Efficacy of dental implants placed into fibula-free flaps for orofacial reconstruction

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.