Dental Implant Survival in Vascularized Bone Flaps: A Systematic Review and Meta-Analysis.

BACKGROUND Maxillofacial reconstruction with vascularized bone restores facial contour and provides structural support and a foundation for dental rehabilitation. Routine implant placement in such cases, however, remains uncommon. This study aims to determine dental implant survival in patients undergoing vascularized maxillary or mandibular reconstruction through a systematic review of the literature. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature was queried for implant placement in reconstructed jaws using MeSH terms on PubMed, Embase, and Cochrane platforms. Weighted implant survivals were calculated for the entire cohort and sub-cohorts stratified by radiotherapy. Meta-analyses were performed to estimate effect of radiation on implant osseointegration. RESULTS Of 3,965 publications identified, 42 studies were reviewed, including 1,084 patients with 3,636 dental implants. Weighted implant survival was 92.2% at a median follow-up of 36 months. Survival was 97.0% in 269 implants placed immediately in 60 patients versus 89.9% in 1,897 delayed implants placed in 597 patients, with follow-up of 14 and 40 months, respectively. Dental implants without RT exposure had better survival than those exposed to radiation (95.3 vs. 84.6%; p<0.01) at median follow-up of 36 months. Meta-analyses showed radiation significantly increased the risk of implant failure (risk ratio [RR]: 4.74, p<0.01) and suggested that implants placed prior to radiotherapy trended towards better survival (88.9% vs. 83.4%, p=0.07, RR: 0.52; p=0.14). CONCLUSIONS Overall implant survival was 92.2%; however, radiotherapy adversely impacted outcomes. Implants placed before radiation may demonstrate superior survival than implants placed after.