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Unique Techniques Utilizing Rib Grafts for Mandibular Reconstruction in the Pediatric Population. J Craniofac Surg 2021; 32:1780-1784. [PMID: 33852516 DOI: 10.1097/scs.0000000000007440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pediatric mandibular reconstruction requires a grafted segment of sufficient height and stability to support dental implant placement. Double barreling and mandibular distraction osteogenesis (MDO) after reconstruction are two techniques to achieve this, but they have only been reported with fibular grafts. Rib grafts not only have a lower donor site morbidity than fibular grafts, but they also provide adequate defect coverage in children. As such, we propose their use with either a double barrel technique or with MDO. METHODS Three pediatric patients underwent mandibular resection and reconstruction using rib grafting. One patient underwent single rib graft placement with subsequent vertical rib distraction. In the remaining two patients, a double-barreled rib technique was used, stacked horizontally in one patient and vertically in the other. RESULTS From March 2018 to May 2019, three patients with an average age of 11 underwent resection of mandibular tumors or tumor-like lesions followed by immediate reconstruction with rib graft. Due to postoperative wound complications, the graft was completely removed in one patient. The remaining two patients had an uneventful recovery with dental implants planned for one and fully osseointegrated in the other. None of the patients experienced donor-site complications. CONCLUSION This case series supports the utility and versatility of autogenous rib grafts as a reconstructive option in children. Not only is rib an excellent bone source with low donor site morbidity, but its height can be augmented through MDO or double barreling, facilitating the successful placement of implants and oral rehabilitation in pediatric patients.
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Shawky M, Elbeialy RR, Khashaba MM, Zedan MH. Assessment of bone density and stability with immediately loaded dental implants with the All-on-Four technique in free vascularized fibular grafts used for mandibular reconstruction. Clin Implant Dent Relat Res 2021; 23:482-491. [PMID: 33998176 DOI: 10.1111/cid.13011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/10/2021] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Following free fibula flaps (FFF) reconstruction of mandibular defects the patients need an early dental rehabilitation to regain their masticatory function and enhance their feeding and nutrition. METHODS This study included 10 patients, with mandibular defects previously reconstructed with FFF that span the area between the two mandibular angles. They received a full arch fixed restoration supported by four implants using a pilot drilling guide to perform a flapless operation. The stability of the placed dental implants was assessed along with the changes in bone density. RESULTS There was a statistically significant increase in stability after 3 and 6 months, and there was a decrease in density after 6 months. The patient satisfaction improved over the follow-up period. CONCLUSION The All-on-Four technique is reliable and economic for early functional rehabilitation of resected jaws reconstructed with FFF; however, further studies are needed to investigate the changes in fibula bone density over time and with function.
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Affiliation(s)
- Mohamed Shawky
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Ramy R Elbeialy
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mohammed M Khashaba
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mohamed H Zedan
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Kahn A, Kün-Darbois JD, Bénateau H, Veyssière A. Alveolar distraction osteogenesis of a fibula free flap in maxillary reconstruction. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:566-569. [PMID: 31204179 DOI: 10.1016/j.jormas.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/16/2022]
Abstract
In maxillary reconstruction, it is challenging to obtain satisfactory maxillary projection and to optimizate the dental implant-prosthetic rehabilitation. We report a case of sagittal distraction of a fibula free flap used to reconstruct maxilla after a ballistic trauma. Distraction began seven days after implantation of the device. The distraction protocol was 0.9mm per day during a total period of 2 months. Cone beam computed tomography acquisitions were performed at 3 months after the end of the distraction. The distractor device was removed 5 months after the end of the distraction protocol to allow bone consolidation. A satisfactory total distraction of 7mm was obtained with an esthetic variation of the projection of the upper lip and closure of the nasolabial angle.
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Affiliation(s)
- A Kahn
- Department of Maxillofacial and Oral surgery, Angers University Hospital 4, rue Larrey, 49100 Angers, France; Department of Plastic, Maxillofacial and Oral surgery, Caen University Hospital, avenue Côte-de-Nacre, 14000 Caen, France.
| | - J D Kün-Darbois
- Department of Maxillofacial and Oral surgery, Angers University Hospital 4, rue Larrey, 49100 Angers, France
| | - H Bénateau
- Department of Plastic, Maxillofacial and Oral surgery, Caen University Hospital, avenue Côte-de-Nacre, 14000 Caen, France
| | - A Veyssière
- Department of Plastic, Maxillofacial and Oral surgery, Caen University Hospital, avenue Côte-de-Nacre, 14000 Caen, France
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Saito N, Funayama A, Arai Y, Suda D, Takata Y, Kobayashi T. Vertical distraction osteogenesis of a reconstructed mandible with a free vascularized fibula flap: a report of two cases. Maxillofac Plast Reconstr Surg 2018; 40:32. [PMID: 30505827 PMCID: PMC6236005 DOI: 10.1186/s40902-018-0172-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background The free vascularized fibula flap presents many advantages such as sufficient length of the bony segment, good vascularization, better quality of the bone, and a long vascular pedicle, but it is also associated with some disadvantages with regard to prosthetic rehabilitation because of its limited height. Improvement in bone height is necessary for ideal dental implant treatment of reconstructed mandibles. Case presentation For two squamous cell carcinoma patients, mandibular bone reconstruction was performed secondarily with the peroneal flap after tumor resection. Since the bone height was insufficient at the time of implant treatment, occlusion reconstruction by dental implant was performed after vertical distraction osteogenesis. Conclusions Vertical distraction osteogenesis is a suitable treatment option for alveolar ridge deficiency resulting from fibula transplantation for mandibular reconstruction following tumor surgery.
