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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (1): 78-84. doi: 10.19723/j.issn.1671-167X.2025.01.012

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One-stage mandibular reconstruction combining iliac flap with immediate implant-based denture

Yifan KANG1, Yanjun GE2, Xiaoming LV1, Shang XIE1, Xiaofeng SHAN1,*(), Zhigang CAI1,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for 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 & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
    2. Department of Prosthodontic, Peking University School and Hospital of Stomatology & National Center for 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 & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2024-09-25 Online:2025-02-18 Published:2025-01-25
  • Contact: Xiaofeng SHAN, Zhigang CAI E-mail:bdkqsxf@163.com;c2013xs@163.com
  • Supported by:
    Capital' s Funds for Health Improvement and Research(CFH2024-2-4104)

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Abstract:

Objective: To evaluate the clinical outcomes and define the indications for a one-stage mandibular reconstruction technique that combines iliac bone flaps with immediate implant-based dentures, and to assess both the accuracy of surgical planning and the long-term success of the procedure. Methods: A total of ten patients underwent the procedure at Peking University Hospital of Stomatology between June 2020 and August 2023. The preoperative biopsy pathology of all the patients confirmed a benign tumor. In this technique, iliac bone flaps were used for mandibular reconstruction, and immediate implant-based dentures were placed during the same surgical session. Various outcome measures were evaluated, including the accuracy of the surgical reconstruction, implant placement deviations (entry point, apical point, depth, and angle), and long-term outcomes, such as cervical bone resorption, implant survival, and the cumulative survival rate. Results: Thirty-eight implants were successfully inserted into the iliac flaps of the ten patients. The median follow-up duration was 23.5 months, and no significant complications occurred during the follow-up period, such as infections, titanium plate exposure, implant loosening, or damage to the implants and dentures. The accuracy of preoperative virtual surgical planning (VSP) was highly reliable. The repeatability of the VSP model compared to the postoperative reconstructed mandible was as follows: 67.82% ±10.16% within 1 mm, 82.14% ±6.58% within 2 mm, and 90.61% ±4.62% within 3 mm. The average maximum deviation from the plan was (6.10±0.89) mm, with an average overall deviation of (1.14±0.31) mm. For the implants, deviations in critical parameters were as follows: entry point deviation was (2.02±0.58) mm, apical point deviation was (2.25± 0.66) mm, depth deviation was (1.26±0.51) mm, and angular deviation was 1.84°±1.10°. The implant survival rate remained 100% during the follow-up, with a cumulative survival rate of 97.37% from 1 to 4 years. Average cervical bone resorption was 0.94 mm. Conclusion: The combination of iliac bone flaps with immediate implant-based dentures for one-stage mandibular reconstruction demonstrated pro-mising clinical outcomes, including high implant survival and minimal complications. This technique proved to be safe and reliable for mandibular reconstruction. However, further studies with larger sample sizes and longer follow-up periods are necessary to confirm the long-term efficacy and optimal indications for this procedure.

Key words: Mandibular reconstruction, Iliac flaps, Implant-supported dental prosthesis, Immediate implant-based denture, Treatment outcome

CLC Number: 

  • R782.23

Figure 1

Preoperative virtual surgical planning A, virtual mandibular reconstruction with iliac bone flap; B, three-dimensional printed model and pre-bent titanium plate; C, three-dimensional printed surgical guides; D, the position of implants and dental prothesis were designed; E, three-dimensional printed implant guides; F, dental prothesis."

Figure 2

Surgical procedure of one-stage mandibular reconstruction combining iliac flap with immediate implant-based denture A, mandibulectomy under the guidance of the surgical guide; B, use model and titanium plate to check the range of mandibulectomy; C, iliac bone flap harvesting and shaping; D, dental implants insertion; E, individual abutments were connected for the fabrication of the implant prothesis using a resin adhesive; F, the prosthesis, implants, iliac bone flap, and titanium plate became a fixed complex, which was transferred to the recipient site as a whole."

Figure 3

Three-dimensional error grade color map represents the surface deviation (mm) between the postoperative and virtual surgical planning mandible models"

Figure 4

Accuracy measurement of dental implants A: Angular deviation, the angle between the long axes of the two implants (green); Depth deviation, depth between the entry point of the two implants (blue); Entry point deviation, distance between the entry point of the two implants (red); Apical point deviation, distance between the apical point of the two implants (yellow). B: Actual measurement example in software."

Figure 5

Profiles of patient preoperatively, postoperatively and at 1-year postoperatively A, preoperative intraoral profile; B, intraoral profile during the surgery; C, intraoral profile at 1 year postoperatively; D, preoperative facial profile; E, facial profile at 1 week postoperatively; F, facial profile at 1 year postoperatively."

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