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Table 2 Summary of implant survival and implant success in autogenous bone grafts

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

  Implant survival Implant success
Author Year of publication Donor site of autogenous bone graft Radiotherapy/chemotherapy to bone graft site Complications
No. of patients who had implants placed into autogenous bone grafts (and failures) Overall patient implant survival in autogenous bone grafts No. of implants placed into autogenous bone grafts (and failures) Overall implant survival in autogenous bone grafts No. of patients who had implants placed into autogenous bone grafts (and unsuccessful) Overall patient implant success in autogenous bone grafts No. of implants placed into autogenous bone grafts (and unsuccessful) Overall implant success in autogenous bone grafts Reasons for a lack of implant success
Studies with an average follow-up of 3 years or greater
Watzinger et al. [29] 1996 Vascularised iliac bone graft and non-vascularised iliac and rib bone graft Yes—all patients had chemotherapy and RDX Marginal bone loss, periodontal pocketing, gingival index and sulcus bleeding index showed wide variation Not reported N/A 52 (14) 73.1%* Not reported N/A 52 (22) 57.7%* Non-functioning implants (not prosthetically loaded)
Teoh et al. [26] 2005 Vascularised fibula free flap Yes—5 patients had chemotherapy, 1 patients had chemo/RDX (pre-implant placement), 6 patients had pre-op RDX and 1 patient had post-op RDX. 13 patients had soft tissue hyperplasia that need debulking or skin grafting 22 (2) 90.9%* 71 (3) 95.8%* Not reported N/A Not reported N/A N/A
Wu et al. [30] 2008 Fibula free flap Yes—3 patients had RDX (unsure if pre or post-op) Soft tissue hyperplasia needed surgical removal in 6 patients (17 implants). 29 (not reported) N/A 100 (9) 91.0% 29 (not reported) N/A 100 (14) 86.0% Unfavourable local soft tissue and implant left as sleepers. Peri-implant bone loss greater than 2 mm
Fenlon et al. [19] 2012 Vascularised free flap—DCIA, radial, fibula and rib Yes—35 implants had RDX High rate of poor implant positioning in primary implant placement. 41 (10) 75.6%* 145 (18) 87.5%* Not reported N/A 145 (34) 76.6%* Implants osseointegrated but prosthetically unusable
Ch’ng et al. [20] 2014 Vascularised fibula free flap Yes −66/243 patients had RDX (43 patients pre-op RDX, 23 patients post-op RDX) ORN 7.7% of all implants (19 patients, 4 cases in vascularised fibula free flap and 15 in native bone) smoking was shown to be a significant risk factors. Also modification of peri-implant soft tissue required such as debulking of soft tissue and vestibuloplasty as required. 54 (10) 81.5%* 243 (20) 91.8% Not reported N/A Not reported N/A N/A
Shaw et al. [31] 2005 Vascularised composite DCIA, fibula and radius and non-vascularised bone grafts Yes—47% of patients had RDX Soft tissue overgrowth in 3 patients (5 implants). Also, surgical debulk of soft tissue reported in number of cases. 33 (12) 63.6%* 123 (32) 69.0% Not reported N/A Not reported N/A N/A
Wang et al. [21] 2015 Vascularised fibula free flap (double barrel or vertical distraction osteogenesis techniques) NO Implant hygiene and bleeding increased over time. 6 patients (11 implants) required soft tissue reduction however recurrence of soft tissue overgrowth occurred. 19 (0) 100% 51 (0) 100%* Not reported N/A 51 (7) 86.3%* Peri-implant bone loss greater than criteria (radiographic assessment)
Yerit et al. [16] 2006 Vascularised and non-vascularised iliac bone graft No—No RDX to bone graft sites None noted only documenting causes of implant loss Not reported N/A 78 (13) 54.0% Not reported N/A Not reported N/A N/A
Linsen et al. [17] 2009 Avascularised iliac bone graft Yes—39 implants had RDX, 44 implants did not have RDX Peri-implantitis in 12 patients (31 implants). Not reported N/A 79 (8) 89.9%* Not reported N/A Not reported N/A N/A
