Ardisson Alan, de Senna Plinio Mendes, Granato Rodrigo, Bergamo Edmara T P, Bonfante Estevam A, Marin Charles
Postgraduate Program in Dentistry, Unigranrio, Rio de Janeiro, Brazil.
Department of Prosthodontics and Periodontology, Bauru School of Dentistry, Bauru, Brazil.
J Oral Implantol. 2023 Feb 1;49(1):85-92. doi: 10.1563/aaid-joi-D-20-00104.
This systematic review addressed the implant success rate after mandible reconstruction with vascularized fibula bone graft. Therefore, preferred reporting items for systematic review and meta-analysis guidelines were used to perform the systematic review, and the search included following databases: PubMed, Lilacs, Google Scholar, Open Gray, Science Direct and Cochrane. A search of medical subject headings (MeSH) and related terms (fibula) OR (vascularized) OR (microvascularized) AND (implant) OR (rehabilitation) OR (osseointegrated) AND (mandible) OR (jaw) OR (maxillofacial), without any language or time restrictions until October 2017 was carried out. The eligible studies primarily consisted of clinical cohorts designed to evaluate the feasibility of mandible reconstruction using vascularized fibula bone grafts and implant-supported rehabilitations, with a minimum observation period of 12 months. After screening, 13 eligible cohort studies for this review were selected (3 retrospective and 10 prospective). Of 285 vascularized fibular reconstructions, only 6 failures were reported with a success rate of approximately 98% after a mean follow-up period of 40 months. In total, 910 implants were placed in vascularized fibular grafts with a success rate of 92.6% (range, 82%-100%) after 40 months. Also, similar success rates for primary (95%; range, 93%-100%) and secondary (91%; range, 83%-100%) implant surgeries have been demonstrated. Considering risk factors, implant survival in irradiated patients was usually lower (76%; range, 38%-88%) than nonirradiated patients (90%; range, 83%-94%); however, it was significantly different in only 1 study. Alcohol and tobacco use has shown no significant association with implant failure in any study. Hence, implant placement in vascularized fibula bone graft presented similar success rates relative to native mandible bone rehabilitations.
本系统评价探讨了采用带血管腓骨骨移植进行下颌骨重建后的种植成功率。因此，本系统评价采用系统评价与Meta分析优先报告条目指南进行，检索的数据库包括：PubMed、Lilacs、谷歌学术、Open Gray、Science Direct和Cochrane。检索医学主题词（MeSH）及相关术语（腓骨）或（带血管的）或（微血管化的）以及（种植体）或（修复）或（骨结合）以及（下颌骨）或（颌骨）或（颌面），检索时间截至2017年10月，无任何语言或时间限制。纳入的研究主要为临床队列研究，旨在评估采用带血管腓骨骨移植及种植体支持修复进行下颌骨重建的可行性，最短观察期为12个月。筛选后，选取了13项符合本评价的队列研究（3项回顾性研究和10项前瞻性研究）。在285例带血管腓骨重建病例中，仅报告了6例失败病例，平均随访40个月后的成功率约为98%。总共在带血管腓骨移植中植入了910枚种植体，40个月后的成功率为92.6%（范围82%-100%）。此外，一期（95%；范围93%-100%）和二期（91%；范围83%-100%）种植手术也显示出相似的成功率。考虑到风险因素，接受放疗患者的种植体存活率通常低于未接受放疗的患者（76%；范围38%-88%）（90%；范围83%-94%）；然而，只有1项研究显示差异有统计学意义。在任何研究中，饮酒和吸烟与种植体失败均无显著关联。因此，与天然下颌骨修复相比，在带血管腓骨骨移植中植入种植体的成功率相似。
