Computer-aided implant surgery in free flaps reconstructed patients. Two-year follow-up results of a prospective clinical study

OBJECTIVES. The aim of this prospective clinical study is to present the benefits of implant restorations performed according to a computer assisted surgical NobelGuide protocol (Procera Software, Nobel Biocare, Goteborg, Sweden) in patients reconstructed with free flaps after oncologic resections or gunshot traumas and to assess the attainment of masticatory and deglutition function recovery, as well as improved facial aesthetics.MATERIALS AND METHODS. 10 patients reconstructed with fibula or iliac crest free flaps after oncologic resections, gunshot wounds or for preprosthetic purposes were selected. Computer-aided, flapless dental implant placement was based on accurate prosthetic and aesthetic analysis.The classical NobelGuide protocol had to be modified due the need to adapt the technique to these reconstructed patients. A total of 56 Replace Tapered Groovy (Nobel Biocare) fixtures were installed, the implant length ranged between 8 and 16 mm, while the diameter was either 3.5, 4.3 or 5 mm.In order to assess the treatment success, the following parameters were examined: survival of implants; marginal bone-level changes; prosthetic complications, such as prosthesis or acrylic facing fractures; biological complications; implants abscesses; swelling implants mucosa; bleeding; major complications (transplanted flap infections or fractures); soft tissue response, Pocket Probing Depth (PPD), and Bleeding on Probing (BoP) index; patient satisfaction. Marginal bone loss was measured with three-dimensional CT scan at the day of loading and at 24 months. Implants were considered successful if no pain nor mobility was caused under unscrewing torque of 20 Ncm. Analytic statistical analysis was carried out on the resulting data.RESULTS. All the cases were subject to a minimum 24-month follow-up, 3 implants were lost (cumulative survival rate 94.6%).Every patient received a correct provisional prosthetic rehabilitation with high degree of satisfaction as to masticatory and deglutition function, facial aesthetics and overall quality of life. Radiological examination showed a mean marginal bone loss of 1.12 mm +/- 0.50 mm in the lingual/palatal site and 1.20 mm +/- 0.45 mm in the vestibular site. All of the patients presented healthy soft tissues with stable PPD and good BoP values after 24 months, with respective values of 4.85 mm +/- 0.82 mm and of 13% +/- 5.2%.CONCLUSIONS. In this study, we applied a modified technique of computer-aided implant surgery in free flaps reconstructed jaws: our preliminary findings confirm that this approach seems valuable when it comes to function, on account of improved prosthetic restorations and aesthetics in challenging patients.