Studies with an average follow-up of less than 3 years or no average follow-up reported
Fierz et al. [25] 2013 Vascularised free flap—fibula, radius, scapula Yes—20 out of 46 implants had RDX Frail patients limited treatment, and prosthetic rehabilitation was challenging Not reported N/A 46 (8) 82.6%* Not reported N/A Not reported N/A N/A
Barrowman et al. [7] 2011 Vascularised free flap—illiac, DCIA and fibula and non-vascularised bone graft. Yes—15 implants in to irradiated vascularised free flap Inability of patients to tolerate prosthesis. Peri-implantitis and lack of integration of some implants. Not reported N/A 38 (5) 86.8%* Not reported N/A Not reported N/A N/A
Zou et al. [22] 2013 Vascularised iliac bone graft No Increase in plaque index over time. Prosthodontic complications overtime after prosthesis fitted also tumour recurrence 32 (not reported) N/A 110 (4) 96.4% Not reported N/A 110 (9) 91.8% Severe gingival hyperplasia and bone resorption in peri-implant area
Schultes et al. [15] 2002 Vascularised scapula and iliac bone graft Yes—all patients had RDX 60 Gys. Increased pocket depth around implants placed into non-native bone in comparison to native bone. 7 implants with pocketing greater than 5 mm were all in vascularised free flaps 38 (2) 94.7%* 96 (2) 97.9%* Not reported N/A 96 (4) 95.8%* Implants inadequately positioned and could not be used for further prosthetic treatment
Buddula et al. [24] 2010 Bone graft—fibula, iliac and scapula (unsure of vascularised or non-vascularised) Yes—all patients had RDX None noted only documenting implant survival Not reported N/A 59 (8) 83.3% Not reported N/A Not reported N/A N/A
Klein et al. [32] 2009 Avascular iliac bone graft Yes—some patients had RDX None noted only documenting implant survival Not reported N/A 128 (22) 78.4% Not reported N/A Not reported N/A N/A
Burgess et al. [27] 2017 Vascularized bone grafts—fibula, DCIA, scapula and radial Yes—some patients had RDX None noted only documenting implant survival 59 (not reported) N/A 199 (11) 93.6% Not reported N/A Not reported N/A N/A
Chiapasco et al. [18] 2006 Vascularised fibula free flap Yes—some patients had RDX and chemo—unknown number Soft tissue overgrowth in 2 patients that required removal and palatal mucosal graft placed 14 (1) 92.9%* 62 (1) 98.3%* 14 (2) 85.7%* 62 (5) 91.9%* Peri-implant bone loss greater than criteria (radiographic assessment)
Chiapasco et al. [23] 2008 Non-vascularised—Calvarium or iliac bone graft Unknown Soft tissue grafting required around implants in 3 patients 16 (1) 93.8%* 60 (2) 96.7% 16 (2) 87.5%* 60 (4) 93.3% Peri-implant bone loss greater than criteria (radiographic assessment)
Chiapasco et al. [33] 2000 Non-vascularised—ilieum and fibula, and vascularised free flap—ilieum and fibula Yes—3 patients had RDX (unknown if pre or post) Soft tissue grafting required around implants in 3 patients 18 (2) 88.9%* 72 (3) 95.8%* 18 (2) 88.9%* 72 (3) 95.8%* N/A
Hessling et al. [28] 2015 Free iliac crest, microvascular iliac, microvascular fibula, microvascular scapula, calavarial bone graft Yes—some patients had RDX and chemo (pre- and post-op) unknown number 67% peri-implantitis due to a lack of attached gingivae Not reported N/A 93 (8) 91.4%* Not reported N/A Not reported N/A N/A
  1. Implant survival and implant success in autogenous bone grafts was extracted on a patient and implant level (where applicable) for all 20 studies included within this review
  2. Those marked with an asterisk have had the survival/success percentages calculated by the authors due to their being adequate information/data within the studies to calculate this
  3. Abbreviations: RDX radiotherapy, chemo chemotherapy, DCIA deep circumflex iliac artery flap, pre-op pre-operative, post-op postoperative