自体血管化游离骨皮瓣及种植体在颌骨缺损中的应用研究进展
Advances in the Application of Autologous Vascularized Free Bone-Panniculus Flaps and Implants in Mandibular Defects
DOI: 10.12677/acm.2026.1631047, PDF,   
作者: 罗 平, 胡嘉琪, 陈 磊:重庆医科大学附属口腔医院口腔颌面外科,重庆;口腔疾病研究重庆市重点实验室,重庆;口腔生物医学工程重庆市高校市级重点实验室,重庆;重庆市卫生健康委口腔生物医学工程重点实验室,重庆;张富贵*:重庆医科大学附属口腔医院口腔颌面外科,重庆
关键词: 颌骨缺损自体血管化骨皮瓣骨移植种植体数字化技术Mandibular Defect Autologous Vascularized Bone-Skin Flap Bone Grafting Dental Implant Digital Technology
摘要: 颌骨缺损常源于肿瘤、创伤或先天性发育畸形等疾病,严重影响患者的面容及咀嚼、吞咽、语言等生理功能。目前,自体血管化游离骨皮瓣移植仍是颌骨重建的“金标准”。随着数字化技术的应用与骨内种植体技术的深度融合发展,颌骨重建已进入功能与形态并重的精准修复阶段。本文就临床常用自体骨瓣的生物学特性、种植体恢复咬合功能的影响因素及数字化技术的辅助作用进行综述。
Abstract: Mandibular defects often result from conditions such as tumors, trauma, or congenital developmental abnormalities, significantly impacting patients’ facial appearance and physiological functions including chewing, swallowing, and speech. Presently, autologous vascularized free bone-skin flap transplantation remains the gold standard for maxillofacial reconstruction. Advancements in digital technology and its deep integration with intraosseous implant techniques have propelled maxillary reconstruction into a new era of precision restoration that prioritizes both function and form. This article reviews the biological characteristics of commonly used autogenous bone grafts in clinical practice, factors influencing the restoration of occlusal function by implants, and the auxiliary role of digital technology.
文章引用:罗平, 胡嘉琪, 陈磊, 张富贵. 自体血管化游离骨皮瓣及种植体在颌骨缺损中的应用研究进展[J]. 临床医学进展, 2026, 16(3): 2481-2491. https://doi.org/10.12677/acm.2026.1631047

参考文献

[1] Chuka, R., Abdullah, W., Rieger, J., Nayar, S., Seikaly, H., Osswald, M., et al. (2017) Implant Utilization and Time to Prosthetic Rehabilitation in Conventional and Advanced Fibular Free Flap Reconstruction of the Maxilla and Mandible. The International Journal of Prosthodontics, 30, 289-294. [Google Scholar] [CrossRef] [PubMed]
[2] Urken, M.L., Buchbinder, D., Weinberg, H., Vickery, C., Sheiner, A. and Biller, H.F. (1989) Primary Placement of Osseointegrated Implants in Microvascular Mandibular Reconstruction. OtolaryngologyHead and Neck Surgery, 101, 56-73. [Google Scholar] [CrossRef] [PubMed]
[3] Cordeiro, P.G., Disa, J.J., Hidalgo, D.A. and Hu, Q.Y. (1999) Reconstruction of the Mandible with Osseous Free Flaps: A 10-Year Experience with 150 Consecutive Patients. Plastic and Reconstructive Surgery, 104, 1314-1320. [Google Scholar] [CrossRef] [PubMed]
[4] Wilkman, T., Apajalahti, S., Wilkman, E., Törnwall, J. and Lassus, P. (2017) A Comparison of Bone Resorption over Time: An Analysis of the Free Scapular, Iliac Crest, and Fibular Microvascular Flaps in Mandibular Reconstruction. Journal of Oral and Maxillofacial Surgery, 75, 616-621. [Google Scholar] [CrossRef] [PubMed]
