Long-term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo-mandibular defects due to extreme atrophy.

PURPOSE: the objectives of this study were to evaluate (a) the clinical outcome of revascularized fibula flaps used for the reconstruction of extremely atrophic jaws and (b) the survival rates of dental implants placed in the reconstructed areas. MATERIALS AND METHODS: between 1999 and 2004, 12 patients presenting with extreme atrophy of the edentulous jaws were reconstructed with fibula free flaps. Five to 12 months after the reconstructive procedure, 75 titanium dental implants were placed in the reconstructed areas, while prosthetic rehabilitation was started 4-6 months afterward. The mean follow-up of patients after the start of prosthetic loading was 77 months (range: 48-116). RESULTS: an uneventful healing of the bone transplants occurred in all patients. One out of the 75 dental implants placed was not loaded due to prosthetic reasons. No dental implants failed to integrate before prosthetic loading, while three were removed during the follow-up period. Despite the high survival rate of dental implants (95.8%), a relevant number of them presented relevant peri-implant bone-level loss, ranging from 1 to 7 mm for maxillary dental implants and from 1 to 4.5 mm for mandibular dental implants. CONCLUSION: although no failures of the bone transplants occurred and a high long-term survival rate of dental implants were observed, this study showed that fibula free flaps do not guarantee dimensional stability of peri-implant bone, despite the immediate blood supply delivered by the vascular pedicle. The peri-implant bone resorption was higher when compared with the one related to dental implants placed in native bone.

Implant-retained removable partial dentures: an 8-year retrospective study.

PURPOSE: To evaluate the long-term outcomes of removable partial dentures (RPDs) retained (but not supported) by dental implants. MATERIALS AND METHODS: We retrospectively evaluated 32 consecutive patients who received implant-retained RPDs. Each patient received one to four endosseus implants; the sample included a total of 64 implants. Follow-up was conducted for a minimum of 8 years, during which satisfaction, implant survival, and prosthetic success were evaluated. RESULTS: Patient satisfaction systematically increased. The implant success rate was 93.75%, and 100% of the prostheses were successful. CONCLUSION: Implant-retained RPDs are a reliable intermediate solution that can reduce biological and economic costs while maintaining implant treatment benefits and the ease of RPD procedures.

Clinical outcome of the use of fresh frozen allogeneic bone grafts for the reconstruction of severely resorbed alveolar ridges: preliminary results of a prospective study.

PURPOSE: The objectives of this study were to evaluate: (1) the clinical outcome of fresh frozen human allogeneic bone grafts (FFB) used for the reconstruction of severely atrophied edentulous ridges; (2) the survival rate of implants placed in the reconstructed areas; and (3) bone resorption. MATERIALS AND METHODS: During a 2-year period, 19 patients with severely atrophied partially or totally edentulous ridges who were candidates for an implant-supported prosthesis were consecutively enrolled and reconstructed with FFB iliac blocks. Five to 7 months later, 117 implants were placed in the reconstructed areas, and prosthetic rehabilitation was started 5 to 6 months afterward. RESULTS: The mean follow-up of patients after prosthetic loading was 27 months (range, 20 to 32 months). Prior to implant placement, graft exposure with partial or total loss of the graft occurred in four patients. After implant placement, bone graft exposures with partial loss of the grafts occurred in nine patients; in two patients, both grafts and implants were removed. The cumulative survival rate of implants was 90.2%. The mean (± standard deviation) graft resorption before implant placement was 0.98 ± 0.77 mm (range, 0 to 4 mm), while these values were 1.21 ± 1.05 mm (range, 0 to 6 mm) at loading, 1.55 ± 1.57 mm (range, 0 to 8 mm) at 12 months, and 1.93 ± 1.38 mm (range, 1 to 9 mm) at 24 months. CONCLUSION: Within the limits of this study (limited sample of patients and short follow-up), the reconstruction of severely atrophic edentulous ridges with FFB is associated with a relevant incidence of bone exposures and partial or total loss of the grafts, which may compromise the long-term survival of implants placed in the reconstructed areas.