Outcome of Osseointegrated Dental Implants in Double-Barrel and Vertically Distracted Fibula Osteoseptocutaneous Free Flaps for Segmental Mandibular Defect Reconstruction

Background: Osseointegrated dental implants in double-barrel, or single-barrel and then vertically distracted, fibula osteoseptocutaneous free flaps can achieve segmental mandibular reconstruction, dental rehabilitation, and premorbid facial height. However, it remains unknown which configuration provides better osseointegration outcomes. Methods: Between 2003 and 2009, all patients who underwent segmental mandibular defect reconstruction using vertical distraction osteogenesis of single-barrel fibula with secondary osseointegration (group A, 10 patients and 35 osseointegrated dental implants) or double-barrel fibula with primary osseointegration (group B, 13 patients and 36 osseointegrated dental implants) were evaluated prospectively for crown-implant ratios, mesial/distal marginal bone losses, and complications. In group B, 18 osseointegrated dental implants were surrounded by palatal mucosal grafts; the other retained fibula skin paddles. Results: Palatal mucosal grafts in group B improved mesial (p < 0.001) and distal (p < 0.001) marginal bone losses. Mesial marginal bone loss of group B with palatal mucosal grafts was better than that of group A (p < 0.05), despite higher crown-implant ratios in group A (p < 0.01). Mesial (p < 0.01) and distal (p < 0.05) marginal bone losses of group A were better than that of group B osseointegrated dental implants without palatal mucosal grafts. Complications in group A were common and complex, unlike group B. All patients completed dental rehabilitation. Conclusions: Osseointegration was adequate to complete dental rehabilitation in group B without palatal mucosal grafts, but was significantly better in group A, and significantly best in group B with palatal mucosal grafts. Given the complexity and frequency of complications in group A, the authors recommend the double-barrel configuration with osseointegrated dental implants for segmental mandibular defect reconstruction. Palatal mucosal grafts have a definite advantage. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.