Factors affecting survival and usefulness of implants placed in vascularized free composite grafts used in post-head and neck cancer reconstruction.
BACKGROUND
Bone-containing vascularized grafts have been used successfully to reconstruct post-cancer surgical defects. Dental implants can be placed in these bone-containing grafts to allow implant-supported prosthodontic reconstruction of these patients.


OBJECTIVE
The aim of this study was to evaluate the survival of dental implants used in the rehabilitation of subjects treated with bone-containing vascularized grafts to compare usability of implants placed at the time of reconstruction and after healing.


METHODS
A cross-sectional study was undertaken to examine survival rates of implants placed in vascularized bone-containing grafts either immediately at the time of surgical reconstruction or after 3 months healing. Other factors such as graft type, whether radiation therapy was given, and implant type were recorded.


RESULTS
A total of 41 patients had 145 implants placed in 47 vascularized bone-containing flaps. Increased failure rate of implants was seen in immediately placed implants. There was also a significant increase in the number of osseointegrated implants that were prosthodontically unusable or sub-optimally placed in the immediate placement group. Radiation therapy was associated with a significant increase in failure rate. Modern implant surfaces appeared to perform better than machined/turned surfaces. Graft donor site did not influence implant survival.


CONCLUSIONS
This study demonstrated the difficulties encountered with immediate placement of dental implants at the time of post-cancer reconstructive surgery.
Fenlon
Michael R
MR
King's College London, London, UK. michael.fenlon@kcl.ac.uk
Lyons
Andrew
A
Farrell
Suzanne
S
Bavisha
Kalpesh
K
Banerjee
Avijit
A
Palmer
Richard M
RM
D016025:Bone Transplantation / Q000473:pathology*; D003430:Cross-Sectional Studies; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants / Q000145:classification; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003814:Dentistry, Operative; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D016348:Osseointegration / Q000528:radiation effects; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D013499:Surface Properties; D013515:Surgery, Oral; D016019:Survival Analysis; D060053:Transplant Donor Site / Q000473:pathology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
D015921:Dental Implants