Use of astra implant system for immediate implantation as primary mandibular reconstruction by double-barrel fibula flap aided by virtual surgical planning - a clinical case series

Background Mandibular reconstruction by microvascular free fibula flap has dramatically improved the quality of life of patient treated by interruptive surgery. Dental implantation at the same time as primary mandibular reconstruction aided by digital technology is becoming the standard for mandibular defects. However, this procedure including implant placement, graft placement, prosthetic design and soft tissues handling is technically difficult. Moreover, the character of fibula is different from mandible. But the index of implant suitable for this procedure was rarely discussed. Aim/Hypothesis The aim of this case series was to evaluate the feasibility of the Astra OsseoSpeed straight implant system for immediate implantation as primary mandibular reconstruction by double-barrel fibula flap aided by virtual surgical planning. Material and Methods From June to September of 2017, 3 patients underwent mandibular reconstruction with double-barrel fibula flap and immediate dental implantation aided by virtual surgical planning. 8 implants (Osseospeed 4.0S; DENTSPLY, Molndal, Sweden) were simultaneous placed in fibula flap for dental rehabilitation. Surgical templates were used for mandiblectomy, harvest and rigid fixation of double-barrel fibula. Implant placement was guided by implant template and cover screw was used for healing. Depending on local healing, the second stage was started between 3 and 6 months after implantation. Radiographic examinations were performed before restoration stage. Implants were uncovered and fitted with the Uniabutment (OsseoSpeed; DENTSPLY) with 20 degrees of different height. After 2 weeks for the healing of soft tissues, impression of abutment level was made and the screw-retained prosthetic suprastructure was placed 7–14 days later. Radiographic examinations were taken to check the mounting of abutment and suprastructure. Results All surgical procedure of each patient including mandiblectomy, harvest and rigid fixation of double-barrel fibula was accomplished according to surgical templates. Implants were correctly placed in the right 3D position with bicortical anchorage. Primary stability of all implants was achieved between 25 and 30 N.cm. Radiographic examinations before restoration demonstrated that each implant had nice osteointegration and stable marginal bone level. Two weeks after the implants were uncovered, soft tissue healed well and showed healthy gingival collar. Both clinical and radiographic examinations demonstrated that screw-retained prosthetic suprastructure had satisfactory passive fit. Follow-up visit a month later showed implant prosthesis had healthy periimplant soft tissue without food impaction. Conclusions and Clinical Implications The conical tip of Astra OsseoSpeed straight implant makes it easy to acquire bicortical anchorage. Its non-aggressive drilling protocol minimized adverse effect on fixation of double barred fibula flap. Implant placement need less mouth open because the implant driver directly inserted implant body. Conclusively, Astra OsseoSpeed straight implant system has favorable attributes for immediate implantation as primary mandibular reconstruction by double-barrel fibula flap aided by virtual surgical planning.