Bodard A-G, Bémer J, Gourmet R, Lucas R, Coroller J, Salino S, Breton P
Unité d'odontologie, service de chirurgie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France.
Rev Stomatol Chir Maxillofac. 2008 Dec;109(6):363-6. doi: 10.1016/j.stomax.2008.06.008. Epub 2008 Oct 18.
Mandibular reconstruction with a microvascular free fibula flap (MFF) is an elegant solution to restore the anatomic arch, oral functions and facial esthetics. But the thin cutaneous tissue, the thickness of subcutaneous tissues, the absence of a pelvilingual and vestibular groove, and the fragility of soft tissues complicated dental prosthetic retention. Implants may restore prosthetic functionality. There is considerable publication on osteo-integration with a microvascular free fibula flap, but few studies were aimed at the prosthetic aspect, finality of any oral reconstruction. The aim of this retrospective study was to present the results of oral reconstruction with implant supported prostheses after mandibular reconstruction with a microvascular free fibula flap.
Twenty-three patients underwent mandibular reconstruction: 17 men and six women with a mean age of 46 years (17-66). Fourteen patients (60.8%) underwent radiotherapy before reconstruction. Mandibular osteoradionecrosis was the indication for reconstruction in seven patients. Each patient was assessed by dentascan. Implants were placed under general anesthesia. Postoperative clinical and radiographic controls were made regularly. Transmucous abutments were placed after six postoperative months and the prosthetic phase was initiated one month later. The criteria for implant and prosthetic success were assessed.
Seventy-five implants were placed, on average 3.2 per patient, with an 80% success rate. Three implants (4%) were not used for prosthesis. Ten permanent prostheses and 13 removable prostheses were placed. The mean delay before implant loading was 7.6 months (6-10) and the mean follow-up was 27.5 months (1-71). The occlusion was considered as "satisfactory" for 69.6% of patients. For 57% of patients, the quality of surrounding soft tissues was considered as "satisfactory". For 74% of patients oral reconstruction was "satisfactory".
The implant supported prosthesis after MFF mandibular reconstruction, on an irradiated site or not, gives satisfactory results despite the thickness and mobility of soft tissues, and despite scar contracture and the absence of keratinization. Implant placement must be performed after a prosthetic planning. Using radio-surgical guides, despite their cost and difficult adaptation, would certainly bring important improvement to the technique.
采用游离腓骨肌瓣微血管吻合术（MFF）进行下颌骨重建是恢复解剖牙弓、口腔功能及面部美观的一种理想方法。但薄的皮肤组织、皮下组织的厚度、无牙槽嵴及前庭沟以及软组织的脆弱性使牙修复体的固位变得复杂。种植体可恢复修复体的功能。关于游离腓骨肌瓣微血管吻合术的骨整合已有大量文献报道，但针对修复方面（任何口腔重建的最终目的）的研究却很少。这项回顾性研究的目的是展示采用游离腓骨肌瓣微血管吻合术进行下颌骨重建后，用种植体支持的修复体进行口腔重建的结果。
23例患者接受了下颌骨重建：17例男性和6例女性，平均年龄46岁（17 - 66岁）。14例患者（60.8%）在重建前接受了放疗。7例患者因下颌骨放射性骨坏死而进行重建。每位患者均接受牙颌扫描评估。种植体在全身麻醉下植入。术后定期进行临床和影像学检查。术后6个月放置穿龈基台，1个月后开始修复阶段。评估种植体及修复体成功的标准。
共植入75枚种植体，平均每位患者3.2枚，成功率为80%。3枚种植体（4%）未用于修复。放置了10个固定修复体和13个可摘修复体。种植体加载前的平均延迟时间为7.6个月（6 - 10个月），平均随访时间为27.5个月（1 - 71个月）。69.6%的患者咬合情况被认为“满意”。57%的患者周围软组织质量被认为“满意”。74%的患者口腔重建“满意”。
无论是否在放疗部位，游离腓骨肌瓣微血管吻合术下颌骨重建后用种植体支持的修复体均可取得满意效果，尽管软组织有厚度和移动性，且存在瘢痕挛缩和无角化情况。种植体植入必须在修复计划后进行。使用放射外科导板，尽管成本高且适配困难，但肯定会给该技术带来重要改进。