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Affiliation(s)
- Naoaki Saito
- 1Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-Dori, Chuo-Ku, Niigata, 951-8514 Japan
| | - Akinori Funayama
- 1Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-Dori, Chuo-Ku, Niigata, 951-8514 Japan
| | - Yoshiaki Arai
- 2Temporomandibular Joint Clinic, Niigata University Medical and Dental Hospital, 1-754, Asahimachi-Dori, Chuo-Ku, Niigata, 951-8520 Japan
| | - Daisuke Suda
- 1Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-Dori, Chuo-Ku, Niigata, 951-8514 Japan
| | - Yoshiyuki Takata
- 3Department of Oral and Maxillofacial Surgery, Niigata City General Hospital, 463-7, Shumoku, Chuo-Ku, Niigata, 950-1197 Japan
| | - Tadaharu Kobayashi
- 1Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-Dori, Chuo-Ku, Niigata, 951-8514 Japan
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Khachatryan L, Khachatryan G, Hakobyan G. The Treatment of Lower Jaw Defects Using Vascularized Fibula Graft and Dental Implants. J Craniofac Surg 2018; 29:2214-2217. [DOI: 10.1097/scs.0000000000005015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rehabilitation of a Patient with Central Giant Cell Granuloma of Mandible by Iliac Graft, Bone Distraction and Implant Retained Telescopic Prosthesis: a Two Year Follow Up. J Indian Prosthodont Soc 2015. [PMID: 26199534 DOI: 10.1007/s13191-014-0356-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Giant cell granulomas of the jaws are lesions that arise either peripherally in periodontal ligament, mucoperiosteum, or centrally in the bone. Histologically, both peripheral and central giant cell granuloma are characterized by the presence of numerous multinucleated giant cells in a prominent fibrous stroma. Traditional treatment has been local curettage, although aggressive sub-types have a high tendency to recur. This case report describes the rehabilitation procedure of a patient with central giant cell granuloma of left side of mandible. Marginal resection of the lesion was done followed by reconstruction of the resected mandible with iliac graft. Distraction of bone was done since there was partial uptake of the fibula graft. Five implants were placed once the distraction was complete. The patient was rehabilitated with implant retained removable telescopic prosthesis.
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Bousdras VA, Kalavrezos N. Distraction osteogenesis of free flap reconstructed mandible following ameloblastoma resection for optimal functional rehabilitation. Ann Maxillofac Surg 2015; 4:237-9. [PMID: 25593885 PMCID: PMC4293856 DOI: 10.4103/2231-0746.147162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This case highlights the use of a custom-made distractor (Synthes GmbH, Oberdorf, Switzerland), used to increase bone height prior to rehabilitation with implant placement, in a patient following excision of an ameloblastoma and reconstruction of her mandible with a fibular flap. A 27-year-old patient had her mandible reconstructed following wide resection of an ameloblastoma. Although a 2.0 LOCK reconstruction plate (Synthes GmbH, Oberdorf, Switzerland) was used for fixation of the fibular bone, the vertical deficiency between the reconstructed segment and the occlusal plane made oral rehabilitation impossible. To overcome this, the fibular bone segment was vertically distracted following a latency period of 4 days. Distractor was left in place for 20 weeks for bone consolidation. Following device removal implants were placed. The novelty of this approach included fixation of the lower arm of the distractor on the LOCK plate. The distractor was unidirectional with two arms of different length. The lower arm composed of a 2.0 mini-plate to fit exactly on the 2.0 LOCK plate whereas the upper arm used a standard 1.5 mini-plate. Advantages of this custom-made distractor included: (i) No need for removal of the reconstruction plate, (ii) no need for an extraoral surgical approach, and (iii) no need for additional drilling to fit the lower arm of the distractor. Technical details and limitations are presented.
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Affiliation(s)
- V A Bousdras
- Private Practice, Al Mihailidi 9, Thessaloniki 54640, Greece
| | - N Kalavrezos
- Clinical Head and Neck Centre, University College Hospital, London NW1 2PG, United Kingdom
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Chacko T, Vinod S, Mani V, George A, Sivaprasad KK. Management of Cleft Maxillary Hypoplasia with Anterior Maxillary Distraction: Our Experience. J Maxillofac Oral Surg 2014; 13:550-5. [PMID: 26225027 PMCID: PMC4518778 DOI: 10.1007/s12663-013-0521-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 04/03/2013] [Indexed: 11/30/2022] Open
Abstract
Maxillary hypoplasia is a common developmental problem in cleft lip and palate deformities. Since 1970s these deformities have traditionally been corrected by means of orthognathic surgery. Management of skeletal deformities in the maxillofacial region has been an important challenge for maxillofacial surgeons and orthodontists. Distraction osteogenesis is a surgical technique that uses body's own repairing mechanisms for optimal reconstruction of the tissues. We present four cases of anterior maxillary distraction osteogenesis with tooth borne distraction device-Hyrax, which were analyzed retrospectively for the efficacy of the tooth borne device-Hyrax and skeletal stability of distracted anterior maxillary segment.
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Affiliation(s)
- Tojan Chacko
- />Department of Orthodontics and Dentofacial Orthopedics, Mar Baselios Dental College, Kothamangalam, Kerala India
| | - Sankar Vinod
- />Department of Oral and Maxillofacial Surgery, Mar Baselios Dental College, Kothamangalam, Kerala India
| | - Varghese Mani
- />Department of Oral and Maxillofacial Surgery, Mar Baselios Dental College, Kothamangalam, Kerala India
| | - Arun George
- />Department of Oral and Maxillofacial Surgery, Mar Baselios Dental College, Kothamangalam, Kerala India
| | - K. K. Sivaprasad
- />Department of Oral and Maxillofacial Surgery, Mar Baselios Dental College, Kothamangalam, Kerala India
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Baykul T, Aydın MA, Fındık Y, Türkaslan SS. Surgical rehabilitation of free fibula graft fracture under local anesthesia with posteriorly directed vertical alveolar distractor. Indian J Surg 2014; 76:336-8. [PMID: 25278664 DOI: 10.1007/s12262-013-0879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/23/2013] [Indexed: 11/26/2022] Open
Abstract
Reconstruction of the mandible with a free fibular graft is one of the most common treatment choices following tumor resection. But as the graft is often vertically deficient, pathological fracture may occur because of occlusal forces after prosthetic rehabilitation. Distraction osteogenesis can be a good choice for the repair of the fibular flap. In this report, a case of fractured fibula flap after 7 years, rehabilitated with a posteriorly directed vertical distractor, will be presented.
