RECONSTRUCTED MANDIBULAR DEFECTS - FIBULA FREE FLAPS AND OSSEOINTEGRATED IMPLANTS

Twenty patients with microvascular fibula flap reconstruction of oroma ndibular defects were selected for implant-retained prosthodontic reha bilitation. A total of 71 osseointegrated implants were placed within the grafted fibulas. Four patients had immediate implant placement at the time of their reconstructive surgery, and the remaining 16 patient s had implants placed secondarily. One patient received postoperative radiation therapy (5940 cGy) 6 weeks following reconstruction and imme diate implant placement. No implants were placed in previously irradia ted flaps. A minimum 6-month period of osseointegration was allowed pr ior to second stage surgery. Fifty-four of the 71 implants were uncove red; 46 of these implants were functional, and 3 were in the process o f being restored. Among the 54 implants (15 patients) that were uncove red, only 1 failed to osseointegrate, 2 implants were reburied, and 2 were removed. The follow-up period ranged from 1 to 49 months since se cond stage surgery. Although a number of prosthodontic designs were us ed, 11 of the 15 patients were restored with removable overlay prosthe ses. Only those implants exposed to postoperative radiation demonstrat ed radiographic hone loss following functional loading.