MANDIBULAR RECONSTRUCTION WITH FIBULAR OSTEOSEPTOCUTANEOUS FREE-FLAP AND SIMULTANEOUS PLACEMENT OF OSSEOINTEGRATED DENTAL IMPLANTS

Insertion of osseointegrated dental implants several months after mand ibular reconstruction using vascularized composite bone grafts has pro ved to be a successful method to achieve mastication and complete oral rehabilitation. Theoretically with primary placement of implants into the new mandible a better access to the bone is achieved, interdental relationships are easier to determine, and oral rehabilitation can be attained in a shorter period of time. Previous results describing thi s approach, however, are inconclusive and controversial. This review d escribes our experience with primary insertion of dental implants into fibular flaps used for mandibular reconstruction during ablative surg ery. Adequate selection of patients for this combined procedure depend s mainly on the pathological nature of the mandible and perioperative radiotherapy. Preoperative determination of soft-tissue and bone requi rements, number of osteotomies, rigid fixation method, and familiarity with the use of osseointegrated implants are important factors that m ust be considered for adequate surgical planning and to achieve good r esults.