Computer-Assisted Implant Rehabilitation of Maxillomandibular Defects Reconstructed With Vascularized Bone Free Flaps | Facial Plastic Surgery | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.204.186.91. Please contact the publisher to request reinstatement.
1.
Urken ML, Buchbinder D, Weinberg H,  et al.  Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients.  Laryngoscope. 1991;101(9):935-9501886442PubMedGoogle ScholarCrossref
2.
Leung AC, Cheung LK. Dental implants in reconstructed jaws: patients' evaluation of functional and quality-of-life outcomes.  Int J Oral Maxillofac Implants. 2003;18(1):127-13412608678PubMedGoogle Scholar
3.
Schmelzeisen R, Neukam FW, Shirota T, Specht B, Wichmann M. Postoperative function after implant insertion in vascularized bone grafts in maxilla and mandible.  Plast Reconstr Surg. 1996;97(4):719-7258628765PubMedGoogle ScholarCrossref
4.
Urken ML, Bridger AG, Zur KB, Genden EM. The scapular osteofasciocutaneous flap: a 12-year experience.  Arch Otolaryngol Head Neck Surg. 2001;127(7):862-86911448364PubMedGoogle Scholar
5.
Hidalgo DA. Fibula free flap: a new method of mandible reconstruction.  Plast Reconstr Surg. 1989;84(1):71-792734406PubMedGoogle ScholarCrossref
6.
Urken ML, Buchbinder D, Costantino PD,  et al.  Oromandibular reconstruction using microvascular composite flaps: report of 210 cases.  Arch Otolaryngol Head Neck Surg. 1998;124(1):46-559440780PubMedGoogle ScholarCrossref
7.
Genden EM, Okay D, Buchbinder D,  et al.  Iliac crest internal oblique osteomusculocutaneous free-flap reconstruction of the post-ablative palatomaxillary defect.  Arch Otolaryngol Head Neck Surg. 2001;127:854-861Google Scholar
8.
Frodel JL Jr, Funk GF, Capper DT,  et al.  Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps.  Plast Reconstr Surg. 1993;92(3):449-4558341743PubMedGoogle ScholarCrossref
9.
Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect.  Head Neck. 1996;18(5):412-4218864732PubMedGoogle ScholarCrossref
10.
Futran ND, Wadsworth JT, Villaret D, Farwell DG. Midface reconstruction with the fibula free flap.  Arch Otolaryngol Head Neck Surg. 2002;128(2):161-16611843725PubMedGoogle ScholarCrossref
11.
Okay DJ, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects.  J Prosthet Dent. 2001;86(4):352-36311677528PubMedGoogle ScholarCrossref
12.
Genden EM, Okay D, Stepp MT,  et al.  Comparison of functional and quality-of-life outcomes in patients with and without palatomaxillary reconstruction: a preliminary report.  Arch Otolaryngol Head Neck Surg. 2003;129(7):775-78012874081PubMedGoogle ScholarCrossref
13.
Brånemark PI. Osseointegration and its experimental background.  J Prosthet Dent. 1983;50(3):399-4106352924PubMedGoogle ScholarCrossref
14.
Urken ML, Buchbinder D, Weinberg H, Vickery C, Sheiner A, Biller HF. Primary placement of osseointegrated implants in microvascular mandibular reconstruction.  Otolaryngol Head Neck Surg. 1989;101(1):56-732547185PubMedGoogle Scholar
15.
Marx RE. A new concept in the treatment of osteoradionecrosis.  J Oral Maxillofac Surg. 1983;41(6):351-3576574217PubMedGoogle ScholarCrossref
16.
Granström G, Jacobsson M, Tjellström A. Titanium implants in irradiated tissue: benefits from hyperbaric oxygen.  Int J Oral Maxillofac Implants. 1992;7(1):15-251398819PubMedGoogle Scholar
17.
Di Giacomo GA, Cury PR, de Araujo NS, Sendyk WR, Sendyk CL. Clinical application of stereolithographic surgical guides for implant placement: preliminary results.  J Periodontol. 2005;76(4):503-50715857088PubMedGoogle ScholarCrossref
18.
Moscoso JF, Keller J, Genden E,  et al.  Vascularized bone flaps in oromandibular reconstruction: a comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants.  Arch Otolaryngol Head Neck Surg. 1994;120(1):36-438274254PubMedGoogle ScholarCrossref
19.
Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite free flaps: report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects.  Arch Otolaryngol Head Neck Surg. 1991;117(7):733-7441863438PubMedGoogle ScholarCrossref
20.