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Affiliation(s)
- Timuçin Baykul
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - M Asım Aydın
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Yavuz Fındık
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - S Süha Türkaslan
- Department of Restorative Dentistry, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
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Yamashita Y, Yamaguchi Y, Noguchi N, Goto M. Mandibular reconstruction using a titanium mesh sheet processed by laser welding after segmental mandibulectomy for implant placement. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2014. [DOI: 10.1016/j.ajoms.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wang F, Huang W, Zhang C, Sun J, Kaigler D, Wu Y. Comparative analysis of dental implant treatment outcomes following mandibular reconstruction with double-barrel fibula bone grafting or vertical distraction osteogenesis fibula: a retrospective study. Clin Oral Implants Res 2013; 26:157-65. [DOI: 10.1111/clr.12300] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Feng Wang
- Department of Oral and Maxillofacial Implantology; Ninth People's Hospital Affiliated with Shanghai Jiao Tong University; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Wei Huang
- Department of Oral and Maxillofacial Implantology; Ninth People's Hospital Affiliated with Shanghai Jiao Tong University; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Chenping Zhang
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital Affiliated with Shanghai Jiao Tong University; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Jian Sun
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital Affiliated with Shanghai Jiao Tong University; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Darnell Kaigler
- Department of Periodontics and Oral Medicine and Biomedical Engineering; University of Michigan; Michigan Center of Oral Health Research; Ann Arbor MI USA
| | - Yiqun Wu
- Department of Oral and Maxillofacial Implantology; Ninth People's Hospital Affiliated with Shanghai Jiao Tong University; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
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12
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Distraction osteogenesis for the cranio-maxillofacial region (III): A compendium of devices for the dentoalveolus. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2013. [DOI: 10.1016/j.ajoms.2012.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Ntounis A, Patras M, Pelekanos S, Polyzois G. Treatment of hemi-mandibulectomy defect with implant-supported telescopic removable prosthesis. A clinical report. J Prosthodont 2013; 22:501-5. [PMID: 23387334 DOI: 10.1111/jopr.12012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2012] [Indexed: 11/29/2022] Open
Abstract
Excision of head and neck tumors (benign or malignant) often leads to large segmental resections of the mandible. The following clinical report describes the oral rehabilitation of a 60-year-old Caucasian man after partial mandibulectomy due to primary oral leiomyosarcoma. Treatment consisted of a free fibula flap and an implant-supported telescopic removable prosthesis.
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Affiliation(s)
- Athanasios Ntounis
- Resident in Graduate Periodontology Clinic, University of Alabama, Birmingham, AL, USA.
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Cheung LK, Chua HDP, Hariri F, Pow EH, Zheng L. Alveolar Distraction Osteogenesis for Dental Implant Rehabilitation Following Fibular Reconstruction: A Case Series. J Oral Maxillofac Surg 2013; 71:255-71. [DOI: 10.1016/j.joms.2012.09.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 09/26/2012] [Accepted: 09/29/2012] [Indexed: 10/27/2022]
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Alveolar distraction osteogenesis in the human mandible: a clinical and histomorphometric study. IMPLANT DENT 2012; 21:317-22. [PMID: 22814557 DOI: 10.1097/id.0b013e318259198f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify the quality of newly formed bone in the distraction region and to determine the percentage of mineralized bone formed in the distraction area. METHODS Ten patients with vertically deficient mandibular alveolar ridges were treated by means of distraction osteogenesis. Four months after consolidation of distracted segments, a total of 40 dental implants were inserted in native bone and distracted bone. Bone biopsies were taken at the implant sites with trephine burrs for histological and histometric analyses. Four months after implant placement, abutments were connected, and prosthetic loading of the implants was started. RESULTS The mean bone gain at the end of distraction was 7.2 ± 0.8 mm. The cumulative success rate of implants 3 years after the onset of prosthetic loading was 100%. The newly formed bone consisted of woven bone reinforced by parallel-fibered bone with bone marrow spaces and the percentage of mineralized bone ranged from 50.56% to 76.88%. CONCLUSIONS Alveolar distraction osteogenesis is able to produce adequate mature bone for the correction of mandibular bone deficits before dental implant insertion.
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Carbiner R, Jerjes W, Shakib K, Giannoudis PV, Hopper C. Analysis of the compatibility of dental implant systems in fibula free flap reconstruction. HEAD & NECK ONCOLOGY 2012; 4:37. [PMID: 22721258 PMCID: PMC3448503 DOI: 10.1186/1758-3284-4-37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 06/07/2012] [Indexed: 12/02/2022]
Abstract
As a result of major ablative surgery, head and neck oncology patients can be left with significant defects in the orofacial region. The resultant defect raises the need for advanced reconstruction techniques. The reconstruction in this region is aimed at restoring function and facial contour. The use of vascularised free flaps has revolutionised the reconstruction in the head and neck. Advances in reconstruction techniques have resulted in continuous improvement of oral rehabilitation. For example, endosteal implants are being used to restore the masticatory function by the way of prosthetic replacement of the dentition. Implant rehabilitation usually leads to improved facial appearance, function, restoration of speech and mastication. Suitable dental implant placement’s site requires satisfactory width, height and quality of bone. Reconstruction of hard tissue defects therefore will need to be tailored to meet the needs for implant placement. The aim of this feasibility study was to assess the compatibility of five standard commercially available dental implant systems (Biomet 3i, Nobel Biocare, Astra tech, Straumann and Ankylos) for placement into vascularised fibula graft during the reconstruction of oromandibular region. Radiographs (2D) of the lower extremities from 142 patients in the archives of the Department of Radiology in University College London Hospitals (UCLH) were analysed in this study. These radiographs were from 61 females and 81 males. Additionally, 60 unsexed dry fibular bones, 30 right sided, acquired from the collection of the Department of Anatomy, University College London (UCL) were also measured to account for the 3D factor. In the right fibula (dry bone), 90% of the samples measured had a width of 13.1 mm. While in the left fibula (dry bone), 90% of the samples measured had a width of 13.3 mm. Fibulas measured on radiographs had a width of 14.3 mm in 90% of the samples. The length ranges of the dental implants used in this study were: 7-13 mm (Biomet 3i), 10-13 mm (Nobel biocare), 8-13 mm (Astra Tech), 8-12 mm (Straumann ) and 8-11 mm (Ankylos). This study reached a conclusion that the width of fibula is sufficient for placement of most frequently used dental implants for oral rehabilitation after mandibular reconstructive procedures.
