Rehabilitation of oral cancer patients with dental implants

The use of osseointegrated fixtures in conjunction with vascularized bone-containing free flaps has enabled the reconstructive team to restore postablative orofacial defects to near normal appearance and function. A number of flaps have been used in oromandibular reconstruction. Implantability of the bone portion of these flaps together with the soft tissue defect often plays an important role in donor site selection. Controversy as to the timing of fixture placement continues. The proponents of primary placement state that taking advantage of the "window of opportunity" before the radiation damage is essential for increased fixture "survival." Those who favor secondary placement maintain that it not only allows the patient to be disease-free for a period of time before an extensive dental reconstructive procedure is initiated but also leads to better prosthetic planning and hence better fixture placement. The effect of radiation therapy and role of hyperbaric oxygen before treatment have been studied. The results remain inconclusive. This paper reviews the most recent English language literature as it pertains to the use of endosseous root form dental implants in conjunction with vascularized bone flaps in orofacial, postoncologic reconstruction.