title: Implants in free fibula flap supporting dental rehabilitation - Implant and peri-implant related outcomes of a randomized clinical trial.
abstract: OBJECTIVE
  The objective of this study was to assess the difference in success rates of implants when using two or four implant-supported-overdentures following segmental mandibular reconstruction with fibula free flap.
  This prospective, parallel designed, randomized clinical study was conducted with 1:1 ratio. At baseline, all participants already had segmental reconstruction of mandible with free fibula flap. The participants were randomized into two groups: Group-I received implant-supported-overdentures on two tissue-level implants and Group-II received implant-supported-overdentures on four tissue-level implants. Success rates of the implants were evaluated at 3 months, 6 months and 12 months following implant loading using marginal bone level changes as well as peri-implant indices (Buser et al., 1990).
  
  
  RESULTS
  52 patients were randomized into two treatment groups (26 each), out of which 18 patients (36 implants) of Group-I and 17 patients (68 implants) of Group-II were evaluated. One implant in Group-I was lost due to infective complications and one patient in the same group had superior barrel necrosis. There was a statistically significant increase at both time points (p = 0.03, p = 0.04 at 6 months, 12 months) in the amount of marginal bone loss in Group-I (0.4 mm, 0.5 mm at 6 months, 12 months) as compared to Group-II (0.1 mm, 0.2 mm at 6 months, 12 months). There were no clinically significant changes peri-implant parameters between both groups. Peri-implant soft tissue hyperplasia was seen in both groups, 32% of implants at 3-months, 26% at 6-months and 3% at 12-months follow-up.
  
  
  CONCLUSIONS
  The results of this study show that patients with 2-implant-supported-overdentures had higher marginal bone loss as compared to patients with 4-implant-supported-overdentures. There were no clinically significant differences in peri-implant soft tissue factors in patients with 2- or 4-implant-supported-overdentures. Hyperplastic peri-implant tissues are common in the early implant-loading phase and tend to decrease over time under appropriate management.
authors.affiliation: Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India; Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany. Electronic address: veezo@rediffmail.com.
authors.forename: Vinay V
authors.initials: VV
authors.lastname: Kumar
authors.affiliation: Department of Periodontics, M. R. Ambedkar Dental College & Hospital, Bangalore, India. Electronic address: supriyaebenezer@gmail.com.
authors.forename: Supriya
authors.initials: S
authors.lastname: Ebenezer
authors.affiliation: Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Rostock University, Rostock, Germany. Electronic address: peer.kaemmerer@uni-rostock.de.
authors.forename: Peer W
authors.initials: PW
authors.lastname: Kämmerer
authors.affiliation: Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India. Electronic address: pcjacob66@gmail.com.
authors.forename: P C
authors.initials: PC
authors.lastname: Jacob
authors.affiliation: Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India. Electronic address: makuriakose@gmail.com.
authors.forename: Moni A
authors.initials: MA
authors.lastname: Kuriakose
authors.affiliation: Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India. Electronic address: hednenaveen@gmail.com.
authors.forename: Naveen
authors.initials: N
authors.lastname: Hedne
authors.affiliation: Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany. Electronic address: wilfried.wagner@unimedizin-mainz.de.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Wagner
authors.affiliation: Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany. Electronic address: Al-Nawas@uni-mainz.de.
authors.forename: Bilal
authors.initials: B
authors.lastname: Al-Nawas
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000209:etiology; D003758:Dental Implantation, Endosseous / Q000009:adverse effects / Q000379:methods*; D017268:Dental Prosthesis Retention; D019094:Dental Prosthesis, Implant-Supported; D003828:Denture, Overlay; D005260:Female; D005360:Fibula / Q000637:transplantation*; D058752:Free Tissue Flaps / Q000601:surgery*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
keywords: Dental implants; Free fibula flap; Mandible reconstruction; Overdentures; Randomized controlled study; Rehabilitation