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Head and Neck Surgery

(134) Dental Implants in Radiated Fibula Free Flaps: A Systematic Review

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Veronica Drozdowski, MD

    Otolaryngology Resident
    Loyola University Medical Center
    Maywood, Illinois, United States

    • Co-Author(s)

  • Veronica Drozdowski, MD

    Otolaryngology Resident
    Loyola University Medical Center
    Maywood, Illinois, United States

    • Presenting Author(s)

  • Morgan Sandelski, MD

    Resident
    Loyola University Medical Center
    Maywood, Illinois, United States

    • Senior Author(s)

  • AP

    Amy Pittman, MD

    Associate Professor
    Loyola University Medical Center
    Maywood, Illinois, USA

  • Eric J. Thorpe, MD

    Chairman
    Loyola University Medical Center, Department of Otolaryngology-Head and Neck Surgery
    Maywood, Illinois, United States

    • Co-Author(s)

  • DA

    Danae Alexandrou, BS

    Medical Student
    Loyola Stritch School of Medicine
    Forest Park, Illinois, United States

Disclosure(s):
Danae Alexandrou, BS: No relevant relationships to disclose.


Introduction: Dental rehabilitation in irradiated patients with free flap reconstruction is a challenge given concern for osseointegration. Current studies cite success rates from 38-90%; however, these percentages are derived from small, largely retrospective chart reviews. Given that the quality of life in these patients is greatly diminished when dental rehabilitation limited, we sought to systematically review the available literature.

Methods: The protocol was registered with the systematic review database, PROSPERO (CRD42022372499). We included studies that discussed osseointegrated dental implants placed into fibula free flaps in patients with a history of radiation, including adjuvant radiation, primary radiation with surgical salvage, or resultant osteoradionecrosis as the indication for free flap.

Results: There were 14 studies that met the criteria for inclusion. On pooled analysis, a total of 415 dental implants were placed in 148 patients. We noted an overall survival (OS), defined as successfully osseointegrated implants, of 74% (308/415). At 6 months post-implant, the OS was 86% (284/330). 5 of the 14 studies provided comparative data between RT vs no RT, 2 reported no difference and 3 reported statistically significant worse outcomes in patients with RT; however, no articles provided data to run pooled statistical analysis. 5 out of 14 studies discussed adjuvant hyperbaric oxygen, with an OS of 69.8% (125/179; p = 0.075). 13 out of the 14 studies reported timing of implant placement, either immediate at the time of surgery or delayed after a period of healing. Immediate implants had an OS of 93.9% (62/66) and delayed of 74.5% (182/244). Immediate placement was associated with better OS (p= < 0.001).

Conclusions: Despite limitations we were able to conclude that a history of radiation does appear to decrease survival rates for dental implants placed into fibula free flaps. An unexpected finding was that immediate placement appears to improve survival; however, data on timing of radiation is still lacking. Our hope is that our paper serves as a catalyst for larger, perhaps prospective research on this topic.