Dental restoration with osseointegrated implants after jaw reconstruction: beyond the fibular height deficiency by distraction osteogenesis and/or prosthodontics

Objectives: To evaluate the best way for functional restoration of the fibular flap “single strut”. Methods: 13 cases were selected for rehabilitation by implant supported dental prosthesis. 7 cases were treated (group 1) overcoming the fibular height deficiency by prosthodontics, the remainder underwent distraction osteogenesis before dental restoration (group 2). The fibular/mandibular height discrepancy was recorded. The evaluation criteria included x-rays and clinical measurement of perimplant bone and gum (skin) level. Results: All 13 of the prosthetic rehabilitations were screw retained fixed prosthesis. The average age was 52; the male/female ratio was 7/6; the mandibular/maxillary ratio was 11/2. The average number of implants placed into the fibula was five. The maximum observation follow-up period after loading was two 30 months for the group 1 and 33.5 (7-93) months on average for the group 2. Surgical complications, implant loss, the mean vertical bone gain, the mean peri-implant bone resorption and post-surgical complication were recorded. Conclusions: Our experience concerns the fibular osteocutaneous free flap utilized in oral malignancy as a “single strut flap” because we prefer to preserve the whole length of the pedicle. Both orthopaedic dental prosthesis and vertical distraction osteogenesis are good solutions in order to overcame the fibular height deficiency. The first is based on the same biomechanics of the dental prosthesis on short implants having a comparable crown/implant ratio, DO procedure applied on fibula constitute a good option in case of young patients and wide fibular/mandibular height discrepancy. The criteria of selection of the treatment plan are done.