Implant-based dental rehabilitation after fibula free-flap reconstruction: a national survey of Restorative Dentistry practice in the United Kingdom

Abstract Aims: To describe current UK practice, service organisation and perceived challenges in implant-based dental rehabilitation of fibula free-flap reconstructions. Methods: A cross-sectional online survey (Microsoft Forms) was distributed to Consultants in Restorative Dentistry through the Restorative Dentistry UK Head and Neck Cancer Clinical Excellence Network between September 2025 and January 2026. Closed responses were summarised descriptively, and free-text responses were analysed qualitatively. Results: Sixteen Consultants from 14 NHS Boards and Trusts responded. Almost all planned fibula reconstructions jointly with oral and maxillofacial surgery (OMFS) teams. Primary or case-dependent implant placement was preferred in 79% of centres and secondary placement after healing in 21%. Virtual surgical planning was used routinely for cases in 57% of centres. Restorative Consultants usually placed implants and OMFS surgeons usually debulked flaps. Fixed prostheses predominated and immediate loading was generally not used. Soft-tissue problems were the most frequently reported complication. Approaches to implant timing when adjuvant radiotherapy was anticipated was divergent. Outcome recording was inconsistent and published patient- reported outcome measures were rarely used. Conclusions: Prosthodontic rehabilitation pathways of fibula free flaps vary considerably in UK hospitals. Agreed national pathways, a minimum outcome dataset that includes patient-reported outcomes, and prospective multi-centre data collection are needed to reduce unwarranted variation and inform service development.