Wu Yi-qun, Huang Wei, Zhang Zhi-yong, Zhang Zhi-yuan, Zhang Chen-ping, Sun Jian
Department of Oral and Craniofacial Implant, College of Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Chin Med J (Engl). 2008 Oct 5;121(19):1861-5.
Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage insertion of dental implants has exhibited growing popularity for such reconstructions. This study was aimed at evaluating the clinical status and the success rates of dental implants inserted in fibula-free flaps for orofacial reconstruction following ablation of tumors.
We conducted a clinical follow-up study based on 29 patients after oral tumor surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 5-year period. The follow-up protocol included clinical examination and radiological evaluation. The clinical records of the patients were reviewed retrospectively. Information on treatment modalities, dentition, implant parameters, and prostheses was collected and analyzed.
In general, a high primary stability for implants placed into the free fibula grafts was achieved. The 1-year and 5-year cumulative survival rates of the implants were 96% and 91%, respectively, using the Kaplan-Meier method. The 1-year and 5-year cumulative success rates of implants placed into the fibula bone grafts were 95% and 87%, respectively. The main reasons for failure of the dental implants were infection, tumor recurrence and soft tissue proliferation. The fibula flap presents many advantages for implant placement, but its limited height sometimes makes implant-supported prosthetic rehabilitation difficult.
Vascularized fibula bone grafts provide a firm basis for the placement of dental implants in jaw reconstruction. Implants placed in fibula bone grafts were shown to integrate normally. The double-barrel technique, or increasing the height of the fibula flap by vertical distraction osteogenesis before implant placement in the mandible, is desirable from a functional and esthetic point of view.
肿瘤切除导致的颌骨缺损功能重建是颌面外科中一个具有挑战性的问题。带血管腓骨骨皮瓣联合同期或二期植入牙种植体在这类重建中越来越受欢迎。本研究旨在评估肿瘤切除后用于口腔颌面重建的腓骨游离瓣中植入牙种植体的临床状况和成功率。
我们对29例口腔肿瘤手术后的患者进行了临床随访研究，这些患者在5年期间接受了带血管腓骨骨移植和骨内种植体以进行功能性颌骨重建。随访方案包括临床检查和影像学评估。对患者的临床记录进行回顾性分析。收集并分析了关于治疗方式、牙列、种植体参数和假体的信息。
总体而言，植入游离腓骨移植体中的种植体实现了较高的初期稳定性。采用Kaplan-Meier法，种植体的1年和5年累积生存率分别为96%和91%。植入腓骨骨移植体中的种植体的1年和5年累积成功率分别为95%和87%。牙种植体失败的主要原因是感染、肿瘤复发和软组织增生。腓骨瓣在种植体植入方面具有许多优势，但其高度有限有时会使种植体支持的修复性康复变得困难。
带血管腓骨骨移植为颌骨重建中牙种植体的植入提供了坚实的基础。植入腓骨骨移植体中的种植体显示能正常整合。从功能和美学角度来看，双筒技术或在下颌骨植入种植体前通过垂直牵张成骨增加腓骨瓣的高度是可取的。