[5] Fujiki, M., Miyamoto, S., Sakuraba, M., Nagamatsu, S. and Hayashi, R. (2013) A Comparison of Perioperative Complications Following Transfer of Fibular and Scapular Flaps for Immediate Mandibular Reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 66, 372-375. [Google Scholar] [CrossRef] [PubMed]
[6] Chang, Y., Wallace, C.G., Tsai, C., Shen, Y., Hsu, Y. and Wei, F. (2011) Dental Implant Outcome after Primary Implantation into Double-Barreled Fibula Osteoseptocutaneous Free Flap-Reconstructed Mandible. Plastic and Reconstructive Surgery, 128, 1220-1228. [Google Scholar] [CrossRef] [PubMed]
[7] Kim, D.D. and Ghali, G.E. (2011) Dental Implants in Oral Cancer Reconstruction. Oral and Maxillofacial Surgery Clinics of North America, 23, 337-345. [Google Scholar] [CrossRef] [PubMed]
[8] He, Y., Zhang, Z.Y., Zhu, H.G., Wu, Y.Q. and Fu, H.H. (2011) Double-Barrel Fibula Vascularized Free Flap with Dental Rehabilitation for Mandibular Reconstruction. Journal of Oral and Maxillofacial Surgery, 69, 2663-2669. [Google Scholar] [CrossRef] [PubMed]
[9] Chen, J., Yin, P., Li, N., Wu, L., Jian, X. and Jiang, C. (2019) Functional Mandibular Reconstruction with Double-Barrel Fibular Flap and Primary Osseointegrated Dental Implants Improve Facial Esthetic Outcome. Journal of Oral and Maxillofacial Surgery, 77, 218-225. [Google Scholar] [CrossRef] [PubMed]
[10] Yoon, H. (2016) Prosthetic Rehabilitation after Fibular Free Flap Surgery of Mandibular Defects in a Patient with Oral Squamous Cell Carcinoma. Journal of Craniofacial Surgery, 27, e685-e688. [Google Scholar] [CrossRef] [PubMed]
[11] Lizio, G., Corinaldesi, G., Pieri, F. and Marchetti, C. (2009) Problems with Dental Implants That Were Placed on Vertically Distracted Fibular Free Flaps after Resection: A Report of Six Cases. British Journal of Oral and Maxillofacial Surgery, 47, 455-460. [Google Scholar] [CrossRef] [PubMed]
[12] Chang, Y., Santamaria, E., Wei, F., Chen, H., Chan, C., Shen, Y., et al. (1998) Primary Insertion of Osseointegrated Dental Implants into Fibula Osteoseptocutaneous Free Flap for Mandible Reconstruction. Plastic & Reconstructive Surgery, 102, 680-688. [Google Scholar] [CrossRef] [PubMed]
[13] Akkocaoglu, M., Cehreli, M.C., Tekdemir, I., Comert, A., Güzel, E., Dağdeviren, A., et al. (2007) Primary Stability of Simultaneously Placed Dental Implants in Extraoral Donor Graft Sites: A Human Cadaver Study. Journal of Oral and Maxillofacial Surgery, 65, 400-407. [Google Scholar] [CrossRef] [PubMed]
[14] Kang, Y., Lv, X., Qiu, S., Ding, M., Xie, S., Zhang, L., et al. (2021) Virtual Surgical Planning of Deep Circumflex Iliac Artery Flap for Midface Reconstruction. Frontiers in Oncology, 11, Article ID: 718146. [Google Scholar] [CrossRef] [PubMed]
[15] 梁建锋, 竺越, 李佳欣, 等. 下颌骨放射性骨坏死血管化游离组织瓣移植手术治疗的主要并发症及处理[J]. 中华口腔医学杂志, 2021, 56(5): 435-440.
