Dental prostheses (known as bridges) can be immediately placed on replacement teeth with highly predictable outcomes during jaw reconstruction that involves taking bone from the patient's leg, a new study finds.
This technique can be used on certain patients who need skin paddles—which includes skin taken with the leg bone to fix soft-tissue defects – according to the study published in the September issue of the Journal of Oral and Maxillofacial Surgery—the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS).
Changes to traditional jaw reconstruction using the fibula—the smaller of the two bones in the lower leg that is removed with an artery, vein and soft tissue, known as a fibula free flap—can help limit problems with soft tissue and prosthetics, the study notes. The researchers explained their use of simultaneous skin paddles and a floating prosthesis for accurately attaching the prosthesis to replacement teeth (known as dental implants) while the fibula receives blood supply on the leg.
The study involved 22 patients who underwent reconstruction of their upper or lower jaw using the fibula, received immediate dental implants and immediate bridgework and were tracked for at least three months.
Of the 95 dental implants placed, 92 fused with the jawbone, known as integration, indicating dental implant success. All 36 dental implants that were next to skin paddles in 10 patients integrated. Overall, the dental implant success rate was 93 percent within nine to 15 months after surgery.
In the past, immediate dental restoration during reconstruction using the fibula was recommended just for benign disease because issues with malignant disease can include uncertain radiation effects, the need for skin paddles and extra time required to create dental prostheses, the researchers note. This study found radiation after surgery is not associated with lower rates of dental implant integration.
The researchers explained that they avoid delay in surgery by using virtual surgical planning to establish dental implant positions and fibula placement before designing and 3D printing teeth the following day. Surgery was not delayed for any patients while they waited for bridgework or for starting radiation due to dental implant or prosthesis issues.
"For successful prosthetic outcomes, planning should be restoratively driven," the researchers wrote. "This requires placement of bone in proper orientation with the opposing dental arch for optimal implant positioning. Soft-tissue health is vital for long-term success to mitigate against peri-implantitis (inflamed tissue around an implant). The depth of implant placement should account for expected marginal bone loss to avoid exposed threads and peri-implantitis."
The authors of "Immediate Teeth in Fibulas: Expanded Clinical Applications and Surgical Technique" are Fayette C. Williams, DDS, MD, from John Peter Smith Health Network in Fort Worth, Texas; Daniel A. Hammer, DDS, from Naval Medical Center San Diego; and Todd R. Wentland, DDS, MD; and Roderick Y. Kim, DDS, MD, from John Peter Smith Health Network.
The full article can be accessed at JOMS.org/article/S0278-2391(21)00326-8/fulltext.
The Journal of Oral and Maxillofacial Surgery is published by the American Association of Oral and Maxillofacial Surgeons to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.