Clinical and dental implant outcomes in patients after mandibular continuity reconstruction with bone flaps versus bone grafts: a systematic review and meta-analysis.

This study was performed to evaluate the failure and complication rates of bone flaps and bone grafts used for mandible reconstruction following partial mandible resection, and the failure and complication rates of implants installed in these grafts. A systematic review and meta-analysis was conducted following the PRISMA protocol. The level of evidence was assessed according to the National Health and Medical Research Council (Australia) classifications. Quantitative data for failures and complications were pooled and evaluated to determine the overall event rate with 95% confidence interval. Twenty-one studies (seven prospective, 14 retrospective) were identified, including 519 transplants: 423 bone flaps with 1428 implants, and 96 bone grafts with 322 implants. The overall mean event rate for graft failure was 3.5% for bone flaps and 4.6% for bone grafts, while the rate for complications was 9.9% for bone flaps and 10.5% for bone grafts. The mean event rate for implant failure was 5.5% for bone flaps and 9.9% for bone grafts. The mean event rate for implant complications was 5.9% for bone flaps; however, implant complications were absent in the bone grafts. Failure rates for both flaps and grafts were low, and complication rates were similar (P > 0.05). Implant survival did not differ significantly between the flaps and grafts (P > 0.05). The data must be interpreted with caution, as the studies evaluated had relatively small samples from which to draw comparisons.