Problems with dental implants that were placed on vertically distracted fibular free flaps after resection: A report of six cases

Abstract 

We report the clinical outcome of dental implants placed on vertically distracted fibular free flaps that were used to reconstruct maxillary and mandibular defects after resection. Distraction osteogenesis (DO) of fibular free flaps was used for six patients (5 men, 1 woman) a mean of 19 months (range 11–38) after 5 mandibular and 1 maxillary reconstructions. A mean of 5 months (range 2–11) after removal of the distractor, 35 implants were inserted and loaded with implant-supported fixed prostheses. The mean (range) follow-up period was 39 (17–81) months. The course of the DO and the clinical and radiographic outcomes of the implants were assessed.

Of six vertically distracted fibular free flaps, there was one case of vector lingual tipping during the consolidation phase and a fracture of the basal fibular cortex that necessitated additional grafting with iliac bone to stabilise the distracted area. The mean (range) vertical bone gain was 14 (12–15) mm. Four of 35 implants (11%) failed during the follow-up period. The mean peri-implant bone resorption was 2.5mm. Cumulative implant survival was 31/35 (89%) and survival after loading 31/33 (94%).

Distraction osteogenesis of fibular free flaps caused a remarkable number of complications and pronounced resorption of bone around the implants, probably as a result of the formation of granulomatous tissue; a careful peri-implant follow-up and the maintenance of oral hygiene are essential.

Keywords: Fibular free flaps, Distraction osteogenesis, Fixed implant-borne prosthetic rehabilitation