 to 3 mm. In 20 implants, probing depths of 4 to 6 mm were observed. In 4 implants, probing depths of greater than 7 mm were observed. These values corresponded with the radiologically assessed values.


CONCLUSIONS
The reconstruction of the upper and lower jaw with a microsurgically reanastomosed fibula flap, in combination with dental implants, leads to satisfactory functional and esthetic results. The fibula flap seems resistant to peri-implantary resorption processes and is capable of withstanding the masticatory forces that develop during functional loading. In conjunction with the new prosthetic attachments, like the titanium magnetic inserts, the fixation of cover dentures and the oral hygiene is simplified and improved.
Gbara
Ali
A
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. gbara@hotmail.com
Darwich
Khaldoun
K
Li
Lei
L
Schmelzle
Rainer
R
Blake
Felix
F
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001732:Bite Force; D016025:Bone Transplantation / Q000379:methods; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D005260:Female; D005360:Fibula / Q000637:transplantation; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008439:Maxillary Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014716:Vertical Dimension
D015921:Dental Implants