Short-term Outcomes Following Immediate Dental Implant Placement in Free Fibula Flaps for Oncologic Mandibular Reconstruction
Jonas A. Nelson, MD, Robert J. Allen, Jr., MD, Deana S. Shenaq, MD, Evan Rosen, DMD, Aadit R. Patel, MD, Nikhil Sobti, Thais Polanco, MD, Vaidehi Patel, Snehal Patel, MD, Ian Ganly, MD, Jay O. Boyle, MD, Evan Matros, MD.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Despite reports demonstrating feasibility of immediate dental implant placement(IDIP) in free fibula flaps for benign disease, this practice is not routinely employed in the oncologic patient because of concerns about timely initiation of radiation and interference with radiotherapy delivery. The study aim is to demonstrate the safety of IDIP in the oncologic setting.
In 2017, our center began IDIP into fibula flaps for oncologic patients necessitating segmental mandibulectomy. Using virtual surgical planning(VSP), the resection margins and fibula construct were planned in conjunction with design of immediate dental implants into the pre-surgical plan and fibula guide. All patients undergoing IDIP were compared to a similar historical cohort(from 6/2010 to 5/2017) also reconstructed with VSP, but without immediate dental implants. All dental implants were uncovered in a second stage vestibuloplasty prior to radiation. Outcomes of interest included complications, total flap loss, partial flap loss, infections, loss of dental implants, time to radiation therapy, and number of patients who received permanent dentition.
Fifty-five patients underwent fibula flaps with the aid of VSP from 2010 to 2018: 20 with IDIP versus 35 without implants. The cohorts were similar with regards to preoperative characteristics and oncologic variables. There was no difference in rate of total (n=1 in non-implant cohort, p=1.0) or partial flap loss(5% vs. 3%, p=1.0). No differences were noted in perioperative complications, including but not limited to rates of fistula, cellulitis or abscess. Overall, 51% of IDIP patients required radiation therapy vs. 55% of those without implants(p=0.51). No difference was observed in time to radiation (64.4 vs 73.4 days; p=0.2). One dental implant was removed for non-osseointegration at the time of vestibuloplasty. No other implants have been removed. Patients undergoing IDIP were significantly more likely to receive permanent dentition following segmental mandibulectomy(55% vs. 5.7%, p=0.0001).
This study demonstrates an unchanged short-term complication profile in oncologic patients undergoing IDIP compared to a historical cohort. Time to initiation of radiation therapy has not been delayed significantly. Patients undergoing IDIP are more likely to complete full dental rehabilitation than those who undergo delayed implant placement. Long-term outcomes including patient health related quality of life remain to be determined.
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