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. 2023 Apr 1;41(2):123-128.
doi: 10.7518/hxkq.2023.2023005.

Dental implant treatment in vascularized bone flaps after jaw reconstruction

[Article in English, Chinese]
Xiaofeng Shan  1 , Zhigang Cai  1
Affiliations

Dental implant treatment in vascularized bone flaps after jaw reconstruction

[Article in English, Chinese]
Xiaofeng Shan et al. Hua Xi Kou Qiang Yi Xue Za Zhi. .

Abstract
in English, Chinese

Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.

因为肿瘤等原因造成的颌骨缺损，常严重影响外形和功能。口腔颌面部肿瘤治疗的目标除了治愈肿瘤，还应该包括尽量恢复患者患病前的功能。显微外科技术和数字化外科技术的发展推动了以血管化游离骨瓣重建颌骨缺损的发展，术前的可视化设计可以帮助获得更好的外形。在重建的颌骨上如何恢复咬合功能，提高患者的生活质量，成为一个重要的研究方向。本文将从颌骨重建理念、血管化骨瓣的选择、种植时机的选择、种植体周围软组织的处理、放疗对颌骨重建后种植义齿的影响等方面进行讨论。.

Keywords: dental implant; jaw defect reconstruction; radial therapy; vascularized fibula flap; vascularized iliac crest flap.

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Conflict of interest statement

利益冲突声明：作者声明本文无利益冲突。

Figures

图 1
图 1. 颌骨重建后种植牙的设计流程
Fig 1 Design flow of dental implant treatment after jaw reconstruction A：传统的数字化颌骨重建流程，先完成颌骨重建，需要行种植义齿修复时再评估是否满足种植修复条件；B：“以终为始”的颌骨重建流程，在确定治疗计划的最早期确定义齿修复方案，反推种植体植入的位置和颌骨重建的设计。
图 2
图 2. 髂骨瓣重建上颌骨缺损可以利用髂骨的骨高度与上颌骨形成支柱
Fig 2 The iliac crest flap can form buttress by the height of iliac bone when reconstructing maxillary defect A：形成鼻旁支柱；B：形成翼上颌支柱；C、D：形成颧上颌支柱。
图 3
图 3. 髂骨嵴朝向牙槽突修复下颌骨缺损
Fig 3 Mandibular reconstruction with iliac crest toward alveolar process A：髂骨嵴朝向牙槽突修复下颌骨缺损侧貌；B：显示修复下颌骨下缘的髂骨较窄，如果用于修复牙槽突无法满足种植义齿需求（箭头示）。
图 4
图 4. 血管化髂骨瓣重建颌骨缺损同期种植即刻义齿修复
Fig 4 One stage mandibular reconstruction with iliac flap and immediate implant-supported prosthesis treatment A：髂骨瓣在髂区未离断血管蒂前，将其固定于颌骨缺损的模型上，进行种植体植入，义齿修复；B：完成义齿修复后将髂骨瓣、钛板、义齿复合体整体转移至颌骨缺损区域，使用钛板钛钉固定，血管吻合，完成血管化髂骨瓣重建同期种植即刻义齿修复。
图 5
图 5. 颌骨重建后的角化组织增量手术，改善种植体周围角化黏膜情况
Fig 5 Keratinized mucosa augmentation after jaw reconstruction to improve soft tissue around dental implants A：角化黏膜移植前；B：角化黏膜移植术中；C：角化黏膜移植术后。
See this image and copyright information in PMC

References

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