Rehabilitation with dental implants after mandibular reconstruction with microvascular fibula flap with previous osteoradionecrosis

This article discusses how the microvascularized fibula flap with or without cutaneous component has become the reconstructive option of choice for mandibular defects due to its length,the ability to be molded, its acceptable and consistent vascular pedicle, and the relative ease to obtain. Since this bone has shown, due to its vascularization, to maintain the bone mass in time, which gives a potential advantage over other free bone flaps, and therefore, the possibility of rehabilitation with dental implants. However, this can be a challenge because most of these patients have large oncologic resections, frequent medical comorbidity, and often require associated radiotherapy. Initially we review some published works about changes over time in height and bone mass of fibula bone in patients treated for osteoradionecrosis (ORN), and therefore, about the success or failure of the implant rehabilitation in these patients was performed. After, the case of a male patient aged 40 is presented who underwent mandibular reconstruction with fibula free flap after an oncological resection which showed a picture of ORN managed with previous surgical therapy and hyperbaric oxygen as adjuvant therapy and on whom rehabilitation was then performed with implant-supported prostheses with favorable development during 7 years follow-up. Therefore we conclude that the microvascularized fibula bone can receive a functional dental rehabilitation with osseointegrated implants even if there has been a previous history of properly treated ORN.