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Affiliation(s)
- Ramin Carbiner
- Head and Neck Centre, University College London Hospitals, London, UK
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Oteri G, Ponte FSD, Pisano M, Cicciù M. Five years follow-up of implant-prosthetic rehabilitation on a patient after mandibular ameloblastoma removal and ridge reconstruction by fibula graft and bone distraction. Dent Res J (Isfahan) 2012; 9:226-32. [PMID: 22623943 PMCID: PMC3353703 DOI: 10.4103/1735-3327.95241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This case report presents a combination of surgical and prosthetic solutions applied to a case of oral implant rehabilitation in post-oncologic reconstructed mandible. Bone resection due to surgical treatment of large mandibular neoplasm can cause long-span defects. Currently, mandibular fibula free flap graft is widely considered as a reliable technique for restoring this kind of defect. It restores the continuity of removed segment and re-establishes the contour of the lower jaw. However, the limited height of grafted fibula does not allow the insertion of regular length implants, therefore favouring vertical distraction osteogenesis as an important treatment choice. This report presents a patient affected by extensive mandibular ameloblastoma who underwent surgical reconstruction by fibula free flap because of partial mandibular resection. Guided distraction osteoneogenesis technique was applied to grafted bone, in order to obtain adequate bone height and to realize a prosthetically guided placement of 8 fixtures. After osseointegration, the patient was rehabilitated with a full arch, screw-retained prosthetic restoration. At five-years follow up, excellent integration of grafted tissue, steady levels of bone around the fixtures and healthy peri-implant tissues were reported.
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Affiliation(s)
- Giacomo Oteri
- Department of Odontostomatology, University of Messina, ME, Italy
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Yin X, Zhang C, Hze-Khoong EP, Shen S, Xu L. Influence of periosteal coverage on the osteointegration and stability of dental implant distractors. Clin Oral Implants Res 2012; 24:826-30. [PMID: 22471749 DOI: 10.1111/j.1600-0501.2012.02466.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Xuelai Yin
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai JiaoTong University; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai; China
| | - Chenping Zhang
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai JiaoTong University; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai; China
| | - Eugene Poh Hze-Khoong
- Department of Oral and Maxillofacial Surgery; Khoo Teck Puat Hospital; Yishun; Singapore
| | - Shunkun Shen
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai JiaoTong University; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai; China
| | - Liqun Xu
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai JiaoTong University; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai; China
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Modabber A, Legros C, Rana M, Gerressen M, Riediger D, Ghassemi A. Evaluation of computer-assisted jaw reconstruction with free vascularized fibular flap compared to conventional surgery: a clinical pilot study. Int J Med Robot 2011; 8:215-20. [PMID: 22213406 DOI: 10.1002/rcs.456] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND The introduction of computer-assisted surgery was a milestone in functional reconstructions of facial skeletal defects. PATIENTS AND METHODS We compared five computer-assisted and five conventional reconstructions with fibular grafts in the course of a pilot study. A rapid prototyping guide translated the computer-assisted surgery plan into intraoperative utilizable models. We intraoperatively measured the time needed for shaping the graft to the recipient site and the ischaemic time. Furthermore, the size of donor site defect compared to the required transplant length was evaluated. RESULTS Shaping procedure and ischaemic time turned out significantly shorter when compared to conventional surgery without cutting guide (p = 0.014). Using surgical guides, there was no change between the defect size of the fibula and the necessary transplant size. In conventional surgery, a mean change of 1.92 cm occurred (p = 0.001). CONCLUSION The surgical guide significantly reduced shaping time and consequently ischaemic time. These factors can influence flap survival. The fibular donor site defect was downsized.
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Affiliation(s)
- Ali Modabber
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Aachen, Germany.
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20
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Alveolar distraction osteogenesis for oral rehabilitation in reconstructed jaws. Curr Opin Otolaryngol Head Neck Surg 2011; 19:312-6. [DOI: 10.1097/moo.0b013e3283488452] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Paranque AR, Steve M, Vazquez L, Bolleyn A, Roze-Pellat MA, Dohan Ehrenfest DM. Esthetic and functional reconstruction of the posttumoral interrupted mandible with double-barrel fibular free flap graft: rationale for a microsurgical and prosthodontic approach. J ORAL IMPLANTOL 2010; 37:571-7. [PMID: 20712447 DOI: 10.1563/aaid-joi-d-10-00060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Reconstruction after substantial osseous, cutaneous, and muscular tissue loss following a mandibular resection is a challenge. The use of a fibular free flap is an outstanding, but delicate, treatment option. These grafts, using the double-barrel technique, can achieve an almost complete reconstruction of the mandibular defect. The challenge posed by these treatments is to achieve an end result that is both functional and esthetically pleasing-an endeavor that requires a defined prosthetic plan prior to complete microsurgical reconstruction. Using a detailed clinical case, this article discusses the importance of planning the mandible reconstruction with double-barrel fibular graft in view of an implant-supported fixed partial denture. Immediate implant loading was even possible in this case. This approach allows improvement of the final esthetic and functional result of such a complex rehabilitation. Maxillofacial reconstructive surgery should seek to establish a near-as-normal anatomic situation that will allow a permanent implant rehabilitation that is both esthetic and durable.
