Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants - a prospective study

: The fibular flap can be used for a variety of indications. Recently, the treatment of four patients with severely atrophied upper jaws using a method to prefabricate the vascularized fibular graft has been published. This technique consists of a two‐stage operation procedure that allows simultaneous prosthodontic rehabilitation and immediate placement of dental implants. In this paper eight patients with 29 ITI implants (Straumann AG, Waldenburg, Switzerland) who had reconstruction of either the upper or lower jaw are presented. The aim of the study was (i) to evaluate the behavior of the newly formed soft tissue around implants inserted in the fibula by applying periodontal parameters, (ii) to monitor prospectively the integration of the implants in the fibular graft, and (iii) to assess the osseous integration of the fibular graft used for reconstruction of the upper or lower jaw. Two implants failed during the observation time because of avascular bone at the distal end of the fibular graft. Stabilization of the graft, however, was never compromised. Due to the prefabrication firmly attached gingiva‐like soft tissue could be provided preventing periimplant soft tissue inflammation and facilitating oral hygiene. After 1 year of observation the mean attachment level was similar to implants placed in original bone whereas vertical bone loss measured radiographically was lower in the present study. This may indicate that the remodeling of a bicortical bone requires a longer period of time compared with the bone of the alveolar crest. The prospective 1‐year results are promising but long‐term evaluation of periodontal and radiological parameters are required. Résumé Le lambeau péroné peut être utilisé pour une variété d'indications. Récemment le traitement de quatre patients avec une atrophie sévère des mâchoires supérieures et utilisant une méthode pour préfabriquer un greffon péroné vascularisé a été publié. Cette technique consiste en une opération en deux étapes qui permet la réhabilitation prothétique simultanée et le placement immédiat des implants dentaires. Dans ce rapport huit patients avec 29 implants ITI (Straumann AG, Waldenburg, Switzerland) ont eu une reconstruction de la mâchoire supérieure ou inférieure. Le but de cette étude a été 1) d'évaluer le comportement des tissus mous nouvellement formés autour des implants insérés dans le péroné en appliquant les paramètres parodontaux, 2) de suivre d'une manière prospective l'intégration des impla