title: Scapular Free Vascularised Bone Flaps for Mandibular Reconstruction: Are Dental Implants Possible?
abstract: OBJECTIVE
  Free fibula flap remains the flap of choice for reconstruction of mandibular defects. If free fibula flap is not possible, the subscapular system of flaps is a valid option. In this study, we evaluated the possibility of dental implant placement in patients receiving a scapular free flap for oromandibular reconstruction.
  
  
  METHODS
  We retrospectively reviewed 10 patients undergoing mandible reconstruction with a subscapular system free-tissue (lateral border of the scapula) transfer at the University Hospital Zürich between January 1, 2010 and January 1, 2013. Bone density in cortical and cancellous bone was measured in Hounsfield units (HU). Changes of bone density, height and width were analysed using IBM SPSS Statistics 22. Comparisons of bone dimensions as well as bone density were performed using a chi-square test.
  
  
  RESULTS
  Ten patients were included. Implantation was conducted in 50%. However, all patients could have received dental implants considering bone stock. Loss of bone height and width were significant (P < 0.001). There was a statistical significant increase in bone density in cortical (P < 0.001) and cancellous (P = 0.004) bone.
  
  
  CONCLUSIONS
  Dental implants are possible after scapular free flap reconstruction of oromandibular defects. Bone height and width were reduced, while bone density increased with time.
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Zurich Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Lanzer
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Zurich Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gander
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Zurich Switzerland.
authors.forename: Klaus
authors.initials: K
authors.lastname: Grätz
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Zurich Switzerland.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rostetter
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Zurich Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zweifel
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Zurich Switzerland.
authors.forename: Marius
authors.initials: M
authors.lastname: Bredell
keywords: bone; bone transplantation; dental implants; free tissue transfer flap; mandibular reconstruction