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Is immediate dental implant in fibula free flap beneficial for implant survival and osteoradionecrosis in jaw reconstruction?

Authors
 Hyounmin Kim  ;  Taeho Roh  ;  Daniel Wilfredo Banegas  ;  In-Ho Cha  ;  Hyung Jun Kim  ;  Woong Nam  ;  Sanghuem Cho  ;  Kyung Chul Oh  ;  Dongwook Kim 
Citation
 ORAL ONCOLOGY, Vol.156 : 106945, 2024-09 
Journal Title
ORAL ONCOLOGY
ISSN
 1368-8375 
Issue Date
2024-09
MeSH
Adult ; Aged ; Dental Implants* ; Female ; Fibula* / surgery ; Fibula* / transplantation ; Free Tissue Flaps* ; Humans ; Jaw ; Male ; Middle Aged ; Mouth Neoplasms / radiotherapy ; Mouth Neoplasms / surgery ; Osteoradionecrosis* / etiology ; Osteoradionecrosis* / surgery ; Plastic Surgery Procedures / methods ; Prospective Studies ; Retrospective Studies
Keywords
Dental implant ; Fibula free flap ; Free tissue flaps ; Kaplan-Meier estimate ; Malignancy ; Mandibular reconstruction ; Oral cancer ; Osteoradionecrosis ; Radiotherapy
Abstract
Objectives: This study aimed to compare the risk of osteoradionecrosis and implant survival in oral cancer patients undergoing immediate dental implants during jaw reconstruction, termed "Jaw in a Day" (JIAD), with those receiving no implants or delayed implants (non-JIAD).

Patients & methods: Clinicopathologic data were collected from prospectively enrolled JIAD patients (n = 10, 29 implants) and retrospectively from non-JIAD patients (n = 117, 86 implants). Survival analyses were performed to assess implant survival and osteoradionecrosis-free survival.

Results: Osteoradionecrosis occurred in 0 % of JIAD cases compared to 19.3 % in non-JIAD cases without implants and 71.4 % in non-JIAD cases with delayed implants (p = 0.008). Osteoradionecrosis-free survival was significantly better in the JIAD group than the non-JIAD group (p = 0.0059). Implants in the JIAD group all survived regardless of radiation therapy (29/29, 100 %) and 95.1 % (58/61) of implants survived in delayed implants in non-irradiated fibula without radiotherapy. Meanwhile, only 11 of 25 implants placed in irradiated fibula flaps survived, even when the implants were placed after a median time interval of 624 days after radiotherapy, and none of them were earlier than 360 days. The survival analysis revealed a significant difference (p < 0.0001).

Conclusion: JIAD appears to offer superior outcomes in terms of implant survival and osteoradionecrosis prevention compared to delayed implant placement. Placing implants in irradiated fibula, even after years, significantly poses high risk of implant failure and osteoradionecrosis. JIAD represents a promising approach for optimal rehabilitation, particularly in oral cancer patients requiring postoperative radiotherapy. Proper positioning and orientation of implants and flaps are crucial for implant survival.
Full Text
https://www.sciencedirect.com/science/article/pii/S136883752400263X
DOI
10.1016/j.oraloncology.2024.106945
Appears in Collections:
2. College of Dentistry (치과대학) > Dept. of Oral and Maxillofacial Surgery (구강악안면외과학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Prosthodontics (보철과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Wook(김동욱) ORCID logo https://orcid.org/0000-0001-6167-6475
Kim, Hyung Jun(김형준) ORCID logo https://orcid.org/0000-0001-8247-4004
Nam, Woong(남웅) ORCID logo https://orcid.org/0000-0003-0146-3624
Oh, Kyung Chul(오경철) ORCID logo https://orcid.org/0000-0003-4584-2597
Cha, In Ho(차인호) ORCID logo https://orcid.org/0000-0001-8259-2190
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/200258
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