Comparison of the Outcome of Free Iliac Bone Graft and Vascularized Iliac Bone Graft in Reconstruction of Mandibular Defects: A Systematic Review

PurposeThe aim of this systematic review was to assess the outcome of non-vascularized iliac bone graft and vascularized iliac bone graft (VBG) in the reconstruction of mandibular defects.MethodsAn electronic search was conducted in PubMed, Google Scholar, Scopus, and Cochrane Library for relevant articles in English, French, and German languages published between 2010 and 2021 using the following keywords: ("mandibular reconstruction" [Mesh] OR "mandibular defect") AND (("deep circumflex iliac artery" OR "DCIA") OR ("non-vascularized iliac crest bone graft" OR "NVICBG") OR (("ilium" [Mesh] OR "iliac") AND ("free" OR "vascularized") AND "graft")). The National Institute of Health (NIH) quality assessment tool was used for risk of bias assessment. The final data were presented as frequencies and percentages.ResultsInitially, 58 articles were found in PubMed, 39 in Scopus, 522 in Google Scholar, and 112 in Cochrane. Finally, 13 met the eligibility criteria of the study. There were 234 patients in the NVICBG group and 89 in the VBG group. The graft failure rate ranged from 8.8 to 23% in the NVICBG group and 0-27.7% in the VBG group. In the one-year follow-up, the graft survival rate in the NVICBG group ranged from 75 to 92%, while it ranged from 73 to 99% in the VBG group.ConclusionNo well-controlled clinical trial was found on the comparative outcome of NVICBG and VBG to reconstruct mandibular defects regarding defect size and site. The prevalence of graft failure was the same in NVICBG and VBG. The selection of graft type based on defect size needs to be more questionable.