PDF icon Download PDF
J Reconstr Microsurg
DOI: 10.1055/a-2659-6993
Original Article

Long-Term Outcomes Following Immediate Dental Implant Placement in Free Fibula Flaps for Oncologic Mandibular Reconstruction

Robert J. Allen Jr.   *
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Kevin K. Zhang    *
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Zack Cohen
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Annu Singh
2   Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Kenneth Kronstadt
2   Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Ian Ganly
3   Head and Neck Oncology Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Farooq Shahzad
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Evan Rosen
4   Rosen Prosthodontics, Peekskill, New York
,
Jonas A. Nelson
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Evan Matros
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
› Author Affiliations
Funding This research was funded in part through the NIH/NCI Cancer Center (grant P30 CA008748).
› Further Information
Also available atMedOne
   Permissions and Reprints
Preview

Abstract

Background

Immediate dental implant placement (IDIP) in free fibula flap (FFF) reconstruction of the mandible is an important treatment paradigm for head and neck cancer patients. This study examines the long-term safety and prosthodontic outcomes of IDIP in oncologic mandible reconstruction.

Methods

A retrospective, noninferiority cohort study was performed comparing IDIP and non-IDIP in patients undergoing FFF reconstruction of oncologic mandibulectomy defects using computer-aided design and computer-aided manufacturing technology. Outcomes of interest included long-term complications and rates of dental rehabilitation with either an implant or nonimplant-supported resection prosthesis.

Results

One hundred forty-eight patients were included in the study. IDIP patients (n = 86) were significantly older (p = 0.017) and had a higher BMI (p < 0.0001) than non-IDIP patients (n = 62). Median follow-up time was 2.4 and 4.9 years in the IDIP and non-IDIP groups, respectively. Complication rates were comparable between groups (p > 0.05). The IDIP cohort received 219 dental implants, whereas four patients in the non-IDIP cohort received 10 implants in a delayed setting (p < 0.0001). IDIP patients were more likely to achieve long-term dental rehabilitation (IDIP: 69.8%, non-IDIP: 25.8%; p < 0.0001) and at an earlier time point (median [interquartile range]: 120 [45, 297] days vs. 355 [243, 595] days; p = 0.0002) after reconstruction. Adjuvant radiation did not affect the likelihood of completing dental rehabilitation in IDIP patients (p = 0.818).

Conclusion

IDIP safely achieves dental restoration in less time and at a higher rate than non-IDIP in oncologic patients. Measurement of patient-reported outcomes is needed to bolster support for IDIP as the standard of care in oncologic patients.

Keywords

immediate dental implant placement - mandibulectomy - fibula free flap - osseointegration

* Denotes first authorship.




