ORIGINAL RESEARCH article
Front. Oral Health
Sec. Oral and Maxillofacial Surgery
This article is part of the Research TopicCurrent Trends in Oral Surgery and ImplantologyView all 7 articles
Relationship Between Fibula Free Flap Complications and Dental Implant Outcomes: A Retrospective Cohort Study
Provisionally accepted
- 1Department of Periodontology, Oral Medicine and Oral Surgery, Charité—Universitätsmedizin Berlin, Berlin, Germany
- 2Justus-Liebig-Universitat Giessen, Giessen, Germany
- 3Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czechia., Brno, Czechia
- 4Czech National Centre for Evidence-Based Healthcare and Knowledge Translation , Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University, Brno, Czechia., Brno, Czechia
- 5Christian-Albrechts-Universitat zu Kiel, Kiel, Germany
- 6Charite - Universitatsmedizin Berlin, Berlin, Germany
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Objective: To clarify how fibula free flap (FFF) complications influence clinical and functional outcomes after implant-supported oral rehabilitation. Materials and Methods: A single-center retrospective cohort of 29 patients (56.41 ± 12.74 years; 31% female, 69% male) who underwent segmental jaw resection, FFF reconstruction and subsequent implant placement (2002-2010) was analyzed. Demographic, oncologic, flap, implant-related and patient-centered functional variables were extracted; associations were tested with exact, rank and regression statistics (⍺ = 0.05). Result: Patients received 7.14 ± 3.06 implants each and 72% were restored with telescopic overdentures. Recipient-site wound-healing defects (WHD) occurred in 31% and were independently associated with multisegment osteotomies (p = 0.012) and longer operative time (p = 0.026); partial flap loss (PFL) was infrequent (6.9%). WHD reduced maximum inter-incisal opening (MIO) by 0.8 cm and PFL by 2.8 cm, both impairing contour ratings. Implant failure (0.59 ± 1.59) correlated with poorer speech intelligibility (p = 0.004) and lower aesthetic scores (p = 0.032). Nonetheless, 96% of patients spoke intelligibly (with or without concentration), 96% judged their dental aesthetic as good or excellent, and 75% consumed a normal diet. Ordinal regression confirmed the number of fibula segments as the sole predictor of contour (p = 0.001). Conclusions: FFF reconstruction permits dependable, implant-supported rehabilitation, but multisegment osteotomies and prolonged surgery heighten soft-tissue morbidity, which in turn constrains both MIO and appearance. Failed implants further degrade speech intelligibility and aesthetics. Long-term success therefore hinges on balancing the contour gains of complex osteotomies with flap vascular resilience while safeguarding implant stability.
Keywords: Fibula, Fibula free flap, implants, complications, Survival, function
Received: 24 Sep 2025; Accepted: 13 Nov 2025.
Copyright: © 2025 Attia, Knitschke, Riad, Mekhemar and Stolte. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sameh Attia, sameh.attia@charite.de
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