Tahmasebi Elahe, Keykha Elham, Hajisadeghi Samira, Moslemi Hamidreza, Shafiei Shervin, Motamedi Mohammad Hosein Kalantar, Torabizadeh Arman, Tabrizi Reza, Alam Mostafa
Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.
School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Maxillofac Plast Reconstr Surg. 2023 Jul 7;45(1):24. doi: 10.1186/s40902-023-00392-8.
This systematic review and meta-analysis aimed to evaluate the factors influencing and success rates of dental implants for functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region.
We conducted a comprehensive search of electronic databases, including MEDLINE, Web of Science, Embase, Scopus, and Cochrane's CENTRAL, as well as gray literature sources and manual searches of notable journals. The search was performed from inception until February 2023. Studies were included if they examined functional and dental rehabilitation outcomes in patients receiving maxillofacial reconstruction using microvascular fibula flaps and were retrospective or prospective cohort studies involving human subjects. Case-control studies, research involving other reconstruction methods, and animal-based studies were excluded. Data was extracted and confirmed by two independent researchers, and risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were conducted for dental implant and graft success rate, with separate analyses for different factors affecting the outcome. Heterogeneity was evaluated using Cochran's Q test and the I test. The pooled success rate for implants was 92% and for grafts, 95%, with significant heterogeneity. Implants in fibular grafts had a 2.91 times higher failure rate than those in natural bones. Radiated bone and smoking were identified as factors influencing implant failure, with radiated bone having a 2.29 times higher risk and smokers having a 3.16 times higher risk compared to their respective counterparts. Patient-reported outcomes showed improvements in key areas such as dietary intake, mastication, speech, and esthetics. The success rates declined over time, emphasizing the importance of long-term follow-up.
Dental implants in free fibula grafts generally have favorable success rates, with minimal bone resorption, manageable probing depths, and limited bleeding on probing. Implant success is influenced by factors such as smoking and radiated bone.
本系统评价和荟萃分析旨在评估影响上颌下颌区域微血管腓骨瓣重建后种植牙进行功能和牙齿修复的因素及成功率。
我们对电子数据库进行了全面检索，包括MEDLINE、科学网、Embase、Scopus和Cochrane中心对照试验注册库，以及灰色文献来源，并对知名期刊进行了手工检索。检索从数据库建立之初至2023年2月。纳入的研究需为检查接受微血管腓骨瓣进行颌面重建患者的功能和牙齿修复结果，且为涉及人类受试者的回顾性或前瞻性队列研究。排除病例对照研究、涉及其他重建方法的研究以及基于动物的研究。数据由两名独立研究人员提取并确认，使用纽卡斯尔-渥太华量表评估偏倚风险。对种植牙和植骨成功率进行荟萃分析，并对影响结果的不同因素进行单独分析。使用Cochrane Q检验和I²检验评估异质性。种植牙的合并成功率为92%，植骨的合并成功率为95%，存在显著异质性。腓骨移植中的种植体失败率比天然骨中的种植体高2.91倍。放疗骨和吸烟被确定为影响种植体失败的因素，与各自的对照相比，放疗骨的风险高2.29倍，吸烟者的风险高3.16倍。患者报告的结果显示在饮食摄入、咀嚼、言语和美观等关键领域有所改善。成功率随时间下降，强调了长期随访的重要性。
游离腓骨移植中的种植牙总体成功率良好，骨吸收极少，探诊深度可控，探诊出血有限。种植体成功受吸烟和放疗骨等因素影响。
