Comparison of the late results of mandibular reconstruction using nonvascularized or vascularized. grafts and dental implants

Purpose: This study evaluates contour restoration in segmental defects of the mandible and the survival rate of endosseous implants placed into these reconstructions. Patients and Methods: Forty-four patients with 23 nonvascularized grafts and 21 patients with vascularized bone flaps were included in the study. The lateral and the sagittal extension of the contour of both the mandibular bone and the overlying soft tissues was determined from serial computed tomography (CT) scans in defined planes through the reconstructed mandible. The success rate of dental implants was determined by a life-table analysis. Results: Average lateral deviation of the reconstructed side from the nonreconstricted side was 4.3 mm (nonvascularized grafts) and 5.6 mm (vascularized grafts). The soft tissue contour followed the skeletal contour quite closely, with slightly smaller degrees of deviation. Asymmetry was greatest in the area of the horizontal ramus. In some cases, skeletal deviation was intentionally produced to compensate for a soft tissue deficit on the reconstructed side. However, in some cases, a major deviation of bone contour was associated with considerable deviation of the soft tissue contour (maximum, 10.5 mm). The cumulative implant success rate was 100% after 5 years and 60.3% after 10 years. None of the seven implant failures accounted for prosthetic failure. Conclusions: Although there are minor differences, both nonvascularized and revascularized grafts allow for satisfactory contour restoration in segmental reconstructions of the mandible. Implants placed into these grafts provide a reliable basis for dental rehabilitation.