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  • Title: Computer-assisted implant rehabilitation of maxillomandibular defects reconstructed with vascularized bone free flaps.
    Author: Okay DJ, Buchbinder D, Urken M, Jacobson A, Lazarus C, Persky M.
    Journal: JAMA Otolaryngol Head Neck Surg; 2013 Apr; 139(4):371-81. PubMed ID: 23599073.
    Abstract:
    IMPORTANCE: Functional recovery for patients who undergo maxillomandibular reconstruction with vascularized bone free flaps (VBFFs) is potentially more attainable with computer-assisted implant rehabilitation. This prosthodontic-driven approach uses software planning and surgical templates for implant placement supporting fixed dental prostheses (FDP). Implant success with immediate load (IL) provisional and definitive FDP restorations in VBFFs is reported for the first time in a patient cohort. OBJECTIVES: To determine implant success for FDP restorations and IL restorations. To determine factors that may influence success and predictability to provide FDP restorations in VBFFs. DESIGN: A retrospective medical chart review was conducted of patients who underwent VBFF reconstruction and computer-assisted planning (CP) for FDP implant rehabilitation. This study was conducted with approval from the institutional review board at Beth Israel Medical Center, New York, New York. SETTING: Clinical procedures were conducted in operating room and outpatient facilities in a tertiary referral medical center. PARTICIPANTS: Twenty-eight consecutive patient treatments were reviewed. Inclusion criteria for all patients were VBFF reconstruction and CP for FDP restoration prior to stage 1 implant surgery. Patients were evaluated for implant success, surgical templates, IL provisional restorations, and prosthodontic framework design. A comparison is made between patients with IL provisional restorations and those patients who did not receive an immediate restoration. MAIN OUTCOMES AND MEASURES: Implants that achieved osseointegration and used for prosthetic reconstruction determined success. Prosthodontic design considerations included whether the patient received an IL provisional restoration and 3 categories of FDP metal framework design. RESULTS Ninety-nine implants of 116 implants placed were used for prosthetic restorations, achieving an 85.4% success rate. Twenty-five of 28 patients received FDP restorations. Thirteen of 28 patients received IL provisional restorations at stage 1 implant surgery. Fifty of 56 implants were successful (89.3%) in the IL group. CONCLUSIONS: Computer-assisted implant rehabilitation of reconstructed defects can achieve superior results to provide FDP and IL provisional restorations. This prosthodontic-driven approach also uses unique framework design to account for mandible height discrepancy after fibula free flap reconstruction. Patient management for FDP rehabilitation is also dependent on radiation status, soft-tissue modification, and patient selection.
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