title: Early bone resorption of free microvascular reanastomized bone grafts for mandibular reconstruction--a comparison of iliac crest and fibula grafts.
abstract: OBJECTIVE
  Patients with continuous bone defects of the mandible after ablative tumor surgery need bony reconstruction for proper function and aesthetics. Free microvascular reanastomized bone grafts provide a clinically proven option for such patients, yet the optimal source of donor tissue has not yet been established. The aim of this study was to evaluate and compare the bone volume stability of vascularized bone grafts, particularly in the early highly resorptive phase, from the iliac crest (DCIA) and the fibula and to assess the implantologic rehabilitations.
  
  
  METHODS
  Thirty-six patients with mandibular continuity defects due to tumor resection were reconstructed by the use of vascularized bone grafts; 21 patients received DCIA flaps and 15 patients received a composite free fibular flap, depending on the size and location of the defect. Bone resorption was assessed using digital panographs. Radiographs were taken immediately after bone reconstruction, 6 months postoperatively, prior to implant surgery, and at prosthetic loading.
  
  
  RESULTS
  After a mean observation period of 6 months, vertical bone resorption was 6.79% for the patients of the iliac crest group (DCIA), 10.20% after 11 months, and 12.58% after 17 months. Fibular grafts showed a bone resorption of 5.30% after a mean observation time of 6 months, 8.26% after 11 months, and 16.95% after 17 months. Eighteen patients received 71 implants for implant-retained dental reconstructions.
  
  
  CONCLUSIONS
  Microvascular reanastomized bone grafts represent a reliable treatment option for reconstruction in cases of large defects of the mandible, with low graft resorption in the early healing phase. Additionally, the compared grafts provide sufficient bone volume to permit implant rehabilitation.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Electronic address: christian.mertens@med.uni-heidelberg.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Mertens
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Decker
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Engel
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Sander
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hoffmann
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors.forename: Kolja
authors.initials: K
authors.lastname: Freier
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D064592:Autografts / Q000637:transplantation; D001862:Bone Resorption / Q000209:etiology*; D016025:Bone Transplantation / Q000379:methods*; D015331:Cohort Studies; D003758:Dental Implantation, Endosseous / Q000379:methods; D005260:Female; D005360:Fibula / Q000502:physiology* / Q000601:surgery; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation; D005881:Gingiva / Q000637:transplantation; D006085:Graft Survival; D006801:Humans; D007085:Ilium / Q000502:physiology* / Q000601:surgery; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery; D063175:Mandibular Reconstruction / Q000379:methods*; D011862:Radiography, Panoramic / Q000379:methods; D012189:Retrospective Studies; D012540:Scapula / Q000502:physiology / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods; D060053:Transplant Donor Site / Q000502:physiology* / Q000601:surgery; D016896:Treatment Outcome; D014727:Vestibuloplasty / Q000379:methods
keywords: Bone resorption; Free fibular flap; Iliac crest; Implant rehabilitation; Mandibular continuity defect; Microvascular bone graft