Publication History

Received: 27 January 2025

Accepted: 22 June 2025

Accepted Manuscript online:
18 July 2025

Article published online:
14 August 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Cracchiolo JR, Klassen AF, Young-Afat DA. et al. Leveraging patient-reported outcomes data to inform oncology clinical decision making: introducing the FACE-Q head and neck cancer module. Cancer 2019; 125 (06) 863-872
    CrossrefPubMedSearch in Google Scholar
  • 2 Cohen WA, Albornoz CR, Cordeiro PG. et al. Health-related quality of life following reconstruction for common head and neck surgical defects. Plast Reconstr Surg 2016; 138 (06) 1312-1320
    CrossrefPubMedSearch in Google Scholar
  • 3 Panchal H, Shamsunder MG, Petrovic I. et al. Dental implant survival in vascularized bone flaps: a systematic review and meta-analysis. Plast Reconstr Surg 2020; 146 (03) 637-648
    CrossrefPubMedSearch in Google Scholar
  • 4 Teoh KH, Huryn JM, Patel S. et al. Implant prosthodontic rehabilitation of fibula free-flap reconstructed mandibles: a Memorial Sloan-Kettering Cancer Center review of prognostic factors and implant outcomes. Int J Oral Maxillofac Implants 2005; 20 (05) 738-746
    PubMedSearch in Google Scholar
  • 5 Allen Jr RJ, Nelson JA, Polanco TO. et al. Short-term outcomes following virtual surgery-assisted immediate dental implant placement in free fibula flaps for oncologic mandibular reconstruction. Plast Reconstr Surg 2020; 146 (06) 768e-776e
    CrossrefPubMedSearch in Google Scholar
  • 6 Ch'ng S, Skoracki RJ, Selber JC. et al. Osseointegrated implant-based dental rehabilitation in head and neck reconstruction patients. Head Neck 2016; 38 (Suppl. 01) E321-E327
    CrossrefPubMedSearch in Google Scholar
  • 7 Patel SY, Kim DD, Ghali GE. Maxillofacial reconstruction using vascularized fibula free flaps and endosseous implants. Oral Maxillofac Surg Clin North Am 2019; 31 (02) 259-284
    CrossrefPubMedSearch in Google Scholar
  • 8 Kumar VV, Jacob PC, Ebenezer S. et al. Implant supported dental rehabilitation following segmental mandibular reconstruction- quality of life outcomes of a prospective randomized trial. J Craniomaxillofac Surg 2016; 44 (07) 800-810
    CrossrefPubMedSearch in Google Scholar
  • 9 Baker DG. The radiobiological basis for tissue reactions in the oral cavity following therapeutic X-irradiation. A review. Arch Otolaryngol 1982; 108 (01) 21-24
    CrossrefPubMedSearch in Google Scholar
  • 10 Moore P, Grinsell D, Lyons B, Hewson I. Outcomes of dental and craniofacial osseointegrated implantation in head and neck cancer patients. Head Neck 2019; 41 (09) 3290-3298
    CrossrefPubMedSearch in Google Scholar
  • 11 Lodders JN, Leusink FKJ, Ridwan-Pramana A. et al. Long-term outcomes of implant-based dental rehabilitation in head and neck cancer patients after reconstruction with the free vascularized fibula flap. J Craniomaxillofac Surg 2021; 49 (09) 845-854
    CrossrefPubMedSearch in Google Scholar
  • 12 Schiegnitz E, Müller LK, Sagheb K. et al. Clinical long-term and patient-reported outcomes of dental implants in oral cancer patients. Int J Implant Dent 2021; 7 (01) 93
    CrossrefPubMedSearch in Google Scholar
  • 13 Kluth EV, Jain PR, Stuchell RN, Frich Jr JC. A study of factors contributing to the development of osteoradionecrosis of the jaws. J Prosthet Dent 1988; 59 (02) 194-201
    CrossrefPubMedSearch in Google Scholar
  • 14 Chambrone L, Mandia Jr J, Shibli JA, Romito GA, Abrahao M. Dental implants installed in irradiated jaws: a systematic review. J Dent Res 2013; 92 (12, suppl): 119S-130S
    CrossrefPubMedSearch in Google Scholar
  • 15 Matros E, Albornoz CR, Rensberger M, Weimer K, Garfein ES. Computer-assisted design and computer-assisted modeling technique optimization and advantages over traditional methods of osseous flap reconstruction. J Reconstr Microsurg 2014; 30 (05) 289-296
    PubMedSearch in Google Scholar
  • 16 Rosen EB, Kyle Gazdeck R, Goldman DA. et al. An anatomic analysis of fibula flap mandible reconstructions: implications for endosseous implant placement. Plast Reconstr Surg 2022; 149 (06) 1419-1428
    CrossrefPubMedSearch in Google Scholar
  • 17 Okay DJ, Buchbinder D, Urken M, Jacobson A, Lazarus C, Persky M. Computer-assisted implant rehabilitation of maxillomandibular defects reconstructed with vascularized bone free flaps. JAMA Otolaryngol Head Neck Surg 2013; 139 (04) 371-381
    CrossrefPubMedSearch in Google Scholar
  • 18 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 (01) 46-55
    CrossrefPubMedSearch in Google Scholar