Nkenke E, Eitner S, Radespiel-Tröger M, Vairaktaris E, Neukam FW, Fenner M. Patient-centred outcomes comparing transmucosal implant placement with an open approach in the maxilla: a prospective, non-randomized pilot study.  Clin Oral Implants Res. 2007;18(2):197-20317348884PubMedGoogle ScholarCrossref
21.
Luongo G, Di Raimondo R, Filippini P, Gualini F, Paoleschi C. Early loading of sandblasted, acid-etched implants in the posterior maxilla and mandible: a 1-year follow-up report from a multicenter 3-year prospective study.  Int J Oral Maxillofac Implants. 2005;20(1):84-9115747678PubMedGoogle Scholar
22.
Vanden Bogaerde L, Pedretti G, Dellacasa P, Mozzati M, Rangert B, Wendelhag I. Early function of splinted implants in maxillas and posterior mandibles, using Brånemark System Tiunite implants: an 18-month prospective clinical multicenter study.  Clin Implant Dent Relat Res. 2004;6(3):121-12915726846PubMedGoogle Scholar
23.
Cornelini R, Cangini F, Covani U, Barone A, Buser D. Immediate loading of implants with 3-unit fixed partial dentures: a 12-month clinical study.  Int J Oral Maxillofac Implants. 2006;21(6):914-91817190301PubMedGoogle Scholar
24.
Schincaglia GP, Marzola R, Scapoli C, Scotti R. Immediate loading of dental implants supporting fixed partial dentures in the posterior mandible: a randomized controlled split-mouth study: machined vs titanium oxide implant surface.  Int J Oral Maxillofac Implants. 2007;22(1):35-4617340895PubMedGoogle Scholar
25.
Del Fabbro M, Testori T, Francetti L, Taschieri S, Weinstein R. Systematic review of survival rates for immediately loaded dental implants.  Int J Periodontics Restorative Dent. 2006;26(3):249-26316836167PubMedGoogle Scholar
26.
Rogers SN, McNally D, Mahmoud M, Chan MF, Humphris GM. Psychologic response of the edentulous patient after primary surgery for oral cancer: a cross-sectional study.  J Prosthet Dent. 1999;82(3):317-32110479259PubMedGoogle ScholarCrossref
27.
Futran N, Urken M. Fibula free flap. In: Urken M, ed. Atlas of Regional and Free Flaps for Head and Neck Reconstruction. 2nd ed. New York, NY: Wolters Kluwer/Lippincott Williams and Wilkins; 2012
28.
Okay D, Buchbinder D. Implant assisted prosthetic reconstruction after tumor ablation. In: Bagheri S, Bell RB, Khan H, eds. Current Therapy in Oral and Maxillofacial Surgery. St Louis, MO: Elsevier-Saunders; 2012:592-603
29.
Odin G, Balaguer T, Savoldelli C, Scortecci G. Immediate functional loading of an implant-supported fixed prosthesis at the time of ablative surgery and mandibular reconstruction for squamous cell carcinoma.  J Oral Implantol. 2010;36(3):225-23020553177PubMedGoogle ScholarCrossref
30.
Chiapasco M, Gatti C. Immediate loading of dental implants placed in revascularized fibula free flaps: a clinical report on 2 consecutive patients.  Int J Oral Maxillofac Implants. 2004;19(6):906-91215623070PubMedGoogle Scholar
31.
Bähr W, Stoll P, Wächter R. Use of the “double barrel” free vascularized fibula in mandibular reconstruction.  J Oral Maxillofac Surg. 1998;56(1):38-449437980PubMedGoogle ScholarCrossref
32.
Buchbinder D, Okay D, Urken M. Oromandibular reconstruction. In: Urken M, ed. Multidisciplinary Head and Neck Reconstruction: A Defect-Oriented Approach. New York, NY: Lippincott Williams & Wilkins; 2010:212-228
33.
Roumanas ED, Garrett N, Blackwell KE,  et al.  Masticatory and swallowing threshold performances with conventional and implant-supported prostheses after mandibular fibula free-flap reconstruction.  J Prosthet Dent. 2006;96(4):289-29717052474PubMedGoogle ScholarCrossref
34.
Raoul G, Ruhin B, Briki S,  et al.  Microsurgical reconstruction of the jaw with fibular grafts and implants.  J Craniofac Surg. 2009;20(6):2105-211719884849PubMedGoogle ScholarCrossref
35.
Smolka K, Kraehenbuehl M, Eggensperger N,  et al.  Fibula free flap reconstruction of the mandible in cancer patients: evaluation of a combined surgical and prosthodontic treatment concept.  Oral Oncol. 2008;44(6):571-58117938001PubMedGoogle ScholarCrossref
36.
Brennan M, Houston F, O’Sullivan M, O’Connell B. Patient satisfaction and oral health-related quality of life outcomes of implant overdentures and fixed complete dentures.  Int J Oral Maxillofac Implants. 2010;25(4):791-80020657876PubMedGoogle Scholar
Original Article
April 2013