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Lee J, Sung HM, Jang JD, Park YW, Min SK, Kim EC. Successful reconstruction of 15-cm segmental defects by bone marrow stem cells and resected autogenous bone graft in central hemangioma. J Oral Maxillofac Surg 2010; 68:188-94. [PMID: 20006176 DOI: 10.1016/j.joms.2009.08.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 08/03/2009] [Accepted: 08/28/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Jun Lee
- Department of Oral & Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, South Korea
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Problems with dental implants that were placed on vertically distracted fibular free flaps after resection: A report of six cases. Br J Oral Maxillofac Surg 2009; 47:455-60. [DOI: 10.1016/j.bjoms.2009.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2009] [Indexed: 11/20/2022]
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Management considerations in reconstruction of postablative defects of the mandible: vertical distraction of a scapular bone flap and removable lip support: a case report. ACTA ACUST UNITED AC 2008; 106:e6-9. [DOI: 10.1016/j.tripleo.2008.05.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 05/21/2008] [Accepted: 05/28/2008] [Indexed: 11/19/2022]
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Thorwarth M, Eulzer C, Bader R, Wolf C, Schmidt M, Schultze-Mosgau S. Free flap transfer in cranio-maxillofacial surgery: a review of the current data. Oral Maxillofac Surg 2008; 12:113-124. [PMID: 18575905 DOI: 10.1007/s10006-008-0112-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The advances of cranio-maxillofacilal surgery are considerably driven by the evolution of microsurgical techniques. At present, these methods continue to provide new therapeutic options to the field. Especially, free flap transfer has evolved to become an integral part of current treatment protocols for head and neck malignancies. It ensures uneventful wound healing even after previous radiotherapy and can often preserve form and function. For many patients, this may lead to a significant improvement in their quality of life. OBJECTIVES This review summarizes aspects of tumor therapy, the impact of radiation, and discusses different techniques of microvascular tissue transfer. DISCUSSION Specific advantages in different anatomical sites of the head and neck region are highlighted in contrast to existing alternatives. Selected cases exemplify the use of popular transplants. SUMMARY While planning reconstructions, it is important to consider both the functional and aesthetic aspects. The best individual outcome is based on a thoughtful match of available methods to a given defect and the patient's condition.
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Affiliation(s)
- M Thorwarth
- Department of Oromaxillofacial Surgery/Plastic Surgery, University of Jena, Erlanger Allee 101, 07747, Jena, Germany.
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González-García R, Naval-Gías L, Rodríguez-Campo FJ, Muñoz-Guerra MF, Sastre-Pérez J. Vascularized free fibular flap for the reconstruction of mandibular defects: clinical experience in 42 cases. ACTA ACUST UNITED AC 2008; 106:191-202. [PMID: 18547843 DOI: 10.1016/j.tripleo.2007.04.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 02/05/2007] [Accepted: 04/10/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Since the advent of modern microvascular techniques, the fibula has become a reliable method for the reconstruction of partial or total mandibular defects. The purpose of this study is to evaluate our experience with the use of the vascularized free fibular flap for the reconstruction of mandibular defects following surgical resection. PATIENTS AND METHODS During a 5-year period, 102 consecutive patients were treated in our department for reconstruction of oral and maxillofacial defects, using microvascularized free flaps. Forty-two patients were reconstructed by means of the free vascularized fibular flap with or without a skin paddle. Patients underwent resection for benign (n = 15) and malignant (n = 27) entities. Fourteen patients received preoperative radiotherapy and only 1 patient received preoperative chemotherapy. The donor site was closed primarily in 7 cases, whereas an abdominal full-thickness skin graft was used in 35 cases. RESULTS Thirty-eight patients were treated by means of an osteocutaneous flap, whereas only 4 developed an osseous flap. Five patients developed complications related to the vascular anastomosis and needed a second surgical look. One patient died in the immediate postoperative period. The skin island flap was completely viable in 37 cases (88%). Considering bone survival as the main objective, an overall flap survival rate of 92.85% was achieved in the whole series. Endosseous dental implants were placed in 11 patients with adequate outcome. In 5 of these cases the double-barrel technique was performed. CONCLUSION Our results reveal that the vascularized free fibular flap is a reliable method for reconstructing mandibular defects with an acceptable low morbidity rate. The use of the osteocutaneous flap provides good reconstruction of composite mandibular defects. It constitutes an adequate support for dental implants.
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Affiliation(s)
- Raúl González-García
- Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital Infanta Cristina, Badajoz, Spain.
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Hirota M, Mizuki N, Iwai T, Watanuki K, Ozawa T, Maegawa J, Matsui Y, Tohnai I. Vertical distraction of a free vascularized osteocutaneous scapular flap in the reconstructed mandible for implant therapy. Int J Oral Maxillofac Surg 2008; 37:481-3. [DOI: 10.1016/j.ijom.2008.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 08/17/2007] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
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Placement of implants in the mandible reconstructed with free vascularized fibula flap: comparison of 2 cases. ACTA ACUST UNITED AC 2008; 105:e36-40. [DOI: 10.1016/j.tripleo.2007.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 08/22/2007] [Accepted: 09/24/2007] [Indexed: 11/18/2022]
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Saulacic N, Iizuka T, Martin MS, Garcia AG. Alveolar distraction osteogenesis: a systematic review. Int J Oral Maxillofac Surg 2008; 37:1-7. [PMID: 17822881 DOI: 10.1016/j.ijom.2007.07.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 06/06/2007] [Accepted: 07/16/2007] [Indexed: 11/26/2022]
Abstract
This literature review was performed to analyse the outcomes of clinical studies of alveolar distraction osteogenesis (DO) listed by PUBMED between January 1996 and December 2006. A PUBMED search identified 128 articles on alveolar DO. Twenty articles covering 209 cases were analysed, considering location, device and procedural parameters, rate of augmentation, aspect of final implant placement and follow up. The mean latency period was 7.26+/-2.31 days, distraction rate 0.71+/-0.27 mm/day, rate of augmentation 6.88+/-2.52 mm and consolidation period 12.22+/-5.58 weeks. A total of 469 implants were placed and followed post loading for an average of 14.19+/-11.03 months, with a survival rate of 97%. Of the different procedural parameters, only the difference between mean consolidation period for failed (8.10+/-2.51 weeks) and successful (12.43+/-5.62 weeks) implants was statistically significant (P=0.01). Use of DO may be advantageous in terms of the success rate of implants placed in augmented sites, but there is still a lack of sufficient data based on long-term follow up. Future experimental studies should evaluate the application of different methods with a view to shortening the overall treatment period and improving the performance of implants placed in distracted alveolar ridges.
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Affiliation(s)
- N Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital, University of Bern, CH-3010 Bern, Switzerland.
