title: Guided implant surgery after free-flap reconstruction: Four-year results from a prospective clinical trial.
abstract: OBJECTIVE
  The aim of this prospective clinical study is to assess the 4-year outcomes of implant-supported restorations performed using a computer-guided template-assisted flapless implant surgery approach in patients reconstructed with fibula or iliac crest free flaps.
  
  
  METHODS
  Twelve jaws in 10 patients were reconstructed with osteomyocutaneous free flap after tumour resection or gunshot wound, after complete healing computer-assisted template-based flapless implant placement, based on prosthetic and aesthetic analysis, was performed using a customized protocol. Treatment success was evaluated using the following parameters: survival of implants/prostheses, prosthetic and biologic complications, marginal bone remodelling, soft tissue parameters and patient satisfaction.
  
  
  RESULTS
  A total of 56 implants were placed; the implants ranged between 8 and 16 mm in length and were either 3.5, 4.3 or 5 mm wide. All the patients have reached the 4-year follow-up. Three implants were lost accounting for an overall implant survival rate of 94.6%. No prosthesis were lost. Some complications were recorded. Four years after loading the mean marginal bone loss was 1.43 ± 0.49 mm at the palatal/lingual site and 1.48 ± 0.46 mm at the vestibular site. All the patients showed healthy soft tissues with stable probing depth (4 .93 ± 0.75%) and successful bleeding on probing values (12 ± 5.8%); 90% of patients were satisfied of the treatment at the 4-year follow-up.
  
  
  CONCLUSIONS
  Computer-guided template-assisted flapless implant surgery seems to be a viable option for patients undergoing reconstruction with free flaps after tumour resection or gunshot trauma, although many challenges remain. A high degree of patient satisfactorily was reported.
authors: Dentistry Unit, University Hospital of Sassari, Sassari, Italy. Electronic address: melonisilviomario@yahoo.it.
authors: Silvio Mario
authors: SM
authors: Meloni
authors: Private Practice, Rome, Italy.
authors: Marco
authors: M
authors: Tallarico
authors: Maxillofacial Surgery Unit (Head: Prof. A. Tullio), University Hospital of Sassari, Sassari, Italy.
authors: Giacomo
authors: G
authors: De Riu
authors: Maxillofacial Surgery Unit (Head: Prof. A. Tullio), University Hospital of Sassari, Sassari, Italy.
authors: Milena
authors: M
authors: Pisano
authors: Maxillofacial Surgery Unit (Head: Prof. A. Tullio), University Hospital of Sassari, Sassari, Italy.
authors: Alessandro
authors: A
authors: Deledda
authors: Dentistry Unit, University Hospital of Sassari, Sassari, Italy.
authors: Francesco Maria
authors: FM
authors: Lolli
authors: Maxillofacial Surgery Unit (Head: Prof. A. Tullio), University Hospital of Sassari, Sassari, Italy.
authors: Olindo
authors: O
authors: Massarelli
authors: Maxillofacial Surgery Unit (Head: Prof. A. Tullio), University Hospital of Sassari, Sassari, Italy.
authors: Antonio
authors: A
authors: Tullio
mesh_terms: D016301:Alveolar Bone Loss / Q000209:etiology; D016723:Bone Remodeling / Q000502:physiology; D016025:Bone Transplantation / Q000379:methods; D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000379:methods*; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D007568:Jaw / Q000293:injuries; D007573:Jaw Neoplasms / Q000601:surgery; D008297:Male; D063175:Mandibular Reconstruction / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000637:transplantation; D056948:Orthognathic Surgical Procedures; D017060:Patient Satisfaction; D010512:Periodontal Index; D011183:Postoperative Complications; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery
chemical_list: D015921:Dental Implants
keywords: Fibula free-flap; Guided implant surgery; Mandibles reconstructed