[16] Möhlhenrich, S.C., Kniha, K., Elvers, D., Ayoub, N., Goloborodko, E., Hölzle, F., et al. (2016) Intraosseous Stability of Dental Implants in Free Revascularized Fibula and Iliac Crest Bone Flaps. Journal of Cranio-Maxillofacial Surgery, 44, 1935-1939. [Google Scholar] [CrossRef] [PubMed]
[17] Scaglioni, M.F., Meroni, M., Fritsche, E. and Rajan, G. (2022) Superficial Circumflex Iliac Artery Perforator Flap in Advanced Head and Neck Reconstruction: From Simple to Its Chimeric Patterns and Clinical Experience with 22 Cases. Plastic & Reconstructive Surgery, 149, 721-730. [Google Scholar] [CrossRef] [PubMed]
[18] Gibber, M.J., Clain, J.B., Jacobson, A.S., Buchbinder, D., Scherl, S., Zevallos, J.P., et al. (2014) Subscapular System of Flaps: An 8‐Year Experience with 105 Patients. Head & Neck, 37, 1200-1206. [Google Scholar] [CrossRef] [PubMed]
[19] Beckers, A., Schenck, C., Klesper, B. and Koebke, J. (1998) Comparative Densitometric Study of Iliac Crest and Scapula Bone in Relation to Osseous Integrated Dental Implants in Microvascular Mandibular Reconstruction. Journal of Cranio-Maxillofacial Surgery, 26, 75-83. [Google Scholar] [CrossRef] [PubMed]
[20] 单小峰, 蔡志刚. 颌骨缺损血管化游离骨瓣重建后的种植修复治疗[J]. 华西口腔医学杂志, 2023, 41(2): 123-128.
[21] Kniha, K., Möhlhenrich, S.C., Foldenauer, A.C., Peters, F., Ayoub, N., Goloborodko, E., et al. (2017) Evaluation of Bone Resorption in Fibula and Deep Circumflex Iliac Artery Flaps Following Dental Implantation: A Three-Year Follow-Up Study. Journal of Cranio-Maxillofacial Surgery, 45, 474-478. [Google Scholar] [CrossRef] [PubMed]
[22] Schardt, C., Schmid, A., Bodem, J., Krisam, J., Hoffmann, J. and Mertens, C. (2017) Donor Site Morbidity and Quality of Life after Microvascular Head and Neck Reconstruction with Free Fibula and Deep-Circumflex Iliac Artery Flaps. Journal of Cranio-Maxillofacial Surgery, 45, 304-311. [Google Scholar] [CrossRef] [PubMed]
[23] Otomaru, T., Sumita, Y.I., Aimaijiang, Y., Munakata, M., Tachikawa, N., Kasugai, S., et al. (2015) Rehabilitation of a Bilateral Maxillectomy Patient with a Free Fibula Osteocutaneous Flap and with an Implant‐Retained Obturator: A Clinical Report. Journal of Prosthodontics, 25, 341-348. [Google Scholar] [CrossRef] [PubMed]
[24] Lonie, S., Herle, P., Paddle, A., Pradhan, N., Birch, T. and Shayan, R. (2015) Mandibular Reconstruction: Meta‐Analysis of Iliac‐ versus Fibula‐Free Flaps. ANZ Journal of Surgery, 86, 337-342. [Google Scholar] [CrossRef] [PubMed]
[25] Politi, M. and Toro, C. (2012) Iliac Flap Versus Fibula Flap in Mandibular Reconstruction. Journal of Craniofacial Surgery, 23, 774-779. [Google Scholar] [CrossRef] [PubMed]
[26] Ling, X.F., Peng, X. and Samman, N. (2013) Donor-Site Morbidity of Free Fibula and DCIA Flaps. Journal of Oral and Maxillofacial Surgery, 71, 1604-1612. [Google Scholar] [CrossRef] [PubMed]
[27] Shpitzer, T., Neligan, P.C., Gullane, P.J., Boyd, B.J., Gur, E., Rotstein, L.E., et al. (1999) The Free Iliac Crest and Fibula Flaps in Vascularized Oromandibular Reconstruction: Comparison and Long-Term Evaluation. Head & Neck, 21, 639-647. [Google Scholar] [CrossRef] [PubMed]
[28] Branemark, P. (1983) Osseointegration and Its Experimental Background. The Journal of Prosthetic Dentistry, 50, 399-410. [Google Scholar] [CrossRef] [PubMed]
[29] Lekholm, U. (1993) New Surgical Procedures of the Osseointegration Technique A.M. Brånemark. Australian Prosthodontic Journal, 7, 25-32.
