游离腓骨瓣修复下颌骨肿瘤切除术后即刻种植虚拟手术辅助短期效果分析
Short-Term Outcomes following Virtual Surgery-Assisted Immediate Dental Implant Placement in Free Fibula Flaps for Oncologic Mandibular Reconstruction.
机构信息
From the Department of Surgery, Plastic and Reconstructive Surgery Service, Head and Neck Surgery Service, and Dental Service, Memorial Sloan Kettering Cancer Center.
出版信息
Plast Reconstr Surg. 2020 Dec;146(6):768e-776e. doi: 10.1097/PRS.0000000000007352.
BACKGROUND
Despite reports demonstrating feasibility of immediate dental implant placement in mandibular reconstruction with free fibula flaps for benign disease, this practice is not routinely used in the oncologic setting. The authors aim to demonstrate the safety of immediate dental implant placement for oncologic mandible reconstruction.
METHODS
In 2017, the authors' center began immediate dental implant placement in free fibula flaps for oncologic patients undergoing mandibulectomy reconstruction. Immediate dental implant placement patients were compared to a historical cohort also reconstructed with computer-aided design and manufacturing technology beginning in 2011 (n = 34) as a noninferiority study design. Primary outcomes of interest included 90-day complications, time to radiotherapy, and time to and number of patients achieving dental restoration.
RESULTS
Sixty-one patients underwent free fibula flaps following mandibulectomy using computer-aided design and manufacturing. Seventy-two dental implants were placed in the immediate dental implant placement cohort (n = 27). No differences were noted in major or minor 90-day complications between groups (p > 0.05). Radiotherapy was required in 55 percent in the immediate dental implant placement cohort versus 62 percent in the historical cohort, with no significant difference in time to radiotherapy (67.6 days versus 62.2 days, respectively). One dental implant was removed for nonosseointegration noted during vestibuloplasty. Fourteen (51.8 percent) immediate dental implant patients had complete dental restoration at 90 days compared with none in the historical cohort (p < 0.05).
CONCLUSIONS
Immediate dental implant placement is a safe procedure with an unchanged short-term complication profile and no delay in radiotherapy initiation. Patients undergoing immediate dental implant placement are more likely to complete full dental rehabilitation. Long-term and health-related quality-of-life outcomes remain to be determined.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
尽管有研究报告表明，对于良性疾病的游离腓骨瓣下颌骨重建，可以实现即刻牙种植，但在肿瘤学领域，这种做法并不常见。作者旨在证明即刻牙种植在肿瘤性下颌骨重建中的安全性。
方法
2017 年，作者所在中心开始在接受下颌骨切除术重建的肿瘤患者的游离腓骨瓣中进行即刻牙种植。即刻牙种植组与 2011 年开始使用计算机辅助设计和制造技术进行重建的历史队列（n=34）进行了非劣效性研究设计。主要观察指标包括 90 天并发症、放疗时间、以及实现牙修复的时间和患者数量。
结果
61 例患者接受了计算机辅助设计和制造的游离腓骨瓣下颌骨切除术。在即刻牙种植组（n=27）中放置了 72 颗牙种植体。两组在主要或次要 90 天并发症方面无差异（p＞0.05）。即刻牙种植组中 55%的患者需要放疗，而历史队列中为 62%，放疗时间无显著差异（分别为 67.6 天和 62.2 天）。1 颗牙种植体因在进行前庭成形术时发现非骨整合而被取出。14 例（51.8%）即刻牙种植患者在 90 天时完成了全口牙修复，而历史队列中无一例患者（p＜0.05）。
结论
即刻牙种植是一种安全的手术方法，短期并发症谱无变化，放疗开始时间也无延迟。进行即刻牙种植的患者更有可能完成全口牙修复。长期和与健康相关的生活质量结果仍有待确定。
临床问题/证据水平：治疗性，III 级。
Zotero 插件