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Pereira MA, Luiz de Freitas PH, da Rosa TF, Xavier CB. Understanding Distraction Osteogenesis on the Maxillofacial Complex: A Literature Review. J Oral Maxillofac Surg 2007; 65:2518-23. [DOI: 10.1016/j.joms.2006.10.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 03/09/2006] [Accepted: 10/16/2006] [Indexed: 10/22/2022]
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Chopra S, Enepekides DJ. The role of distraction osteogenesis in mandibular reconstruction. Curr Opin Otolaryngol Head Neck Surg 2007; 15:197-201. [PMID: 17620890 DOI: 10.1097/moo.0b013e3282495925] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Distraction osteogenesis is finding increasing application in the management of mandibular defects. It provides an alternative method of mandibular reconstruction in varied clinical settings, notably following trauma and ablation of malignant tumors. Many recent studies have explored modifications in surgical technique, refinements in device design, and experiments in animal models. This review attempts to discuss all of the above. RECENT FINDINGS In addition to managing the segmental mandibular gap, the vertical distraction technique is highly useful for increasing fibular bony height, allowing osseointegrated implant placement and dental rehabilitation. Variations in distraction planes, parameters and device placement have made it possible to tailor appropriate reconstructive strategies to the specific patient. Newer developments in distractor design and constituents, and the application of staged distraction procedures, have facilitated optimal management of the challenging defect. SUMMARY Distraction osteogenesis is a continually evolving field of research and study, and an aesthetically and functionally acceptable option for managing extensive mandibular defects, and those not amenable to conventional methods. It offers distinct advantages over other available reconstructive options, but does have its disadvantages. With further improvement in devices and technique, it has the potential of being much more widely used in the future.
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Affiliation(s)
- Shamit Chopra
- Department of Otolaryngology - Head and Neck Surgery, University of California - Davis Medical Center, Sacramento, California 95817, USA.
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Ortakoglu K, Suer BT, Ozyigit A, Ozen T, Sencimen M. Vertical distraction osteogenesis of fibula transplant for mandibular reconstruction: a case report. ACTA ACUST UNITED AC 2006; 102:e8-11. [PMID: 16997100 DOI: 10.1016/j.tripleo.2006.01.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 12/28/2005] [Accepted: 01/23/2006] [Indexed: 11/27/2022]
Abstract
Bone continuity defects in the mandible are caused by tumor surgery, trauma, infection, or osteoradionecrosis. Today, reconstruction of long-span mandibular defects with a free fibular flap is a routine procedure. However the bone height of the mandible after reconstruction is about half that of the dentulous mandible. Therefore, the deficiency in bone height makes implant placement impractical. In our case, because it was necessary to restore the mandibular height, a vertical distraction osteogenesis was performed on the grafted mandible of the patient who was referred to our clinic with a reconstructed mandible owing to a gunshot injury. As a result, the vertical discrepancy between the fibula and the native hemimandible of the patient was corrected. And the placement of dental implants was performed without any complications. In conclusion, we believe that the vertical distraction osteogenesis of free vascularized fibula flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation.
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Affiliation(s)
- Kerim Ortakoglu
- Department of Oral and Maxillofacial Surgery, Center for Dental Sciences, Gulhane Military Medical Academy, Ankara, Turkey.
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Chiapasco M, Lang NP, Bosshardt DD. Quality and quantity of bone following alveolar distraction osteogenesis in the human mandible. Clin Oral Implants Res 2006; 17:394-402. [PMID: 16907770 DOI: 10.1111/j.1600-0501.2005.01247.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this prospective study on humans were to evaluate (a) the clinical outcome of alveolar distraction osteogenesis for the correction of vertically deficient edentulous mandibular ridges, (b) the clinical outcome of dental implants placed in the distracted areas, and (c) the quality and quantity of the bone that had formed in the distraction gap. MATERIAL AND METHODS Seven patients presenting vertically deficient edentulous ridges were treated by means of distraction osteogenesis with an intraoral alveolar distractor. Approximately 3 months after consolidation of the distracted segments, 20 ITI solid screw SLA implants were placed in the distracted areas. Three to 4 months later, abutments were connected and prosthetic loading of the implants started. During implant site preparation, bone biopsies were taken at the implant sites with trephine burrs for histologic and histometric analyses. RESULTS The mean follow-up after the initial prosthetic loading was 18 months (range 12-24 months). The mean bone gain obtained at the end of distraction was 7 mm (range 5-9 mm). The cumulative success rate of implants 2 years after the onset of prosthetic loading was 95%, whereas the survival rate of implants was 100%. The newly formed bone consisted of woven bone reinforced by parallel-fibered bone with bone marrow spaces between the bone trabeculae. The bone area fraction in the distraction region ranged from 21.6% to 57.8% (38.5+/-11.7%). DISCUSSION AND CONCLUSIONS Results from this study showed that (a) distraction osteogenesis is a reliable technique for the correction of vertically deficient edentulous ridges, (b) the regenerated bone withstood the functional demands of implant loading, (c) survival and success rates of implants placed in the distracted areas were consistent with those of implants placed in native bone, and (d) there is sufficient bone volume and maturity in the distracted region for primary stability of the implant.
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Affiliation(s)
- Matteo Chiapasco
- Unit of Oral Surgery Department of Medicine, Surgery, and Dentistry San Paolo Hospital, University of Milan, Milan Italy.
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Chiapasco M, Biglioli F, Autelitano L, Romeo E, Brusati R. Clinical outcome of dental implants placed in fibula-free flaps used for the reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis. Clin Oral Implants Res 2006; 17:220-8. [PMID: 16584419 DOI: 10.1111/j.1600-0501.2005.01212.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES (a) To evaluate the clinical outcome of fibula revascularized flaps used for the reconstruction of maxillary and mandibular defects due to resection for tumors or osteoradionecrosis and (b) to evaluate the survival and success rates of implants placed in the reconstructed areas. MATERIAL AND METHODS In a 8-year period (1995-2002), 59 patients, 38 males and 21 females, aged from 13 years to 69 years (mean age: 48.7 years), presenting with maxillary and mandibular defects due to resection for tumors or osteoradionecrosis, were reconstructed with fibula-free flaps. Of the 59 patients, 16 received 71 implants for the prosthetic rehabilitation of the reconstructed edentulous areas. RESULTS Out of 59 fibula-free flaps, three failed and had to be removed, nine underwent partial necrosis involving the bone segment and/or the skin paddle but survived, while the remaining 47 healed uneventfully. The mean follow-up of patients after the reconstruction was 55 months (range: 24-120 months). The cumulative survival rate of fibula-free flaps was 94.9%. The mean follow-up of the 16 patients treated with dental implants and implant-supported prostheses was 50.2 months (range: 24-96 months). The cumulative implant success and survival rates of implants were 98.6% and 93.1% respectively. CONCLUSION The reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis with fibula-free flaps has been demonstrated to be a reliable technique with good long-term results. Implants placed in the reconstructed areas were demonstrated to integrate normally, with success and survival rates comparable to those obtained in case of implants placed in native bone.