[30] Zhu, H., Kang, Y., Shan, X., Ge, Y. and Cai, Z. (2022) Effect of Dental Rehabilitation on Masticatory Function Following Jaw Reconstruction. The International Journal of Oral & Maxillofacial Implants, 37, 494-500. [Google Scholar] [CrossRef] [PubMed]
[31] Anne-Gaëlle, B., Samuel, S., Julie, B., Renaud, L. and Pierre, B. (2011) Dental Implant Placement after Mandibular Reconstruction by Microvascular Free Fibula Flap: Current Knowledge and Remaining Questions. Oral Oncology, 47, 1099-1104. [Google Scholar] [CrossRef] [PubMed]
[32] Nguyen, T.T.H., Eo, M.Y., Myoung, H., Kim, M. and Kim, S.M. (2020) Implant-Supported Fixed and Removable Prostheses in the Fibular Mandible. International Journal of Implant Dentistry, 6, Article No. 44. [Google Scholar] [CrossRef] [PubMed]
[33] Kang, Y., Ding, M., Qiu, S., Cai, Z., Zhang, L. and Shan, X. (2022) Mandibular Reconstruction Using Iliac Flap Based on Occlusion-Driven Workflow Transferred by Digital Surgical Guides. Journal of Oral and Maxillofacial Surgery, 80, 1858-1865. [Google Scholar] [CrossRef] [PubMed]
[34] Tabet, P., Bellavance, S., Harris, J.R., Ansari, K., Osswald, M., Nayar, S., et al. (2024) Prefabricated Fibula Flap vs Bone-Driven and Delayed Implant Installation for Jaw Reconstruction. JAMA OtolaryngologyHead & Neck Surgery, 150, 483-491. [Google Scholar] [CrossRef] [PubMed]
[35] Woods, B., Schenberg, M. and Chandu, A. (2019) A Comparison of Immediate and Delayed Dental Implant Placement in Head and Neck Surgery Patients. Journal of Oral and Maxillofacial Surgery, 77, 1156-1164. [Google Scholar] [CrossRef] [PubMed]
[36] Patel, A., Harrison, P., Cheng, A., Bray, B. and Bell, R.B. (2019) Fibular Reconstruction of the Maxilla and Mandible with Immediate Implant-Supported Prosthetic Rehabilitation. Oral and Maxillofacial Surgery Clinics of North America, 31, 369-386. [Google Scholar] [CrossRef] [PubMed]
[37] Jackson, R.S., Price, D.L., Arce, K. and Moore, E.J. (2016) Evaluation of Clinical Outcomes of Osseointegrated Dental Implantation of Fibula Free Flaps for Mandibular Reconstruction. JAMA Facial Plastic Surgery, 18, 201-206. [Google Scholar] [CrossRef] [PubMed]
[38] 刘宝林. 肿瘤术后颌骨缺损的功能重建[J]. 中华口腔医学杂志, 2003, 38(1): 9-11.
[39] Burgess, M., Leung, M., Chellapah, A., Clark, J.R. and Batstone, M.D. (2017) Osseointegrated Implants into a Variety of Composite Free Flaps: A Comparative Analysis. Head & Neck, 39, 443-447. [Google Scholar] [CrossRef] [PubMed]
[40] Chang, Y., Coskunfirat, O.K., Wei, F., Tsai, C. and Lin, H. (2004) Maxillary Reconstruction with a Fibula Osteoseptocutaneous Free Flap and Simultaneous Insertion of Osseointegrated Dental Implants. Plastic and Reconstructive Surgery, 113, 1140-1145. [Google Scholar] [CrossRef] [PubMed]
[41] Williams, F.C., Hammer, D.A., Wentland, T.R. and Kim, R.Y. (2021) Immediate Teeth in Fibulas: Expanded Clinical Applications and Surgical Technique. Journal of Oral and Maxillofacial Surgery, 79, 1944-1953. [Google Scholar] [CrossRef] [PubMed]
[42] Levine, J.P., Bae, J.S., Soares, M., Brecht, L.E., Saadeh, P.B., Ceradini, D.J., et al. (2013) Jaw in a Day: Total Maxillofacial Reconstruction Using Digital Technology. Plastic & Reconstructive Surgery, 131, 1386-1391. [Google Scholar] [CrossRef] [PubMed]
