Functional implantation reconstruction of acquired jaw defects after tumor resection / 中华口腔医学杂志

ABSTRACT

<p><b>OBJECTIVE</b>Partial or full defects of jawbone following tumor resection frequently lead to a loss of mastication, an impaired speech function and a severe deformity of appearance. To improve the life quality of such patients, implantation or bone grafting-combined implantation was utilized to functionally reconstruct the jaw defects.</p><p><b>METHODS</b>1. Fragmental or full mandibular defects were reconstructed by vascularized or non-vascularized bone grafts in combination with immediate or delayed implants. 2. The unilateral maxillary defect with an edentulous counter-side was rehabilitated by a prosthesis secured on implants placed on the healthy side. 3. For bilateral maxillary defect, implants were placed in the zygmatic bone or augmented zygmatic bone to support a prosthesis with magnetic retention.</p><p><b>RESULTS</b>64 jaw defects (10 in maxilla; 54 in mandible) were reconstructed by three different methods to restore the appearance and functions. The longest follow-up period was 12 years and the shortest 5 year, only 6 implants were lost due to failure of osseointegration. The implant survival rate for the maxillary defects was 97.5%, for the mandibular defects with vascularized bone grafts was 97.1%, and with non-vascularized bone grafts was 97.7%.</p><p><b>CONCLUSIONS</b>Implants-borne prosthesis is an applicable technique in restoration of maxillary defects. In case of insufficient zygomatic thickness, bone augmentation is often needed prior to implantation. As for the mandibular reconstruction, bone grafting in combination with implantation is an ideal method. Compared to non-vascularized bone grafting, the vascularized method is much more suitable for bone grafting beds with poor blood supply. From the practical point of view, non-vascularized bone graft in combination with implantation is more practicable. The reduced off-body time of bone grafts from donor to recipient site keeps most of osteoblasts vital and enables simultaneous implants to achieve osseointegration. This confirms the osteogenesis, osteoconduction and osteoinduction of bone autografts.</p>