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Table 1 Study characteristics and MINORS scores

From: Survival of dental implants placed in autogenous bone grafts and bone flaps in head and neck oncology patients: a systematic review

Author Year of publication Study design Outcome measure Criteria—survival Criteria—success Quality assessment using the MINORS assessment tool Head and neck cancer diagnosis Patients age range Follow-up period Implant site Implant system Implant placement protocol Prosthodontic rehabilitation
Studies with an average follow-up of 3 years or greater
Watzinger et al. [29] 1996 Retrospective observational Implant survival in irradiated mandibles and Outcomes of Peri-implant bone Not defined N/A 7/16 SCC Range = 41–79 years Up to 3 years Mandible IMZ Primary and secondary implant placement. Secondary placement 6 months after oncological reconstruction. Delayed loading of implants of at least 6 months. Removable
Teoh et al. [26] 2005 Retrospective observational Implant survival in the reconstructed mandible and prognostic factors. Own—implant not removed then survived. N/A 12/16 SCC, Osteogenic sarcoma, Benign tumours, mucoepidermoid carcinoma and other sarcomas Mean = 42 years (range = 67–80.5 years) Mean = 51.7 months (range = 1.3–138 months) Mandible Nobel and Osseotite Delayed loading of implants 6 months after placement. Fixations screws removed prior to implant placement Fixed and removable
Wu et al. [30] 2008 Retrospective observational Clinical outcomes of dental implants placed in fibula free flaps for orofacial reconstruction Own—implants still functioning with no mobility, pain or infection, but with peri-implant bone resorption more than 2 mm were classified as survived. Albrektsson et al.1986 9/16 Benign and malignant head and neck tumours Average 47.1 years Average 47.8 months Maxilla and mandible ITI and Branemark 19 patients had primary implant placement 10 patients had secondary placement after oncological reconstruction. Delayed loading of implants of at least 3 months after placement. Fixed and removable
Fenlon et al. [19] 2012 Retrospective observational Implant survival Poorly defined—implant osseointegrated and in situ then survived (usefulness of implant assessed using own 4-point index) N/A 12/16 Cancer Unknown At least 3 years Unknown Nobel Biocare, Endopore, Astra and unknown implants 95 implants were primarily placed and 50 implants had secondary placement 3 months after oncological reconstruction. Unknown
Ch’ng et al. [20] 2014 Retrospective observational Implant survival, assess effect of risk factors associated with poor healing. N/A Own—implant success was defined as a painless and stable fixture without evidence of peri-implant infection or radiographic lack of osseointegration 12/16 SCC, recurrence, osteosarcoma, desmoid tumour, adenoid cystic carcinoma, adenocarcinoma, fibrosarcoma, melanoma, MEC, hemangioma-endotheiloma Median age = 59 years Mean = 3.1 years Unknown Astra Primary and secondary implant placement. Patients had implants placed prior to radiotherapy. Reconstruction plates and screws removed if hindering implant placement. Debulking of soft tissues and vestibuloplasty also carried out as required. All removable
Shaw et al. [31] 2005 Retrospective observational Implant survival and complications and surgical complications N/A Own—implant success was defined as remaining function, no mobility, pain or infection. 10/16 80% of patients SCC, other 20% unknown Mean = 58 year (range = 15–80 years) Mean = 3.5 years (range = 0.3/14 years) Maxilla and mandible Frialit II, IMZ, Branemark, and IMTEC Secondary implant placement 1 year after oncological reconstruction. Delayed loading of implants of 3–6 months. Debulking of soft tissue and mucosal grafts carried out as required. Fixed and removable
