Evaluation of Oral Function After Dental Implant Treatment For Mandibular Reconstruction Patients Using Vascularized Fibular Flap

Objectives: Surgical treatment of oral tumor may lead to significant disability, including facial deformity, loss of hard and soft tissue, and impaired oral function such as speech, swallowing, and mastication. Bone resection by large mandibular tumorcan cause long-term defects. After extensive mandibular defect, it is difficult to recover sufficient oral function with conventional prostheses. Dental implants are useful to improve the stability and support of a prosthesis, and dental implants have recently gained an important role in the rehabilitation of patients with bone resectionby facilitating the provision of a stable prosthesis.
Methods: The subjects were 8 patients wearing implant prostheses after mandibular reconstruction using vascularized fibular flaps between April 2012 and March 2019. We conducted 5 tests to evaluate oral function for each patient with and without an implant prosthesis: occlusal force, masticatory performance, tongue pressure, repetitive saliva swallowing test (RSST), and oral diadcokinesis.
Results: Indications for mandibular resection were 6 cases of gingival carcinoma, a tongue carcinoma and a benign tumor. After 18-59 months mandibular reconstruction (mean: 31.6 months), we performed implant placement surgery. The total number of placed implants was 25 implants. A total of20 dental implants were placed into the reconstructed bone, and 5 dental implants were placed into the remaining jaw bone, with an average of 3.6 dental implants per case. The prosthesis included 6 cases of fixed implant-supported prostheses and 2 cases of implant-supported overdentures. The occlusal force and masticatory performance and tongue pressure witha prosthesissignificantly increased compared with that withouta prosthesis.RSST and oral diadcokinesis were also improved but not significantly.
Conclusions: Dental implant treatment after mandibular reconstruction using vascularized fibular flap improved not only masticatory performance but function of swallowing.