  • 19 Wetzels JGH, Meijer GJ, de Haan AFJ, Merkx MAW, Speksnijder CM. Immediate implant placement in edentulous oral cancer patients: a long-term retrospective analysis of 207 patients. Int J Oral Maxillofac Implants 2021; 50 (11) 1521-1528
    CrossrefPubMedSearch in Google Scholar
  • 20 Anolik RA, Nelson JA, Rosen EB, Disa J, Matros E, Allen Jr RJ. Immediate dental implant placement in the oncologic setting: a conceptual framework. Plast Reconstr Surg Glob Open 2021; 9 (09) e3671
    CrossrefPubMedSearch in Google Scholar
  • 21 Allen Jr RJ, Shenaq DS, Rosen EB. et al. Immediate dental implantation in oncologic jaw reconstruction: workflow optimization to decrease time to full dental rehabilitation. Plast Reconstr Surg Glob Open 2019; 7 (01) e2100
    CrossrefPubMedSearch in Google Scholar
  • 22 Harris D, Höfer S, O'Boyle CA. et al. A comparison of implant-retained mandibular overdentures and conventional dentures on quality of life in edentulous patients: a randomized, prospective, within-subject controlled clinical trial. Clin Oral Implants Res 2013; 24 (01) 96-103
    CrossrefPubMedSearch in Google Scholar
  • 23 Sumida T, Kobayashi Y, Ishikawa A. et al. Bite force and masticatory performance using implant-supported overdentures after treatment of mandibular cancer. Anticancer Res 2016; 36 (08) 4077-4080
    PubMedSearch in Google Scholar
  • 24 Ganeles J, Zöllner A, Jackowski J, ten Bruggenkate C, Beagle J, Guerra F. Immediate and early loading of Straumann implants with a chemically modified surface (SLActive) in the posterior mandible and maxilla: 1-year results from a prospective multicenter study. Clin Oral Implants Res 2008; 19 (11) 1119-1128
    CrossrefPubMedSearch in Google Scholar
  • 25 Bornstein MM, Wittneben JG, Brägger U, Buser D. Early loading at 21 days of non-submerged titanium implants with a chemically modified sandblasted and acid-etched surface: 3-year results of a prospective study in the posterior mandible. J Periodontol 2010; 81 (06) 809-818
    CrossrefPubMedSearch in Google Scholar
  • 26 Oates TW, Valderrama P, Bischof M. et al. Enhanced implant stability with a chemically modified SLA surface: a randomized pilot study. Int J Oral Maxillofac Implants 2007; 22 (05) 755-760
    PubMedSearch in Google Scholar
  • 27 Sandoval ML, Rosen EB, Robert AJ, Nelson JA, Matros E, Gelblum DY. Immediate dental implants in fibula free flaps to reconstruct the mandible: a pilot study of the short-term effects on radiotherapy for patients with head and neck cancer. Clin Implant Dent Relat Res 2020; 22 (01) 91-95
    CrossrefPubMedSearch in Google Scholar
  • 28 Avraham T, Franco P, Brecht LE. et al. Functional outcomes of virtually planned free fibula flap reconstruction of the mandible. Plast Reconstr Surg 2014; 134 (04) 628e-634e
    CrossrefPubMedSearch in Google Scholar
  • 29 Menapace DC, Van Abel KM, Jackson RS, Moore EJ. Primary vs secondary endosseous implantation after fibular free tissue reconstruction of the mandible for osteoradionecrosis. JAMA Facial Plast Surg 2018; 20 (05) 401-408
    CrossrefPubMedSearch in Google Scholar
  • 30 Kurlander DE, Garvey PB, Largo RD. et al. The cost utility of virtual surgical planning and computer-assisted design/computer-assisted manufacturing in mandible reconstruction using the free fibula osteocutaneous flap. J Reconstr Microsurg 2023; 39 (03) 221-230
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 van Gemert JT, van Es RJ, Rosenberg AJ, van der Bilt A, Koole R, Van Cann EM. Free vascularized flaps for reconstruction of the mandible: complications, success, and dental rehabilitation. J Oral Maxillofac Surg 2012; 70 (07) 1692-1698
    CrossrefPubMedSearch in Google Scholar
  • 32 Iizuka T, Häfliger J, Seto I, Rahal A, Mericske-Stern R, Smolka K. Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer. Clin Oral Implants Res 2005; 16 (01) 69-79
    CrossrefPubMedSearch in Google Scholar
  • 33 Laverty DP, Addison O, Wubie BA. et al. Outcomes of implant-based oral rehabilitation in head and neck oncology patients-a retrospective evaluation of a large, single regional service cohort. Int J Implant Dent 2019; 5 (01) 8
    CrossrefPubMedSearch in Google Scholar
  • 34 Schiegnitz E, Al-Nawas B, Kämmerer PW, Grötz KA. Oral rehabilitation with dental implants in irradiated patients: a meta-analysis on implant survival. Clin Oral Investig 2014; 18 (03) 687-698
    CrossrefPubMedSearch in Google Scholar
  • 35 Nelson JA, Allen Jr RJ, Rosen EB, Matros E. Cost-effectiveness and virtual surgical planning in head and neck reconstruction: measuring what matters most. Plast Reconstr Surg 2021; 147 (06) 1091e-1092e
    CrossrefPubMedSearch in Google Scholar