Short-term Outcomes Following Immediate Dental Implant Placement (IDIP) in Free Fibula Flaps for Oncologic Mandibular Reconstruction
Robert Allen, Jr., MD, Jonas Nelson, MD, Evan Rosen, DMD MPH, Thais Polanco, MD, Meghana Shamsunder, MPH, Aadit Patel, MD, Nikhil Sobti, MS, Snehal Patel, MD FRCS, Ian Gangly, MD, Jay Boyle, MD, Snehal Patel, MD, Evan Matros, MD MMSc MPH.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Despite reports demonstrating feasibility of immediate dental implant placement in mandibular reconstruction with free fibula flaps for benign disease, this practice is not routinely employed in the oncologic patient. The study aims to demonstrate the safety of IDIP in the oncologic setting.
In 2017, our center began IDIP into fibula flaps for oncologic patients necessitating segmental mandibulectomy. Patients undergoing IDIP were compared to a historical cohort (from 2010-2017) reconstructed with virtual surgical planning(VSP), but without IDIP. Primary outcomes included 90-day complications, loss of dental implants, time to radiotherapy, and permanent dentition. All patients undergoing IDIP underwent a separate vestibuloplasty to uncover the implants prior to or following radiation.
Sixty-six patients underwent fibulas with the aid of VSP from 2010 to 2018: 31 with IDIP versus 35 without implants. A total of 83 mandibular implants were placed. No differences were noted in complications(p>0.05). Radiotherapy was required in 55% of IDIP vs. 62% of those without implants, with no difference in time to radiation(64 vs 113 days; p=0.52). Three dental implants were removed for non-osseointegration at the time of vestibuloplasty. All IDIP patients initiated dental rehabilitation and were significantly more likely to receive permanent dentition following segmental mandibulectomy at 90 days (37% vs. 0%, p<.001).
The currents study demonstrates an unchanged short-term complication profile in oncologic patients undergoing IDIP compared to a historical cohort, with no delay in time to radiation therapy. Patients undergoing IDIP are more likely to complete full dental rehabilitation by 90 days.
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