背景:由于骨和软组织的受累,肿瘤治疗引起的下颌骨缺损带来了重大的美学和功能挑战。立即重建对于解决诸如错牙合等并发症至关重要,下颌偏斜,颞下颌关节(TMJ)改变,和软组织回缩.这些问题可能导致功能障碍,包括咀嚼困难,吞咽,和演讲。腓骨瓣由于骨段长、血管供应强,被广泛用于下颌骨重建,尽管它可能并不总是为最佳的牙齿康复提供足够的骨骼高度。本系统综述旨在确定双管腓骨皮瓣(DBFF)配置是否是下颌骨重建的可行替代方法,并评估放置在这种类型皮瓣中的牙科植入物的结果。材料和方法:本研究遵循Cochrane协作标准和PRISMA指南,并在国际注册系统评价和荟萃分析方案数据库平台(INPLASY2023120026)上注册。我们包括以英文发表的临床研究,西班牙语,或法语,重点是成年患者接受节段性下颌骨切除术,然后进行DBFF重建和牙科康复。数据源包括Medline/PubMed,Cochrane图书馆,EMBASE,Scopus,和手动搜索。两名审稿人独立筛选和选定的研究,差异由第三位审阅者解决。数据提取捕获的变量,如出版年份、患者人口统计学,植入物的数量,随访持续时间,皮瓣存活,植入失败,和美学结果。使用JBI评估工具评估偏差的风险,并使用等级方法评估证据的确定性。结果:共纳入17项临床研究,评估245名患者和402名牙科植入物。患者平均年龄为43.7岁,平均随访时间为34.3个月。皮瓣存活率很高,成功率为98.3%,皮瓣损失仅4次。植入物失败率低,为1.74%。美学结果各不相同,只有三项研究使用标准化方案进行评估。皮瓣存活的总体确定性是中等的,植入失败低,由于评估的主观性和报告的可变性,美观性非常低。结论:本综述中包含的证据的主要局限性是研究的观察性设计,导致固有的偏见风险,报告方法不一致,和结果测量的不精确。此外,审美评价的主观性和评价工具的可变性进一步限制了研究结果的可靠性。DBFF技术显示了下颌骨重建的良好结果,皮瓣存活率高,植入失败率低,使其成为牙科康复的可行选择。然而,美学结果的证据不太确定,强调需要更严格和标准化的研究。这篇评论支持DBFF作为下颌骨重建的良好替代方案,并成功整合了牙种植体,尽管需要进一步的研究来提高美学评价的可靠性。
Background: Mandibular defects resulting from oncological treatment pose significant aesthetic and functional challenges due to the involvement of bone and soft tissues. Immediate reconstruction is crucial to address complications such as malocclusion, mandibular deviation, temporomandibular joint (TMJ) changes, and soft tissue retraction. These issues can lead to functional impairments, including difficulties in chewing, swallowing, and speech. The fibula flap is widely used for mandibular reconstruction due to its long bone segment and robust vascular supply, though it may not always provide adequate bone height for optimal dental rehabilitation. This systematic
review aims to determine if the double-barreled fibula flap (DBFF) configuration is a viable alternative for mandibular reconstruction and to evaluate the outcomes of dental implants placed in this type of flap. Materials and Methods: This study adhered to the Cochrane Collaboration criteria and PRISMA guidelines and was registered on the International Platform of Registered Systematic
Review and Meta-Analysis Protocols Database (INPLASY2023120026). We included clinical studies published in English, Spanish, or French that focused on adult patients undergoing segmental mandibulectomy followed by DBFF reconstruction and dental rehabilitation. Data sources included Medline/PubMed, the Cochrane Library, EMBASE, Scopus, and manual searches. Two reviewers independently screened and selected studies, with discrepancies resolved by a third reviewer. Data extraction captured variables such as publication year, patient demographics, number of implants, follow-up duration, flap survival, implant failure, and aesthetic outcomes. The risk of bias was assessed using the JBI appraisal tool, and the certainty of evidence was evaluated using the GRADE approach. Results: A total of 17 clinical studies were included, evaluating 245 patients and 402 dental implants. The average patient age was 43.7 years, with a mean follow-up period of 34.3 months. Flap survival was high, with a 98.3% success rate and only four flap losses. The implant failure rate was low at 1.74%. Esthetic outcomes were varied, with only three studies using standardized protocols for evaluation. The overall certainty of evidence for flap survival was moderate, low for implant failure, and very low for aesthetics due to the subjective nature of assessments and variability in reporting. Conclusions: The primary limitations of the evidence included in this
review are the observational design of the studies, leading to an inherent risk of bias, inconsistency in reporting methods, and imprecision in outcome measures. Additionally, the subjective nature of aesthetic evaluations and the variability in assessment tools further limit the reliability of the findings. The DBFF technique demonstrates excellent outcomes for mandibular reconstruction, with high flap survival and low implant failure rates, making it a viable option for dental rehabilitation. However, the evidence for aesthetic outcomes is less certain, highlighting the need for more rigorous and standardized research. This
review supports the DBFF as a good alternative for mandibular reconstruction with successful dental implant integration, although further studies are needed to enhance the reliability of aesthetic evaluations.