[43] Cebrian-Carretero, J., Guinales-Diaz de Cevallos, J., Sobrino, J., Yu, T. and Burgueno-Garcia, M. (2014) Predictable Dental Rehabilitation in Maxillomandibular Reconstruction with Free Flaps. The Role of Implant Guided Surgery. Medicina Oral Patología Oral y Cirugia Bucal, 19, e605-e611. [Google Scholar] [CrossRef] [PubMed]
[44] Mashrah, M.A., Aldhohrah, T., Abdelrehem, A., Sakran, K.A., Ahmad, H., Mahran, H., et al. (2021) Survival of Vascularized Osseous Flaps in Mandibular Reconstruction: A Network Meta-Analysis. PLOS ONE, 16, e0257457. [Google Scholar] [CrossRef] [PubMed]
[45] Curi, M.M., Condezo, A.F.B., Ribeiro, K.D.C.B. and Cardoso, C.L. (2018) Long-Term Success of Dental Implants in Patients with Head and Neck Cancer after Radiation Therapy. International Journal of Oral and Maxillofacial Surgery, 47, 783-788. [Google Scholar] [CrossRef] [PubMed]
[46] Carbiner, R., Jerjes, W., Shakib, K., Giannoudis, P.V. and Hopper, C. (2012) Analysis of the Compatibility of Dental Implant Systems in Fibula Free Flap Reconstruction. Head & Neck Oncology, 4, Article No. 37. [Google Scholar] [CrossRef] [PubMed]
[47] Smith Nobrega, A., Santiago, J.F., de Faria Almeida, D.A., dos Santos, D.M., Pellizzer, E.P. and Goiato, M.C. (2016) Irradiated Patients and Survival Rate of Dental Implants: A Systematic Review and Meta-Analysis. The Journal of Prosthetic Dentistry, 116, 858-866. [Google Scholar] [CrossRef] [PubMed]
[48] Wang, M., Abdelrehem, A., Qu, X. and Zhang, C. (2021) Thinned-out Skin Paddle versus Collagen Matrix as an Optimized Peri-Implant Soft Tissue Following Fibula Osteoseptocutaneous Free Flap: 3-Year Retrospective Study. International Journal of Oral and Maxillofacial Surgery, 50, 391-397. [Google Scholar] [CrossRef] [PubMed]
[49] Li, R., Meng, Z., Zhang, Y., Shan, X., Wang, Y. and He, Y. (2021) Soft Tissue Management: A Critical Part of Implant Rehabilitation after Vascularized Free-Flap Reconstruction. Journal of Oral and Maxillofacial Surgery, 79, 560-574. [Google Scholar] [CrossRef] [PubMed]
[50] Messias, A., Nicolau, P. and Guerra, F. (2021) Different Interventions for Rehabilitation of the Edentulous Maxilla with Implant-Supported Prostheses: An Overview of Systematic Reviews. The International Journal of Prosthodontics, 34, s63-s84. [Google Scholar] [CrossRef] [PubMed]
[51] Liu, P., Li, Q., Yang, Q., Zhang, S., Lin, C., Zhang, G., et al. (2020) Three-Dimensional Cell Printing of Gingival Fibroblast/Acellular Dermal Matrix/Gelatin-Sodium Alginate Scaffolds and Their Biocompatibility Evaluation in Vitro. RSC Advances, 10, 15926-15935. [Google Scholar] [CrossRef] [PubMed]
[52] Wu, Y., Huang, W., Zhang, Z., Zhang, Z. and Zou, D. (2016) Long-Term Success of Dental Implant-Supported Dentures in Postirradiated Patients Treated for Neoplasms of the Maxillofacial Skeleton: A Retrospective Study. Clinical Oral Investigations, 20, 2457-2465. [Google Scholar] [CrossRef] [PubMed]
[53] Zen Filho, E.V., Tolentino, E.d.S. and Santos, P.S.S. (2015) Viability of Dental Implants in Head and Neck Irradiated Patients: A Systematic Review. Head & Neck, 38, E2229-E2240. [Google Scholar] [CrossRef] [PubMed]
[54] Ernst, N., Sachse, C., Raguse, J.D., Stromberger, C., Nelson, K. and Nahles, S. (2016) Changes in Peri-Implant Bone Level and Effect of Potential Influential Factors on Dental Implants in Irradiated and Nonirradiated Patients Following Multimodal Therapy Due to Head and Neck Cancer: A Retrospective Study. Journal of Oral and Maxillofacial Surgery, 74, 1965-1973. [Google Scholar] [CrossRef] [PubMed]
