Mandibular Reconstruction and Implantology: Anatomical Study and CT Scan of Dried Human Fibulas

Research Article

Austin J Dent. 2015;2(3): 1023.

Mandibular Reconstruction and Implantology: Anatomical Study and CT Scan of Dried Human Fibulas

Almeida FCS¹*, Moreira MS², Farias BUL³, Dias RB4, Crossato EM¹ and Silva DP4

¹Department of Community Dentistry, Universidade de São Paulo, Brazil

²Postgraduate Course in Dentistry, Universidade Ibirapuera, Brazil

³Department of Pediatric and Orthodontics, University of São Paulo, Brazil

4Department of Maxillofacial Surgery, University of Sao Paulo, Brazil

*Corresponding author: Almeida FCS, Department of Community Dentistry, University of Sao Paulo, Av. Prof Lineu Prestes, 2227, Cidade Universitária, São Paulo, SP, Brazil

Received: April 08, 2015; Accepted: June 22, 2015; Published: June 24, 2015


The aim of this study was to evaluate the potential presented by human dried fibula on regular implants installation (7 mm or more) and to search for a standard anatomical position of more appropriate areas. Thirty human dried fibulas, in five distinct areas of each bone, were evaluated in a tomographic study and the data were processed statistically. The results revealed that the thirty bones examined showed significant differences between the maximum and minimum values measured, without any anatomical standard for these differences and that only three of these bones showed values less than the standard 7 mm, but these same bones presented other dimensions compatible with the installation of implants. The differences between maximum and minimum values ranged from 2.50 mm up to 11.50 mm (p=0 000). The analyzed data showed that 29 of the 30 bones presented viable areas for the installation of regular implants. The indication for CT scan of the patient’s fibulae can be a valuable test, to the installation of larger implants, thus increasing the survival of the implants and the success of oral rehabilitation.

Keywords: Free flap fibula; Computed tomography; Maxillofacial rehabilitation


The fibula has been the bone of choice in mandibular reconstruction, also starting to be used and applied with great efficiency in maxillary reconstructions [1]. This bone has characteristics that facilitate its plasticity by the surgeon, do not cause much morbidity, allow multiple osteotomies and promote good modeling in mandibular reconstruction. This is a bone that has good quality for being bicortical, offers sufficient quantity for bone reconstruction, besides being a good bed for receiving dental implants [2-4].

On the other hand, the prosthetic rehabilitation of a jaw segment reconstructed by fibula without the aid of implants is a very difficult task. Considering that sometimes a lack of vestibule and the presence of excess skin, replacing the keratinized mucosa from the oral cavity, are observed in the reconstructed section. Also, in these cases, an occlusal discrepancy (anteroposterior) relationship between the maxilla and mandible, and large vertical differences between the fibula and the remaining bone are still common [5].

Additionally, the literature alerts us to the fact that the vast majority of patients reconstructed by fibula does not use functional prostheses and does not receive dental rehabilitation; and, in some cases, these numbers may exceed the 80% So, this is a challenge to be overcome, as the quest for quality of life should be the ultimate goal of any treatment. Implants can also increase the rate of use of prostheses by these patients, since they assist in the retention and stability of the parts. Assuming advantages in the use of osseointegrated implants in the prosthetic rehabilitation of jaws reconstructed with the fibula, anatomic and radiographic knowledge of this bone is required so that the maxillo-facial professional can be prepared and secure when discussing the rehabilitation, the means of retention and the stability of the prostheses.

Materials and Methods

Thirty dried human fibulae were selected at random from the Department of Anatomy, Institute of Biomedical Sciences (ICB) of the University of Sao Paulo. Inclusion criteria for selection were that the bones had to have good anatomic integrity and possess the essential proximal and distal ends in great condition. The pieces were measured on the long axis by the same observer. Then, the center of each bone was marked and, to the right and left of this center, two new points were marked at a distance of 3 cm from each other, thus forming two areas on the right and two on the left of the center. These areas served as markers for the tomographic images taken images and were classified in sections 1, 2, 3, 4, 5 (Figure 1); and, each section was evaluated in three distinct areas A, B, C (Figures 2A and 2B). After marking all the bones, they underwent CT examination performed using the General Electric Prospeed helical unit (WW 2500, WL 1000) (Figure 3). The fibulae were examined in groups of four parts, making five CT slices of 1 mm collimation, with 30 mm spacing in the part during the anatomical analysis. In each section, the presence of three cortical bones per piece was observed. The cortical thickness was measured by the same observer, resulting in a (N) total of 15 measurements for each fibula (Table 1). The data were entered and analyzed using the statistical package Stata 10. Descriptive measurements were carried out (minimum and maximum values, standard deviation, differences between minimum and maximum values). To investigate the differences between the heights of fibulae, the t-test for paired data was performed. Based on the supply of regular implants, on the international market, a minimum value of 7.00 mm thickness was established as the minimum acceptable for the installation of implants. The significance level was 95%.