Comparison of the late results of mandibular reconstruction using nonvascularized or vascularized grafts and dental implants

[The use of autogenous free vascularized fibula transplant for the correction of severe mandibular atrophy]

The purpose of the study was to increase the effectiveness of surgical treatment and rehabilitation of patients with severe mandibular atrophy by means of autogenous free vascularized fibula transplant use with subsequent dental implants placement in the reconstructed mandible and implant-retained fixed dentures. In 2017 5 female patients underwent surgical treatment of severe mandibular atrophy with autogenous free vascularized fibula transplant in Maxillofacial Surgery department of CRID with additional nonvascularized iliac bone grafts and functional rehabilitation with implant-supported constructions in two of the cases. Due to its form, length and vascularization fibular bone represents a good plastic material for full length mandibular alveolar part reconstruction. The inclusion of the skin paddle in the autogenous free vascularized fibula transplant promotes secure primary closure of the surgical wound in the oral cavity. The use autogenous free vascularized fibula transplant in patients with severe mandibular atrophy with demands a thorough presurgical planning and intraoperative modeling.

Functional Rehabilitation of the Atrophic Mandible and Maxilla with Fibula Flaps and Implant-Supported Prosthesis

Historically, nonvascularized bone grafts have been the standard treatment for severe mandibular and maxillary atrophy, followed by immediate or delayed implant placement. Extreme atrophy is an unfavorable biological and mechanical location for nonvascularized autologous bone transplants. The authors present the results of a multidisciplinary treatment protocol for rehabilitation of extreme mandibular and maxillary atrophy by use of the vascularized fibular flap. This protocol includes bone augmentation, implant surgery, soft-tissue management, and prosthetic restoration. Since 1993, 18 patients with a mean age of 47.5 years presented with extreme mandibular and/or maxillary atrophy and underwent alveolar crest augmentation with vascularized fibular flaps. Bone healing was achieved in 17 of the 18 patients. Seventy-three osteointegrated implants were inserted in 12 of 17 fibular flaps. Altogether, 62 implants were loaded and 11 dental prostheses were made. Average follow-up of the loaded implants was 41 months. The success rate of loaded implants was 100 percent. The authors strongly recommend the use of the fibular bone flap when dealing with extreme atrophy of the mandible and maxilla and suggest the protocol outlined in this review.