Immediate Dental Implantation in Oncologic Jaw Reconstruction: Workflow Optimization to Decrease Time to Full Dental Rehabilitation

Dental restoration following segmental mandibulectomy for tumor ablation is germane to head and neck reconstruction and should be the goal for every patient. Nonetheless, despite advances in adjuvant treatments and reconstructive techniques, many patients do not complete dental rehabilitation.1 Recognizing this deficiency, we have adopted an innovative workflow to increase the number of patients receiving dental restoration, irrespective of pathology, or need for radiotherapy. Immediate placement of endosseous implants was pioneered by Urken et al.2 to reduce the time required for dental rehabilitation and ensure early aesthetic restoration of the mandible. Levine3 popularized the “Jaw In A Day” surgery, which places dental implants into the fibula flap concurrently following tumor ablation, mainly in the setting of benign tumors (eg, ameloblastoma). In contrast, for malignancies, concern has been raised about the potential for bone loss around the implants from radiation or compromise of the flap skin island needed for oral lining replacement; therefore, many institutions have elected to delay implant placement until a secondary procedure or after radiation.4,5 The drawback of the latter approach is the protracted dental rehabilitation time, unpredictable nature of osseointegration following radiation, and increased risk for osteonecrosis of the jaw when placing implants into irradiated oral tissues.6,7 At our cancer center, a paradigm shift has occurred, due in part to the use of virtual surgical planning, toward immediate endosseous dental implantation at the time of fibula flap for mandibular or maxillary reconstruction. This approach has not only increased the number of patients completing dental rehabilitation but also dramatically reduced the time to full functional recovery. Herein, a novel workflow is presented (Fig. ​(Fig.1)1) along with technical pearls for successful execution. Open in a separate window Fig. 1. Workflow and timeline for dental rehabilitation in oncologic osseous jaw reconstruction. CAD-CAM, computer-aided design and computer-aided modeling; PRS, plastic and reconstructive surgery.