[55] Raoul, G., Ruhin, B., Briki, S., Lauwers, L., Haurou Patou, G., Capet, J., et al. (2009) Microsurgical Reconstruction of the Jaw with Fibular Grafts and Implants. Journal of Craniofacial Surgery, 20, 2105-2117. [Google Scholar] [CrossRef] [PubMed]
[56] Singh, K., Huang, T.C.T., Meaike, J.D., Mills, A.M., Nathan, J.M., Lettieri, S.C., et al. (2021) The Medial Femoral Condyle Free Flap for Reconstruction of Recalcitrant Defects in the Head and Neck. Annals of Plastic Surgery, 87, 291-297. [Google Scholar] [CrossRef] [PubMed]
[57] Chang, C.T., Liu, S.P., Muo, C.H., Tsai, C.H. and Huang, Y.F. (2017) Dental Prophylaxis and Osteoradionecrosis: A Population-Based Study. Journal of Dental Research, 96, 531-538. [Google Scholar] [CrossRef] [PubMed]
[58] Shaw, R.J., Butterworth, C.J., Silcocks, P., Tesfaye, B.T., Bickerstaff, M., Jackson, R., et al. (2019) HOPON (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis): A Randomized Controlled Trial of Hyperbaric Oxygen to Prevent Osteoradionecrosis of the Irradiated Mandible after Dentoalveolar Surgery. International Journal of Radiation Oncology, Biology, Physics, 104, 530-539. [Google Scholar] [CrossRef] [PubMed]
[59] Sultan, A., Hanna, G.J., Margalit, D.N., Chau, N., Goguen, L.A., Marty, F.M., et al. (2017) The Use of Hyperbaric Oxygen for the Prevention and Management of Osteoradionecrosis of the Jaw: A Dana-Farber/Brigham and Women’s Cancer Center Multidisciplinary Guideline. The Oncologist, 22, 343-350. [Google Scholar] [CrossRef] [PubMed]
[60] Peterson, D.E., Koyfman, S.A., Yarom, N., Lynggaard, C.D., Ismaila, N., Forner, L.E., et al. (2024) Prevention and Management of Osteoradionecrosis in Patients with Head and Neck Cancer Treated with Radiation Therapy: ISOO-MASCC-ASCO Guideline. Journal of Clinical Oncology, 42, 1975-1996. [Google Scholar] [CrossRef] [PubMed]
[61] Bulsara, V.M., Bulsara, M.K. and Lewis, E. (2019) Protocol for Prospective Randomised Assessor-Blinded Pilot Study Comparing Hyperbaric Oxygen Therapy with PENtoxifyl-Line+ Tocopherol ± CLOdronate for the Management of Early Osteoradionecrosis of the Mandible. BMJ Open, 9, 026662.
[62] Fritz, M.A., Arianpour, K., Liu, S.W., Lamarre, E.D., Genther, D.J., Ciolek, P.J., et al. (2024) Managing Mandibular Osteoradionecrosis. OtolaryngologyHead and Neck Surgery, 172, 406-418. [Google Scholar] [CrossRef] [PubMed]
[63] Brandão, T.B., Vechiato Filho, A.J., Prado Ribeiro, A.C., Gebrim, E.M.M.S., Bodard, A., da Silva, D.P., et al. (2016) Evaluation of Use of Acrylic Resin-Based Surgical Guide in the Function and Quality of Life Provided by Mandibular Prostheses with Microvascular Free Fibula Flap: A Four-Year, Randomized, Controlled Trial. The Journal of Prosthetic Dentistry, 116, 457-463.e2. [Google Scholar] [CrossRef] [PubMed]
[64] Pinchasov, G., Haimov, H., Druseikaite, M., Pinchasov, D., Astramskaite, I., Sarikov, R., et al. (2017) Oral Cancer around Dental Implants Appearing in Patients with\without a History of Oral or Systemic Malignancy: A Systematic Review. Journal of Oral and Maxillofacial Research, 8, e1. [Google Scholar] [CrossRef] [PubMed]
