GP1b - Immediate Implants in Fibulas: Does the Implant to Fibula Osteotomy Distance Impact Early Implant Failure?

Abstract: Background
No current literature is available to guide planning of implant distance from the fibula osteotomy edge.
Purpose
The purpose of this study was to determine if the distance from the implant to the fibula osteotomy edge impacts early implant failure in patients who received free fibula flap reconstruction with immediate implants.1,2
Study design:
A retrospective case series was designed and implemented. The study population was composed of patients who underwent free fibula flap transfer with immediate dental implant placement for the treatment of benign or malignant conditions of the head and neck from 2015 to 2022.
Predictor variable:
The primary predictor variable was the implant distance from the fibula osteotomy edge.
Outcome variable:
The primary outcome variable was early implant failure, defined as implant exfoliation noted by the patient or failure due to implant movement or pain necessitating explantation.
Covariates:
There were 8 covariates, including age, sex, diabetes diagnosis, American Society of Anesthesiologists classification, smoking status, history of head and neck radiation, pathology treated, and if postoperative radiation treatment was received.
Analyses:
Mann-Whitney U test and Kruskal-Wallis test were used to compare covariates of interest and implant distance. A generalized estimating equations (GEE) model with binary distribution, logit link, and compound symmetry covariance structure were used to assess the relation between the primary predictor and the primary outcome.
Results
Forty-eight patients had 130 implants placed, with early failures occurring in 5 implants (3.9%) in 3 patients. The average implant distance was 4.2 mm (SD: 1.5). The minimum implant distance was 1.6 mm, and the maximum was 9.8 mm. Among the 5 implants which failed, the average distance was 3.52 mm (SD: 1.04). There was a statistically significant relation between implant distance and early implant failure (P = .007, OR 0.6, 95% CI 0.42 to 0.87).

Conclusions:
This study found that as implant to fibula osteotomy edge distance increases, the odds of early implant failure decreases. Specifically, for each millimeter increase in distance, there is an associated 40% decrease in the odds of early implant failure.

References
1. Williams FC, Hammer DA, Wentland TR, et al. Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing. J Oral Maxillofac Surg. 2020;78(8):1320-1327. doi: 10.1016/j.joms.2020.04.006.
2. Williams FC, Hammer DA, Wentland TR, et al. Immediate Teeth in Fibulas: Expanded Clinical Applications and Surgical Technique. J Oral Maxillofac Surg. 2021;79(9):1944-1953. doi: 10.1016/j.joms.2021.04.005.