Linear and volumetric gain after vertical bone augmentation in the posterior mandible using an autologous cortical tenting method

Esthetic and functional reconstruction of large mandibular defects using free fibula flap and implant-retained prosthetics - a case series with long-term follow-up

Background

The reconstructive and rehabilitative management of large mandibular defects with basal continuity is challenging in many respects, especially in the vertical dimension. The free fibula flap is an under-utilised but efficient approach in this indication. The aim of this case series is to demonstrate its use and long-term success.

Case presentation

Three cases are presented, where the patient had a large bone defect (at least 5 cm in length and 1 cm in the vertical dimension), but the continuity of the mandible was maintained. Two cases were related to pathological fracture and one was a large defect due to oncological surgery. Vertical augmentation with free microvascularised fibula flap was carried out, followed by implant-retained prosthetic therapy. Clinical status has been followed up for 5 to 6 years, with special attention to the condition of the peri-implant tissues and any radiographically detectable alterations or complications. No complications occurred during the follow-up. Function and esthetics have remained unchanged throughout.

Conclusions

Free microvascularised fibula flap reconstruction combined with implant-retained prosthetics allows a lasting functional and esthetic solution in the discussed indication.