Radiographic Evaluation of Peri-Implant Bone Thickness in Fibular Mandible Reconstruction With Preoperative Occlusion-Driven Design

INTRODUCTION: Restoration of dental rehabilitation is the ultimate goal of functional jaw reconstruction, which is called "occlusion-driven jaw reconstruction", whereas fibular mandibular reconstruction (FMR) in the Asian population fails to adequately provide adequate bone volume for subsequent dental implantation. This study proposed a preoperative occlusion-driven design of FMR and compared the peri-implant bone thickness in fibular-reconstructed mandibles with or without preoperative occlusion-driven design. METHODS: The patients underwent FMR and following dental implantation were reviewed, consisting of 10 cases with preoperative occlusion-driven design of free fibular flap (FFF) as the experimental group and the other 12 cases as the control group. A total of 82 endosseous implants were radiographically evaluated and the cross-sectional buccal, lingual, and bottom distances between implant and fibula were calculated. RESULTS: The lingual bone thickness at the crown third of the peri-implant in the premolar region and at the middle third of the peri-implant in the molar region was 2.36±0.36 and 4.90±0.43 mm in the experimental group, significantly greater than 1.57±0.15 and 3.73±0.32 mm in the control group, respectively (P=0.04, P=0.032). The bone thickness at the root of the peri-implant in the experimental group was significantly greater than that in the control group (P=0.007). Specifically, the anterior and premolar regions in the experimental group were 4.31±0.24 and 4.29±0.30 mm, significantly greater than 3.21±0.40 and 4.16±0.30 mm in the control group, respectively (P=0.019 and P=0.009). No significant difference was found in the buccal bone thickness at the crown, middle, and root third of the peri-implant between the experimental and control groups. CONCLUSIONS: On the basis of the results of limited cases, this study demonstrated preoperative occlusion-driven design of the intended fibula segment for implant placement could provide adequate bone volume for endosseous implants, contributing to maximize successful osseointegration and minimize complications for FMR patients.