[65] Zhu, N., Liu, J., Ma, T. and Zhang, Y. (2023) A Fully Digital Workflow for Prosthetically Driven Alveolar Augmentation with Intraoral Bone Block and Implant Rehabilitation in an Atrophic Anterior Maxilla. The Journal of Prosthetic Dentistry, 130, 668-673. [Google Scholar] [CrossRef] [PubMed]
[66] Gamborena, I., Sasaki, Y. and Blatz, M.B. (2021) Predictable Immediate Implant Placement and Restoration in the Esthetic Zone. Journal of Esthetic and Restorative Dentistry, 33, 158-172. [Google Scholar] [CrossRef] [PubMed]
[67] Puleio, F., Lo Giudice, G., Marenzi, G., Bucci, R., Nucera, R. and Lo Giudice, R. (2025) Digitally Designed Bone Grafts for Alveolar Defects: A Scoping Review of CBCT-Based CAD/CAM Workflows. Journal of Functional Biomaterials, 16, Article 310. [Google Scholar] [CrossRef
[68] Donker, V.J.J., Raghoebar, G.M., Vissink, A. and Meijer, H.J.A. (2025) Immediate Implant Placement and Provisionalization in the Aesthetic Zone Using a Digital Workflow: A 1‐Year Prospective Case Series Study. Clinical Implant Dentistry and Related Research, 27, e70079. [Google Scholar] [CrossRef] [PubMed]
[69] Aslan, S. (2018) Improved Volume and Contour Stability with Thin Socket-Shield Preparation in Immediate Implant Placement and Provisionalization in the Esthetic Zone. International Journal of Esthetic Dentistry, 13, 172-183.
[70] Gadah, T., Dutra, V., Polido, W., Al‐Shahrani, A., Lin, W. and Morton, D. (2021) Use of a CAD‐CAM Surgical Template to Improve Accuracy for Simultaneous Implant Removal, New Implant Placement, and Bone Graft. Journal of Prosthodontics, 31, 452-455. [Google Scholar] [CrossRef] [PubMed]
[71] Lin, C., Hsu, C., Adarsh, K., Hsu, C. and Wu, C. (2022) Real-time Intraoperative Computed Tomography Can Accurize Virtual Surgical Planning on the Double-Barrel Fibular Flap for Mandibular Reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 75, 2702-2705. [Google Scholar] [CrossRef] [PubMed]
[72] Antúnez-Conde, R., Salmerón, J.I., Díez-Montiel, A., Agea, M., Gascón, D., Sada, Á., et al. (2021) Mandibular Reconstruction with Fibula Flap and Dental Implants through Virtual Surgical Planning and Three Different Techniques: Double-Barrel Flap, Implant Dynamic Navigation and CAD/CAM Mesh with Iliac Crest Graft. Frontiers in Oncology, 11, Article ID: 719712. [Google Scholar] [CrossRef] [PubMed]
[73] Dang, R.R., Chang, Y., Tsai, C. and Wei, F. (2025) Evolution of Dental Rehabilitation in Free Fibula Flap for Segmental Jaw Defects. Seminars in Plastic Surgery, 39, 211-215. [Google Scholar] [CrossRef
[74] Pellegrino, G., Tarsitano, A., Basile, F., Pizzigallo, A. and Marchetti, C. (2015) Computer-Aided Rehabilitation of Maxillary Oncological Defects Using Zygomatic Implants: A Defect-Based Classification. Journal of Oral and Maxillofacial Surgery, 73, 2446.e1-2446.e11. [Google Scholar] [CrossRef] [PubMed]
[75] Takeshita, R.S., Bento, V.A.A. and Castillo, D.B. (2023) Root-Supported Overdenture in a Patient with a Cleft Palate and Extensive Bone Loss after Traumatic Injury. General Dentistry, 71, 25-30.
[76] Battaglia, S., Ricotta, F., Maiolo, V., Savastio, G., Contedini, F., Cipriani, R., et al. (2019) Computer-Assisted Surgery for Reconstruction of Complex Mandibular Defects Using Osteomyocutaneous Microvascular Fibular Free Flaps: Use of a Skin Paddle-Outlining Guide for Soft-Tissue Reconstruction. A Technical Report. Journal of Cranio-Maxillofacial Surgery, 47, 293-299. [Google Scholar] [CrossRef] [PubMed]