Abstract
Purpose
This study aims to evaluate the clinical and radiographic outcomes of dental implants, inserted in consolidated free bone grafts; postsegmental mandibular resection, after following a fully guided staged protocol, which established a systematic approach that correlates the grafted bone and the enclosed implants to the undisturbed mandibular segments and the maxillary occlusal plane.
Methods
Seven patients were enrolled in the study; all were diagnosed for mandibular locally aggressive tumors. All of the patients were subjected to computer-guided segmental mandibular resections, secondary free iliac crest bone graft; aided by computer-guided harvest and prosthetic guidance of the graft positioning and fixation. Finally, the guided bone grafts; after being consolidated, received twenty-nine computer-guided dental implants.
Results
By the end of the period of osseointegration, the predetermined criteria of implant success judged the success of twenty-five implants, versus the failure of four implants, with (86.2%) percentage of success.
Conclusion
The clinical and radiographic assessments demonstrated sound base bone grafts, which succeeded not only to restore the native mandibular continuity and configuration but also to direct the fair-sized embedded dental implants into favorable coastal locations and axial projections, which influenced a smooth prosthetic rehabilitation.
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References
Wu YQ, Huang W, Zhang ZY, Zhang ZY, Zhang CP, Sun J (2008) Clinical outcome of dental implants placed in fibula free flaps for orofacial reconstruction. Chin Med J (Engl) 121(19):1861–1865
Sittitavornwong S, Gutta R (2010) Bone graft harvesting from regional sites. Oral Maxillofac Surg Clin North Am 22(3):317–330
Dreiseidler T, Kaunisaho V, Neugebauer J, Zöller JE, Rothamel D, Kreppel M (2016) Changes in volume during the four months’ remodeling period of iliac crest grafts in reconstruction of the alveolar ridge. Br J Oral Maxillofac Surg 54(7):751–756
Schepers RH, Raghoebar GM, Lahoda LU, Van der Meer WJ, Roodenburg JL, Vissink A, Reintsema H, Witjes MJ (2012) Full 3-D digital planning of implant-supported bridges in secondary mandibular reconstruction with prefabricated fibula free flaps. Head Neck Oncol 4(2):44
Zheng GS, Su YX, Liao GQ, Chen ZF, Wang L, Jiao PF, Liu HC, Zhong YQ, Zhang TH, Liang YJ (2012) Mandible reconstruction assisted by preoperative virtual surgical simulation. Oral Surg Oral Med Oral Pathol Oral Radiol 113(5):604–611
Juergens P, Krol Z, Zeilhofer HF, Beinemann J, Schicho K, Ewers R, Klug C (2009) Computer simulation and rapid prototyping for the reconstruction of the mandible. J Oral Maxillofac Surg 67(10):2167–2170
Okay DJ, Buchbinder D, Urken M, Jacobson A, Lazarus C, Persky M (2013) Computer-assisted implant rehabilitation of maxillomandibular defects reconstructed with vascularized bone free flaps. JAMA Otolaryngol Head Neck Surg 139(4):371–381
Peñarrocha M, Boronat A, Carrillo C, Albalat S (2008) Computer-guided implant placement in a patient with severe atrophy. J Oral Implantol 34(4):203–207
Albrektsson T, Zarb G, Worthington P, Eriksson AR (1986) The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1(1):11–25
Zhou LB, Shang HT, He LS, Bo B, Liu GC, Liu YP, Zhao JL (2010) Accurate reconstruction of discontinuous mandible using a reverseengineering/computer-aided design/rapid prototyping technique:a preliminary clinical study. J Oral Maxillofac Surg 68:2115–2121
Yamashita Y, Yamaguchi Y, Tsuji M, Shigematsu M, Goto M (2008) Mandibular reconstruction using autologous iliac bone and titanium mesh reinforced by laser welding for implant placement. Int J Oral Maxillofac Implants 23:1143–1146
Bähr W, Stoll P, Wächter R (1998) Use of the “double barrel” free vascularized fibula in mandibular reconstruction. J Oral Maxillofac Surg 56(1):38–44
Roden RD Jr (2010) Principles of bone grafting. Oral Maxillofac Surg Clin North Am 22:295–300
Gary Orentlicher G, Abboud M (2011) Guided surgery for implant therapy. Oral Maxillofacial Surg Clin N Am 23:239–256
Lal K, Eisig SB, Fine JB, Papaspyridakos P (2013) Prosthetic outcomes and survival rates of implants placed with guided flapless surgery using stereolithographic templates: a retrospective study. Int J Periodontics Restorative Dent 33(5):661–667
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Mounir, S., Mounir, M. & Gibaly, A. Full-staged digital and prosthetic guided protocol for the insertion of dental implants in autogenous free bone grafts after reconstruction of segmental mandibular defects. Oral Maxillofac Surg 24, 189–201 (2020). https://doi.org/10.1007/s10006-020-00839-6
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DOI: https://doi.org/10.1007/s10006-020-00839-6