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Affiliation(s)
- Matteo Chiapasco
- Unit of Oral Surgery, Department of Medicine, Surgery, and Dentistry, San Paolo Hospital, University of Milan, Milan, Italy.
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Valentini V, Agrillo A, Battisti A, Gennaro P, Calabrese L, Iannetti G. Surgical Planning in Reconstruction of Mandibular Defect With Fibula Free Flap: 15 Patients. J Craniofac Surg 2005; 16:601-7. [PMID: 16077304 DOI: 10.1097/01.jps.0000157811.06921.c5] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The authors present a descriptive work on the reconstruction of large oromandibular defects with revascularized fibula free flaps in a group of patients treated by surgical resection of bony and soft tissues of the mandible. The principal objective is preoperative planning for the best morphological, functional, and aesthetic result. The authors report 15 reconstructions of wide oromandibular defects by revascularized fibula free flaps. The average patient age was 42 years. The mean follow-up period was 18 months. Correct surgical planning reduces surgical timing, minimizes the chance of failure during the reconstruction, and contemporaneously increases treatment efficacy and the best functional and aesthetic results.
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Affiliation(s)
- V Valentini
- Maxillofacial Surgery Department of Tor vergata, University of Rome, Rome, Italy
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Kramer FJ, Dempf R, Bremer B. Efficacy of dental implants placed into fibula-free flaps for orofacial reconstruction. Clin Oral Implants Res 2004; 16:80-8. [PMID: 15642034 DOI: 10.1111/j.1600-0501.2004.01040.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The transfer of the osseofasciocutaneus fibula-free flap has become a routine procedure in the reconstruction of comprehensive orofacial defects. Besides its length, major advantages of the fibula-free flap include the trigonal diameter of the fibular bone, which usually allows the placement of dental implants. PATIENTS AND METHODS In a prospective study, 16 consecutive patients who received free fibula grafts and in total 51 dental implants between 1999 and 2001 were examined. All implants were inserted secondary after bone grafting and loaded after 3 months of submerged healing. The observation period extended 2.5 years on average. The implant success was controlled clinically, radiographically and by resonance frequency analysis. RESULTS One implant that was located at the interface between the fibula graft and the mandible was lost due to dehiscence and local infection during the healing period. In two other patients, one implant had to remain unexposed as 'sleeper' due to an unfavourable soft tissue situation. The success rate calculated by Kaplan-Meier analysis was 96.1% after an observation period of 1400 days. Resonance frequency analysis (ISQ-values) revealed significant differences related to the orientation (vestibulo-oral/mesio-distal; vo/md) of the transducer unit (P < 0.01). In general, a high primary stability for implants placed in free fibula grafts could be achieved (vo/md 66/74.1), which on average increased slightly during the healing period (vo/md 67.4/75.4) and within 12 month of functional loading (vo/md 72.1/79.9). Additional augmentation with iliac bone grafts or reconstructions with a double barred fibula resulted in an improved reconstruction of the alveolar process, thus allowing superior individual implant positions or angulations, but no elevation of the ISQ-values. CONCLUSION The fibula-free flap provides a consistent bone graft that allows a reliable and predictable restoration with dental implants.
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Affiliation(s)
- Franz-Josef Kramer
- Department of Oral and Maxillofacial Surgery, Medical University of Hanover, Carl-Neuberg-Str. 1, D-30625 Hanover, Germany.
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Nocini PF, Albanese M, Buttura da Prato E, D'Agostino A. Vertical distraction osteogenesis of the mandible applied to an iliac crest graft: report of a case. Clin Oral Implants Res 2004; 15:366-70. [PMID: 15142101 DOI: 10.1111/j.1600-0501.2004.01018.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This clinical case represents a particular application of vertical distraction osteogenesis of the mandible. The surgical technique was applied to an iliac crest bone graft previously positioned on an anterior mandibular defect with the aim to restore the vertical height after a partial resorption in a trauma patient. CASE REPORT Distraction osteogenesis was applied because it was necessary to restore the mandibular height in a young male patient who presented with a post-trauma anterior mandibular bony deficiency. Because of the irregularity of the mandibular surface and the depth of the defect, the patient first underwent an iliac crest bone grafting that, after 3 months, showed partial resorption. Vertical distraction osteogenesis was performed on the grafted mandible in order to obtain a satisfactory bony height of the mandibular ridge. Then the patient was successfully rehabilitated by means of an implant-supported prosthesis. CONCLUSION Vertical distraction osteogenesis appears to be a versatile surgical procedure, which can be applied as a secondary treatment in patients presenting with mandibular trauma sequelae.
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Affiliation(s)
- Pier Francesco Nocini
- Department of Odontostomatology and Maxillo-Facial Surgery, University of Verona, Verona, Italy.
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Lee JH, Kim MJ, Choi WS, Yoon PY, Ahn KM, Myung H, Hwang SJ, Seo BM, Choi JY, Choung PH, Kim SM. Concomitant reconstruction of mandibular basal and alveolar bone with a free fibular flap. Int J Oral Maxillofac Surg 2004; 33:150-6. [PMID: 15050071 DOI: 10.1054/ijom.2003.0487] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2003] [Indexed: 11/18/2022]
Abstract
Repair of long-span mandibular defects with a free fibular flap is now a routine procedure. However, the bone height of the neo-mandible after reconstruction with a fibular flap is about half that of the dentulous mandible. When a fibular graft is placed only at the inferior border of the mandible, the resulting vertical discrepancy between the graft segment and the occlusal plane can adversely affect implant mechanics or denture stability and retention. To overcome these problems, we developed a technique for two-strut type mandibular reconstruction. A vascularized fibular segment is used to reconstruct the inferior basal portion of the neo-mandible, while a non-vascularized residual fibular segment is used to simulate the superior alveolar portion. We used this technique in 22 patients. Graft survival, graft resorption, and the ability to place implants were assessed as compared with those after the conventional one-strut type technique. The fibular segment grafted to the alveolar region was removed in one patient with intraoral wound dehiscence and in two with postoperative infection. All vascularized fibular flaps were successful. The resorption rate was 13.6+/-7.2% for non-vascularized segments and 3.0+/-3.7% for vascularized segments. Dental implants were placed in five of our 22 patients. The crown:fixture length ratio was improved to 1:1.7, as compared with a ratio of 1:1.21 with use of a conventional fibular flap. We conclude that our technique is very easy and safe and provides substantially improved lower-lip and cheek support and implant-prosthetic mechanics than conventional procedures for the repair of long-span mandibular defects.
