Meta-analysis Of The Survival Rate And Complications Of Primary And Secondary Implants After Vascularized Fibula Transplantation For Reconstruction Of Jaw Defects

Objective: Vascularized fibula flap transplantation is the most effective and commonly used method to reconstruct the jaw bones defects.And implant repair is the first choice to restore dentition on the graft fibula.The implant is usually implanted at least 6 months after fibula transplantation.Primary implantation of implants during surgery may result in earlier restoration of dentition,but whether the primary implantation can achieve the same restorative effect as delayed implantation has not been determined.Method: A systematic review and meta-analysis were conducted according to PRISMA protocol and the Cochrane Handbook for Systematic Reviews of Interventions.We performed a comprehensive search using Pub Med,Embase,Web of Science,Cochrane Library 、 Chinese National Knowledge Infrastructure(CNKI)、 Chinese Bio Medical Literature Database(CBM)according to established inclusion and exclusion criteria,and the deadline is October 2022.After careful screening,the NOS scale was used to assess the quality of the included studies.Meta-analysis was conducted to compare the survival rate and complication rate of primary and secondary implantation.Results: Seven studies were involved in our research,involving 187 patients.Five of the studies detailed implant success in 107 patients(primary implantation 50,secondary implantation 56),and four studies documented infection after implantation in 119patients(primary implantation 52,secondary implantation 66);The survival rate of the first stage implant was 93.5%,and the incidence of postoperative infection was 18%.The survival rate of the delayed implant was 93.3%,and 26% had postoperative infection.Meta-analysis showed that there was no significant difference in the survival rate between primary implantation and secondary implantation,OR=0.821(95 % CI:0.387-1.743,P= 0.607),and there was no significant difference in the incidence of postoperative infection,OR=0.614(95%CI: 0.239-1.581,P= 0.312>0.05).Conclusions: Based on the available study,the review found no evidence of difference in survival rate or infection rates between primary and secondary implantation.After appropriate indications selection,primary implantation can be used to reconstruct the dentition with less waiting time,restore dentition earlier,help patients return to normal life as soon as possible and also bring a good quality of life for patients.