Optimizing the Timing of Dental Implants in Oromandibular Reconstruction

Sunday, September 29, 2024

8:18 AM – 8:24 AM EDT

Location: MBCC, 208

Disclosure(s):

Amanda Joy Bastien, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Allen S. Ho:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Luv A. Amin:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jon Mallen-St. Clair, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction:

Objective: To assess the success rate and associated complications of dental implant rehabilitation in patients undergoing mandibular reconstruction with a fibula free flap at a tertiary hospital.

Methods: A retrospective review was conducted examining 64 consecutive patients who underwent mandibular reconstruction with fibula free flaps. We analyzed the rate of dental rehabilitation, timing of implant placement, associated complications, and patient related factors influencing implant success.

Results: Out of the 64 patients who underwent fibula free flap reconstruction, 30 underwent immediate dental implants and 12 underwent immediate implants with provisional prosthesis (“Jaw in a day”). Diagnoses included malignant pathology (36 patients), benign pathology (10), osteomyelitis (3), osteoradionecrosis (10), and medication-related osteonecrosis (5). Complications included osteoradionecrosis of the fibula, bone loss, peri-implantitis, and limited mouth opening. We analyzed our cohort with respect to factors and found that radiation and maxillary reconstructions were associated with increased risk of implant failure and need for revision surgery. None of the 34 patients who did not receive implants at the time of surgery went on to achieve dental implants. In patients who underwent dental implants without the placement of a provisional prosthesis 13/18 went on to obtain a final prosthesis. In patients who underwent immediate dental implants with a provisional prosthesis 10/12 obtained a final prosthesis.

Conclusions: Although secondary dental implant placement in fibula free flaps is theoretically feasible and is described in the literature, our experience is that it is seldom performed. Our findings support the immediate placement of dental implants, with or without a provisional prosthesis during the initial reconstruction. This approach not only demonstrates a high success rate but also aligns with the most efficient strategy for dental rehabilitation across various indications, including benign and malignant pathologies as well as osteonecrosis.

Presenting Author(s)

AB

Amanda Joy Bastien, MD

Resident Physician
Cedars Sinai
Los Angeles, California, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

JL

Jay Lee, DDS, MD

The Los Angeles Center for Oral & Maxillofacial Surgery, United States

Disclosure information not submitted.
Allen S. Ho

Professor of Surgery
Cedars-Sinai Medical Center
Los Angeles, CA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Luv A. Amin

Medical Student
California University of Science and Medicine, School of Medicine
San Clemente, CA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
SK

Steven Kupferman, DDS, MD

The Los Angeles Center for Oral & Maxillofacial Surgery, United States

Disclosure information not submitted.

Senior Author(s)

Jon Mallen-St. Clair, MD, PhD

Assistant Professor
Cedars Sinai
Los Angeles, CA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.