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Affiliation(s)
- J H Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University, Seoul, South Korea
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Chiapasco M, Romeo E, Casentini P, Rimondini L. Alveolar distraction osteogenesis vs. vertical guided bone regeneration for the correction of vertically deficient edentulous ridges: A 1-3-year prospective study on humans. Clin Oral Implants Res 2004; 15:82-95. [PMID: 14731181 DOI: 10.1111/j.1600-0501.2004.00999.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this prospective study was to compare vertical guided bone regeneration (GBR) and vertical distraction osteogenesis (DO) for their ability in correcting vertically deficient alveolar ridges and their ability in maintaining over time the vertical bone gain obtained before and after implant placement. Eleven patients (group 1) were treated by means of vertical GBR with autogenous bone and e-PTFE membranes, while 10 patients (group 2) were treated by means of DO. In group 1, six patients received implants at the time of GBR (subgroup 1A), while five patients had implants placed at the time of membrane removal (subgroup 1B). In group 2, implants were placed at the time of distraction device removal. A total of 25 implants were placed in group 1 and 34 implants were placed in group 2 patients. Three to 5 months after implant placement, patients were rehabilitated with implant-borne dental prostheses. The following parameters were evaluated: (a) bone resorption of the regenerated ridges before and after implant placement; (b) peri-implant clinical parameters 1, 2, and 3 years after prosthetic loading of implants; (c) survival and success rates of implants. Bone resorption values before and after implant placement were significantly higher in group 1. The results suggested that both techniques may improve the deficit of vertically resorbed edentulous ridges, although distraction osteogenesis seems to be more predictable as far as the long-term prognosis of vertical bone gain is concerned. Implant survival rates as well as peri-implant clinical parameters do not differ significantly between the two groups, whereas the success rate of implants placed in group 2 patients was higher than that obtained in group 1 patients.
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Affiliation(s)
- Matteo Chiapasco
- Unit of Oral Surgery, Department of Medicine, Surgery, and Dentistry, San Paolo Hospital, University of Milan, Italy.
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Kuriakose MA, Shnayder Y, DeLacure MD. Reconstruction of segmental mandibular defects by distraction osteogenesis for mandibular reconstruction. Head Neck 2003; 25:816-24. [PMID: 12966505 DOI: 10.1002/hed.10294] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Distraction osteogenesis is an established technique for the lengthening of long bones and correction of selected craniofacial deformities. Regenerate osteoid bone matrix formed during the distraction phase is malleable and can recreate the three-dimensional form of native bones. Animal experiments and early clinical experience have confirmed that distraction osteogenesis can be used for the reconstruction of segmental bony defects. Herein we discuss the principles of distraction osteogenesis in reference to reconstruction of segmental bony defects and report its clinical application of the mandible continuity defects. PATIENTS AND METHODS Four patients (age, 7-83 years) with critical segmental mandibular defects (range, 3.5 cm-6.5 cm), resulting from ablative oncologic head and neck surgery underwent primary mandibular reconstruction by transport distraction osteogenesis. Two defects were at the angle and body region, one at the body, and the other at the parasymphysis and body region. Synthes Titanium Multi-vector and Leibinger Multi-guide distractors in bifocal (n = 2) and trifocal (n = 2) architecture were used after the stabilization of the segmental continuity defect using a defect-bridging mandibular reconstruction plate. Osteodistraction was carried out at a rate of 1 mm per day, with once or twice a day rhythm, after a 1-week latency period. The consolidation period was equal to the period of distraction. RESULTS All patients tolerated the distraction procedure. Satisfactory bone formation was observed in two patients, and partial bone formation was seen in one patient. Treatment failure was encountered in one patient who had a second oral cavity primary tumor observed during the consolidation period, requiring interruption of the treatment sequence. CONCLUSIONS Mandibular reconstruction with distraction osteogenesis is a potentially useful technique in selected patients with segmental mandibular continuity defects after ablative head and neck cancer surgery.
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Affiliation(s)
- M Abraham Kuriakose
- Division of Head and Neck Surgery and Oncology, Department of Otolaryngology, New York University School of Medicine, Suite 7U, Skirball Building, 530 First Ave, New York, New York 10016, USA.
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Takahashi T, Fukuda M, Aiba T, Funaki K, Ohnuki T, Kondoh T. Distraction osteogenesis for reconstruction after mandibular segmental resection. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:21-6. [PMID: 11805773 DOI: 10.1067/moe.2002.119002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Distraction osteogenesis with the shortening and lengthening method is a well-established procedure for repairing extremities. We used this technique for reconstruction after mandibular segmental resection. A 74-year-old woman underwent distraction osteogenesis with an intraoral device, initially shortening the mandible after a 20-mm-long segmental resection, followed by lengthening at a rate of 0.8 mm per day for 21 days. Eight weeks after the distraction, the device was removed and a dental implant was placed at the site of distraction. Radiographic observation showed new bone formation, and the implant was completely osseointegrated. Although the follow-up period is relatively short, the clinical course was uneventful. Distraction osteogenesis with the shortening and lengthening method seems to be a feasible option for reconstruction after segmental resection of the mandible.
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Affiliation(s)
- Tetsu Takahashi
- Second Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kitakyushu, Japan.
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Schimmele SR. Delayed reconstruction of continuity defects of the mandible after tumor surgery. J Oral Maxillofac Surg 2001; 59:1340-4. [PMID: 11688039 DOI: 10.1053/joms.2001.27826] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S R Schimmele
- Oral and Maxillofacial Surgery Associates, Fort Wayne, IN 46815, USA.
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