Prosthetically-Driven Implant Placement in a Free Fibula Flap-Reconstructed Mandible by Dynamic Navigation: A Retrospective Study

Background/Purpose: Implant placement in free fibula flap reconstructed mandibles is challenging due to anatomical irregularity, thick and elastic soft tissue, and limited mouth opening. This study aims to evaluate the feasibility and accuracy of real-time dynamic navigation systems applied for implant placement in patients with free fibula flap-reconstructed mandible. Materials and methods A total of 10 patients who received free fibula flap-reconstructed surgery in the mandible were included in this retrospective study. Virtual implant placement was planned according to the concept of "prosthetically-driven dental implant surgery". Then, dental implants were placed under guidance of real-time navigation systems. Linear and angular deviations between the actually placed and virtually planned implants were analyzed. SPSS software (IBM, USA) was used for the analysis of the data. Results A total of 24 dental implants were placed in 8 patients. The coronal, apical, and angular deviations of the dental implants were 1.51 ± 0.84 mm, 1.84 ± 0.85 mm, and 4.98 ± 3.2°, respectively. There was no significant difference between implants on the left and right sides ( p  = 0.41, 0.34, and 0.17, respectively) and between different registration methods ( p  = 0.24, 0.22, and 0.17, respectively). No intra- or postoperative complications occurred, and there was no dental implant failure during the healing period. Conclusion Dynamic navigation can acquire accurate and promising outcome of implant placement in the free fibula flap-reconstructed mandibles. Future studies should include larger sample sizes of different defect types to evaluate its reliability and accuracy further.