Optimizing Results in Mandible Reconstruction Using Osteointegrated Dental Implants

ABSTRACT

Reconstruction of segmental mandibular defects with vascularized bone and placement of osteointegrated implants have allowed total dental restoration in properly selected patients. Osteointegrated dental implantation can be performed during the primary operation in patients with mandibular defects resulting from the excision of benign lesions and some nonbenign lesions with excellent prognoses; otherwise they can be performed secondarily. Radiation therapy may affect the ability to place osteointegrated implants into the reconstructed mandible and may compromise the final outcome. Selection of the proper bone flap, optimal timing of dental implant placement (primary versus secondary), meticulous bone stabilization, and accurate implant positioning and alignment are critical for successful total mandibular rehabilitation.

KEYWORDS

Mandible reconstruction - osteointegrated implants - microsurgical reconstruction

REFERENCES

• 1 Branemark P I, Adell R, Breine U, Hansson B O, Lindstrom J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Experimental studies.  Scand J Plast Reconstr Surg . 1969;  3 81-100
• 2 Branemark P I, Hansson B O, Adell R. et al . Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period.  Scand J Plast Reconstr Surg Suppl . 1977;  16 1-132
• 3 Gurlek A, Miller M J, Jacob R F, Lively J A, Schusterman M A. Functional results of dental restoration with osseointegrated implants after mandible reconstruction.  Plast Reconstr Surg . 1998;  101 650-655
• 4 Chang Y M, Santamaria E, Wei F C. et al . Primary insertion of osseointegrated dental implants into fibula osteoseptocutaneous free flap for mandible reconstruction.  Plast Reconstr Surg . 1998;  102 680-688
• 5 Urken M L, Buchbinder D, Costantino P D. et al . Oromandibular reconstruction using microvascular composite flaps: report of 210 cases.  Arch Otolaryngol Head Neck Surg . 1998;  124 46-55
• 6 Kildal M, Wei F C, Chang Y M, Chen H C, Chang M H. Mandibular reconstruction with fibula osteoseptocutaneous free flap and osseointegrated dental implants.  Clin Plast Surg . 2001;  28 403-410
• 7 Urken M L. In discussion of: Gurlek A, Miller MJ, Jacob RF, Lively JA, Schusterman MA. Functional results of dental restoration with osseointegrated implants after mandible reconstruction.  Plast Reconstr Surg . 1998;  101 656-659
• 8 Smith D E, Zarb G A. Criteria for success of osseointegrated endosseous implants.  J Prosthet Dent . 1989;  62 567-572
• 9 Ellies L G, Hawker P B. The prevalence of altered sensation associated with implant surgery.  Int J Oral Maxillofac Implants . 1993;  8 674-679
• 10 Berggren A, Weiland A J, Dorfman H. The effect of prolonged ischemia time on osteocyte and osteoblast survival in composite bone grafts revascularized by microvascular anastomoses.  Plast Reconstr Surg . 1982;  69 290-298
• 11 Wei F C, Santamaria E, Chang Y M, Chen H C. Mandibular reconstruction with fibular osteoseptocutaneous free flap and simultaneous placement of osseointegrated dental implants.  J Craniofac Surg . 1997;  8 512-521
• 12 Horiuchi K, Hattori A, Inada I. et al . Mandibular reconstruction using the double barrel fibular graft.  Microsurgery . 1995;  16 450-454
• 13 Kim M J, Lee J H, Choi W S. Concomitant reconstruction of mandibular basal and alveolar bone using free vascularized and non-vascularized composite fibular flaps. World Society for Reconstructive Microsurgery (WSRM).Inaugural Congress: Abstract-October 30-November 3, 2001, Taipei, Taiwan.  J Reconstr Microsurg . 2002;  18 554-555
• 14 Mardini S, Wei F C, Lin C H, Jeng S F. Mandible reconstruction with vascularized fibula.  Semin Plast Surg . 2003;  17 373-382
• 15 Chang Y M, Chana J S, Wei F C, Shen Y F, Chan C P, Tsai C Y. Use of waxing screws for accurate primary placement of endosteal implants in the vascularized fibular bone-reconstructed mandible.  Plast Reconstr Surg . 2003;  111 1693-1696
• 16 Chang Y M, Chan C P, Shen Y F, Wei F C. Soft tissue management using palatal mucosa around endosteal implants in vascularized composite grafts in the mandible.  Int J Oral Maxillofac Surg . 1999;  28 341-343
• 17 Cordeiro P G, Hidalgo D A. Conceptual considerations in mandibular reconstruction.  Clin Plast Surg . 1995;  22 61-69
• 18 Taylor T D, Worthington P. Osseointegrated implant rehabilitation of the previously irradiated mandible: results of a limited trial at 3 to 7 years.  J Prosthet Dent . 1993;  69 60-69
• 19 Schliephake H, Neukam F W, Schmelzeisen R, Wichmann M. Long-term results of endosteal implants used for restoration of oral function after oncologic surgery.  Int J Oral Maxillofac Surg . 1999;  28 260-265
• 20 Larsen P E, Stronczek M J, Beck F M, Rohrer M. Osteointegration of implants in radiated bone with and without adjunctive hyperbaric oxygen.  J Oral Maxillofac Surg . 1993;  51 280-287
• 21 Sclaroff A, Haughey B, Gay W D, Paniello R. Immediate mandibular reconstruction and placement of dental implants. At the time of ablative surgery.  Oral Surg Oral Med Oral Pathol . 1994;  78 711-717
• 22 Schmelzeisen R, Neukam F W, Shirota T, Specht B, Wichmann M. Postoperative function after implant insertion in vascularized bone grafts in maxilla and mandible.  Plast Reconstr Surg . 1996;  97 719-725
• 23 Roumanas E D, Markowitz B L, Lorant J A, Calcaterra T C, Jones N F, Beumer III J. Reconstructed mandibular defects: fibula free flaps and osseointegrated implants.  Plast Reconstr Surg . 1997;  99 356-365
• 24 Johnsson K, Hansson A, Granstrom G, Jacobsson M, Turesson I. The effects of hyperbaric oxygenation on bone-titanium implant interface strength with and without preceding irradiation.  Int J Oral Maxillofac Implants . 1993;  8 415-419