title: Bone impacted fibular free flap: a novel technique to increase bone density for dental implantation in osseous reconstruction.
abstract: BACKGROUND
  Fibular free flap (FFF) bone has thick cortical bone surrounding a fatty marrow. The cortex has sufficient density for dental implantation, but the marrow limits bone stock. A novel technique was devised to increase bone density: the bone-impacted fibular free flap (BIFFF). The purpose of this study was to: (1) describe the BIFFF technique; (2) evaluate the bone density of BIFFF; and (3) evaluate the stability/success of implants placed in BIFFFs.
  
  
  METHODS
  Patients undergoing maxillary/mandibular reconstruction with FFFs were prospectively enrolled from 1998 to 2008. Two cohorts were compared: BIFFF and nonmodified FFF. The main outcome was bone density as seen on CT scans. Primary dental implant stability was determined via Periotest.
  
  
  RESULTS
  Thirty-eight patients were included in this study. BIFFFs achieved higher bone density versus unmodified FFFs (p < .05). Greater primary dental implant stability occurred in BIFFFs (p < .05). One hundred percent of BIFFF and 59% of nonmodified FFF implants were successful at 1 year.
  
  
  CONCLUSIONS
  BIFFF increases reconstructed bone density, initial dental implant stability, and 1-year implant success.
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada; Department of Otolaryngology, University of Florida, Gainesville, Florida.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Dziegielewski
authors.forename: Alex M
authors.initials: AM
authors.lastname: Mlynarek
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Harris
authors.forename: Adam
authors.initials: A
authors.lastname: Hrdlicka
authors.forename: Brittany
authors.initials: B
authors.lastname: Barber
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Qahtani
authors.forename: John
authors.initials: J
authors.lastname: Wolfaardt
authors.forename: Don
authors.initials: D
authors.lastname: Raboud
authors.forename: Hadi
authors.initials: H
authors.lastname: Seikaly
mesh_terms: D000368:Aged; D015519:Bone Density / Q000502:physiology; D016025:Bone Transplantation / Q000379:methods*; D015331:Cohort Studies; D003758:Dental Implantation, Endosseous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005360:Fibula / Q000601:surgery / Q000637:transplantation*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
keywords: bone impaction; dental implant; fibular free flap; mandibular reconstruction; maxillary reconstruction