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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (1): 66-73. doi: 10.19723/j.issn.1671-167X.2024.01.011

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Clinical analysis of denture rehabilitation after mandibular fibula free-flap reconstruction

Congwei WANG,Min GAO,Yao YU,Wenbo ZHANG,Xin PENG*()   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing 100081, China
  • Received:2023-10-08 Online:2024-02-18 Published:2024-02-06
  • Contact: Xin PENG E-mail:pxpengxin@263.net

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Abstract:

Objective: To evaluate the postoperative denture restoration and denture function in patients with mandibular defect reconstructed with vascularized free fibula flap. Methods: In the study, 154 patients who underwent mandibular segment resection and used vascularized free fibula flap to repair mandibular defects due to inflammation, trauma and tumor from January 2015 to December 2020 were collected. These patients had common inclusion criteria which were stable occlusal relationship before operation, segmental defects of mandibular bone caused by lesions of mandible and adjacent parts (such as floor of mouth, tongue, cheek), free fibula flap used for repair and surviving after operation. Relevant data were reviewed and situation of denture restoration was followed up. A questionnaire related to denture functional evaluation had been proposed for those who had completed the denture rehabilitation. The evaluation index of denture restoration function was assigned by expert authority to obtain the denture function score. SPSS 18.0 software was used for statistical analysis of the basic information of the patients included in the study and the denture restoration of the patients. Results: The rate of postoperative denture restoration in the patients with mandibular defects repaired by free fibula flap was 17.5%, and the rate of postoperative denture restoration in the patients with benign mandibular tumors was 25.0% (18/72), which was significantly greater than that in the patients with malignant tumors 11.0% (9/82, P < 0.05). There was no significant difference in denture function score between the patients with condylar defect and those without condylar defect in denture repair rate and denture function score (P>0.05). The functional score of implant denture was significantly greater than that of removable denture (P < 0.05). According to Brown classification, the denture function score of the patients with the defect invo-lving the anterior mandibular region was significantly greater than that of the patients without the anterior mandibular region involved (P < 0.05). The poor oral conditions, such as less amount of remaining teeth, insufficient retention strength, large mobility of soft tissue in the surgical area, poor oral vestibular groove condition became the main reason of not receiving denture restoration (37.86%). Conclusion: The denture rehabilitation of mandibular defect reconstructed with vascularized free fibula flap is closely rela-ted to pathological properties and oral conditions. The clinical outcome of implant denture has been confirmed effectively and it is a better choice for future denture restoration after mandibular reconstruction.

Key words: Free tissue flaps, Fibula transplantation, Mandibular reconstruction, Dental implants

CLC Number: 

  • R782.2

Figure 1

A 29-year-old male patient suffering from ameloblastoma was performed with double-barrel fibular flap transplantation, the implant supported fixed restoration was completed and the functional score was 48.54 A, segmental osteotomy of mandible; B, preparation of fibular osseous flap; C, pedicle division of fibular osseous flap; D, double-barrel fibular flap transplantation; E-G, panoramic tomography of fibular flap construction, implants placement surgery, implant supported fixed restoration surgery; H and I, intraoral view after denture rehabilitation."

Figure 2

An 18-year-old female patient suffering from tuberous sclerosis was performed with fibula free-flap reconstruction and iliac crest onlay bone graft by digital design, the implant overdenture was completed and the functional score was 46.66 A, intraoral view after fibula free-flap reconstruction; B, implant-oriented iliac crest onlay bone graft by digital design; C and D, cutting guide plate of ilium via computer-assisted manufacture; E, performance of iliac crest onlay bone graft; F, implants placement 1 years after surgery; G-I, panoramic tomography of 1 year after fibula free-flap reconstruction, 3 months after iliac crest onlay bone graft, 5 months after implants placement; J-L, intraoral view after denture rehabilitation."

Figure 3

Index judgment matrix A, judgement matrix for each expert; B, indicators for denture function; aij, the relative importance of i element and j element in the matrix."

Table 1

Final weight of indicators"

Items Distribution of scores Weight
Appearance improvement 10, 20, 30, 40, 50 0.059
Denture comfort 10, 20, 30, 40, 50 0.247
Pronunciation 10, 20, 30, 40, 50 0.087
Mastication 10, 30, 50 0.307
Self-evaluation of quality of life 10, 30, 50 0.300

Table 2

Exploratory factor analysis results"

Items Characteristic root Explanation rate of variance after rotation
Characteristic root Variance explanation rate Cumulative percentage Characteristic root Variance explanation rate Cumulative percentage
Appearance improvement 3.136 62.7 62.7 3.136 62.7 62.7
Denture comfort 0.805 16.1 78.8
Pronunciation 0.610 12.2 91.0
Mastication 0.322 6.4 97.5
Self-evaluation of quality of life 0.127 2.5 100.0

Table 3

The correlation between the nature of disease and the denture rehabilitation by Pearson Chi-square test"

Denture rehabilitation Nature of disease Total χ2 P
Benign Malignant
Yes 18 9 27 5.215 0.022
No 54 73 127
Total 72 82 154

Table 4

The correlation between the condylar defect and the denture rehabilitation by Pearson Chi-square test"

Denture rehabilitation Condylar defect Total χ2 P
Yes No
Yes 6 21 27 1.221 0.269
No 42 85 127
Total 48 106 154

Table 5

Single factor analysis of condylar defect"

Items Sample size Function scores t P Mean difference Cohen’s d
Mean Standard deviation
With condylar defect 5 39.318 8.975 0.965 0.344 5.751 0.48
Without condylar defect 21 33.567 12.490
Total 26 34.673 11.960

Table 6

Single factor analysis of denture restoration methods"

Items Sample size Function scores t P Mean difference Cohen’s d
Mean Standard deviation
Implant denture 12 43.482 5.934 4.741 < 0.001 16.359 1.865
Removable denture 14 27.123 10.595
Total 26 34.673 11.960

Table 7

Single factor analysis of the location of mandibular defect"

Items Sample size Function scores t P Mean difference Cohen’s d
Mean Standard deviation
Without involvement of anterior teeth area 14 30.442 13.430 -2.073 0.049 9.167 0.815
With involvement of anterior teeth area 12 39.609 7.909
Total 26 34.673 11.960
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