Free fibula flap for reconstruction of the severely atrophic mandible: a retrospective study.

The purpose of this retrospective study was to assess the feasibility of using a free fibula flap (FFF) for reconstruction of the alveolar region of the severely atrophic mandible, by determining bone stability after dental implant insertion and prosthetic rehabilitation in a series of eight female patients aged 36-65 years. Dental implant insertion was performed 3-4 months after reconstruction. Prosthetic loading was performed 3-4 months after implant insertion. The height of the reconstructed mandible after surgery was 21.20±1.87mm, with an increase of 8.80±1.71mm from the preoperative height. The height of the FFF immediately after reconstruction was 11.24±1.10mm; this showed a vertical loss of 0.99±0.52mm (8.79%) and maintenance of 91.21% of the initial height at a mean 14 months post-reconstruction. Applying the Wical and Swoope formula to estimate the original mandibular body height, it was found that the difference between this calculated height (21.17±3.76mm) and the reconstructed height (21.20±1.87mm) was only 0.03±3.17mm (0.14%). An overall insignificant decrease of 0.46±1.14 cm in FFF volume had occurred at 3-4 months after dental implant functional loading, while in two cases an increase in volume was found (1.22cm and 1.71cm). The good and stable results obtained show that the FFF may be used to reconstruct the whole mandibular alveolar region, with the best possible outcomes.