Wang et al. [21] 2015 Retrospective observational Vertical bone Height—double barrel vs vertical distraction Osteogenesis in Fibula Free Flaps, Implant Survival and Success Poorly defined - implant still in situ then survived. Albrektsson et al.1986 12/16 Ameloblastoma and OKC Range = 28–55 years Mean = 42.5 months ± 4 months Mandible Straumann Secondary implant placement after oncological reconstruction. Delayed loading of implants 3-5 months after placement. Distraction osteogenesis devices used as implants and restored. All fixed
Yerit et al. [16] 2006 Retrospective observational Implant survival in the mandible after radiotherapy and radical surgery in oral cancer patients. N/A Own - Implant Success when no complaints of the patient, no mobility, no peri-implant tissue inflammation and no peri-implant bone loss exceeding one-third of implant length was observed 10/16 Cancer of oral cavity (majority of the subjects having destructive oral squamous cell carcinomas stage T2–T4) Range = 16–84.1 years Mean = 5.42 years ± 3.21 years Mandible IMZ, Frialit II and Xive Implant insertion at various intervals with the mean at 1.41 years after reconstruction. Delayed loading of implants of at least 6 months. Gingivoplasty and vestibuloplaty procedures carried out as required. Removable
Linsen et al. [17] 2009 Retrospective observational Survival of implants and implant-retained prostheses in patients after ablative surgery of oral cancer with or without adjunctive radiation therapy. N/A Kaplan et al. 1958 9/16 SCC, Ameloblastoma, Adenoid Cystic Carcinoma, OKC, Carcinoma of other origins Mean = 55.7 year (range = ± 16.25 years) Mean = 47.99 months ± 134.31 months) unknown Branemark and Straumann Delayed implant placement with an average of 41 months after oncological treatment. Delayed loading of implants of 4.9 months (average). Fixed and removable
Studies with an average follow-up of less than 3 years or no average follow-up reported
Fierz et al. [25] 2013 Retrospective observational Reports on surgical and prosthodontic rehabilitation after resection for oral oncology resection Own—implant not removed then survived, those functioning given a ‘survival rating’ N/A 9/16 SCC, Adenocarcinoma and Others tumours Mean = 57 year (range = ± 7.2 years) Range = Less than 12 months up to 5 years Maxilla and Mandible Unknown No described protocol. Fixed and removable
Barrowman et al. [7] 2011 Retrospective observational Audit experience of implant placement in jaws after oral cancer resection, Success of Prosthodontic Rehabilitation Poorly defined - implant still in situ then survived N/A 10/16 SCC, Verrucous Carcinoma, Osteosarcoma and Adenoid Cystic Carcinoma Range = 20–76 years Up to 15 years Maxilla and Mandible Branemark No described protocol. Fixed and removable
Zou et al. [22] 2013 Retrospective observational Long-term clinical outcomes on immediate or staged Implant Placement in iliac bone for restoring defects after tumour resection. Own - Implants provided supportive function and were stable when torque tested Albrektsson et al.1986 7/16 SCC, Ameloblastoma, OKC, Myxoma Range = 24–61 years Up to 12 years Mandible Nobel and Straumann 17 patients had primary implant placement 15 patients had secondary placement after oncological reconstruction. Delayed loading of implants of 5–6 months. Bone condensing was performed to enhance the bone density. Fixed and removable
Schultes et al. [15] 2002 Retrospective observational Stability of implants in microvascular free flaps Poorly defined - implant still in situ then survived N/A 8/16 Alveolar crest carcinoma T4 Average 58.2, 53.6 years Up to 12 months Mandible SIS (Austria) Implants placed 4 months after radiotherapy Delayed loading of implants of 4 months All removable
Buddula et al. [24] 2010 Retrospective observational Implant survival in irradiated bone Own—implant present in oral cavity at time of data collection then deemed to have survived. N/A 13/16 SCC, adenoid cystic carcinoma, BCC and unknown Mean = 60.2 years Up to 7 years Maxilla and mandible Unknown Median time from ending radiotherapy to implant placement was 3.4 years. Unknown
