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

Abstract

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.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.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).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.