Focus - Implant Rehabilitation on Free Fibula Flap. Planning, Limits and Perspectives
Seance of wednesday 20 january 2021 (La chirurgie orale, l'ANC reçoit l'Académie Nationale de Chirurgie Dentaire)
DOI number : 10.26299/h7g7-bj52/emem.2019.1.006
Abstract
The reconstruction of maxillary and / or mandibular material losses using a free fibula flap is now the gold standard in oncology and/or post-traumatic surgery. Prosthetic rehabilitation by implant technique also appears to be a solution of choice. It is possible thanks to a good vascularization and a bone quality ensuring a potential for osteointegration. A recent meta-analysis reports a survival rate nearly of 95 % approaching that of conventional implantology.
However, difficulties may appear with regard to implant durability; the skin palette linked to these flaps is a hostile environment to implants; no phenomenon of keratinization was demonstrated in the "cutaneous-implant groove". The absence of a "pseudo epithelial junction" thus induces chronic inflammatory phenomena at the origin of hyperplasias. These appear in 10 % of cases, on average 3 months postoperatively and have a characteristic have a characteristic circular (toric) shape. They are the major factor in implant loss; the absence of pelvilingual and vestibular grooves associated with scar retraction promotes the appearance of bridles. All of these phenomena can create implant dehiscences and initiate peri-implantitis.
Osteointegration and implant stability on a micro-anastomosis fibula free flap are now data acquired from science. Despite everything, complications related to the cutaneous-implant environment restrict its indication to the most compliant patients. The indication must therefore be carefully considered, taken in consultation with the various players in the overall reconstruction. The outlook for developments now turns to a reduction in the number of operations and better reproducibility through the contribution of 3D techniques.
However, difficulties may appear with regard to implant durability; the skin palette linked to these flaps is a hostile environment to implants; no phenomenon of keratinization was demonstrated in the "cutaneous-implant groove". The absence of a "pseudo epithelial junction" thus induces chronic inflammatory phenomena at the origin of hyperplasias. These appear in 10 % of cases, on average 3 months postoperatively and have a characteristic have a characteristic circular (toric) shape. They are the major factor in implant loss; the absence of pelvilingual and vestibular grooves associated with scar retraction promotes the appearance of bridles. All of these phenomena can create implant dehiscences and initiate peri-implantitis.
Osteointegration and implant stability on a micro-anastomosis fibula free flap are now data acquired from science. Despite everything, complications related to the cutaneous-implant environment restrict its indication to the most compliant patients. The indication must therefore be carefully considered, taken in consultation with the various players in the overall reconstruction. The outlook for developments now turns to a reduction in the number of operations and better reproducibility through the contribution of 3D techniques.