Computer-Assisted Implant Rehabilitation of Maxillomandibular Defects Reconstructed With Vascularized Bone Free Flaps

Author Affiliations

Author Affiliations: Divisions of Prosthodontics (Dr Okay) and Oral and Maxillofacial Surgery (Drs Okay and Buchbinder), Department of Otolaryngology–Head and Neck Surgery (Drs Okay, Buchbinder, Urken, Jacobson, Lazarus, and Persky), and Institute for Head and Neck and Thyroid Diseases (Drs Okay, Buchbinder, Urken, Jacobson, Lazarus, and Persky), Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York.

JAMA Otolaryngol Head Neck Surg. 2013;139(4):371-381. doi:10.1001/jamaoto.2013.83
Abstract

Importance Functional recovery for patients who undergo maxillomandibular reconstruction with vascularized bone free flaps (VBFFs) is potentially more attainable with computer-assisted implant rehabilitation. This prosthodontic-driven approach uses software planning and surgical templates for implant placement supporting fixed dental prostheses (FDP). Implant success with immediate load (IL) provisional and definitive FDP restorations in VBFFs is reported for the first time in a patient cohort.

Objectives To determine implant success for FDP restorations and IL restorations. To determine factors that may influence success and predictability to provide FDP restorations in VBFFs.

Design A retrospective medical chart review was conducted of patients who underwent VBFF reconstruction and computer-assisted planning (CP) for FDP implant rehabilitation. This study was conducted with approval from the institutional review board at Beth Israel Medical Center, New York, New York.

Setting Clinical procedures were conducted in operating room and outpatient facilities in a tertiary referral medical center.

Participants Twenty-eight consecutive patient treatments were reviewed. Inclusion criteria for all patients were VBFF reconstruction and CP for FDP restoration prior to stage 1 implant surgery. Patients were evaluated for implant success, surgical templates, IL provisional restorations, and prosthodontic framework design. A comparison is made between patients with IL provisional restorations and those patients who did not receive an immediate restoration.

Main Outcomes and Measures Implants that achieved osseointegration and used for prosthetic reconstruction determined success. Prosthodontic design considerations included whether the patient received an IL provisional restoration and 3 categories of FDP metal framework design.

Results Ninety-nine implants of 116 implants placed were used for prosthetic restorations, achieving an 85.4% success rate. Twenty-five of 28 patients received FDP restorations. Thirteen of 28 patients received IL provisional restorations at stage 1 implant surgery. Fifty of 56 implants were successful (89.3%) in the IL group.

Conclusions Computer-assisted implant rehabilitation of reconstructed defects can achieve superior results to provide FDP and IL provisional restorations. This prosthodontic-driven approach also uses unique framework design to account for mandible height discrepancy after fibula free flap reconstruction. Patient management for FDP rehabilitation is also dependent on radiation status, soft-tissue modification, and patient selection.

×