Klein et al. [32] 2009 Retrospective observational Prognostic parameters for the rehabilitation of mandibular continuity defects with free autologous bone and dental implants for patients after intra-oral squamous cell carcinoma N/A Naert et al. 1992 11/16 SCC Mean = 55.7 years Not documented Mandible Unknown Implants were principally placed into the following 4 tissue conditions: non-irradiated local bone, irradiated local bone, osteoplastic in non-irradiated tissue and osteoplastic in irradiated tissue. Unknown
Burgess et al. [27] 2017 Retrospective observational Implant survival in a variety of composite free flaps Own—implant not removed then survived N/A 10/16 Head and neck neoplasia Average age at implantation was 51 years (range, 18–77 years) At least 6 months follow-up Maxilla and mandible Neoss, Straumann Dentsply Sirona, South Africa - Head Office implants Primary and secondary implant placement. The mean time to implant placement from reconstruction was 19 months (range, 0–141 months) with 2 patients (7 implants) having their implants placed into the fibula 6 weeks before harvesting. Unknown
Chiapasco et al. [18] 2006 Retrospective observational Fibula Free flap survival, implant survival Albrektsson et al.1986 Albrektsson et al.1986 9/16 Rhabdomyosarcoma, sarcoma, SCC, osteosarcoma and ameloblastoma Range = 13–66 years Range = 24–106 months Maxilla and mandible Branemark, ITI and 3i Placement using surgical guides. Secondary implant placement 3–12 months after oncological reconstruction. Implants immediately loaded in 2 patients. Delayed loading for the all other patients 3-6 months after placement. Fixed and removable
Chiapasco et al. [23] 2008 Retrospective observational Bone graft success, implant success, patient satisfaction Own—similar to Albrektsson et al.1986 authors allow greater bone loss around implants. Albrektsson et al.1986 7/16 Ameloblastoma, ossifying fibroma, cementoblastoma, myxoma, SCC, gigantocellular tumour, OKC and rhabdomyosarcoma. Range = 17–54 years Range = 48–132 months Mandible Straumann, Nobel biocare and Branemark Placement using surgical guides. Secondary implant placement 4–7 months after oncological reconstruction. Delayed loading of implants 4-6 months after placement. All fixed
Chiapasco et al. [33] 2000 Retrospective observational Bone resorption of bone grafts, behaviour of bone around implants, implant failure Albrektsson et al.1986 Albrektsson et al.1986 10/16 Ewing sarcoma, epidermoid carcinoma, cylindroma, desmoplastic fybroma, chondroblastic sarcoma, cementoblastoma, ameloblastoma, chondrosarcoma, ossifying fibroma, myxoma and giantocellular tumour Range = 20–58 years Range = 14–34 months Maxilla and mandible Branemark and ITI Placement using surgical guides. Secondary implant placement 4–8 months after oncological reconstruction. Delayed loading of implants 4-6 months after placement. Unknown
Hessling et al. [28] 2015 Retrospective observational Implant survival, peri-implantitis Poorly defined—implant still in situ then survived. N/A 8/16 SCC and odontogenic tumours with malignant degeneration Range = 18–77 years Range = 3–82 months Maxilla and mandible Xive and templant No described protocol. Fixed and removable
  1. The characteristics and MINORS (Methodological Index for Non-Randomized Studies) score for each of the 20 studies included within the review divided into those studies with a mean follow-up of 3 years or greater and those studies with a mean follow-up of less than 3 years or where no mean follow-up was reported within the study
  2. Those marked with an asterisk have had the survival percentages calculated by the authors due to their being adequate information/data within the studies to calculate this
  3. Abbreviations: SCC squamous cell carcinoma, BCC basal cell carcinoma, OKC odontogenic keratinocyst, ACC adenoid cystic carcinoma, RDX radiotherapy, chemo chemotherapy, ORN osteoradionecrosis, DCIA deep circumflex iliac artery flap, MINORS Methodological Index for Non-Randomized studies