Immediate dental implant placement (IDIP) in free fibula flap (FFF) reconstruction of the mandible is an important treatment paradigm for head and neck cancer patients. This study examines the long-term safety and prosthodontic outcomes of IDIP in oncologic mandible reconstruction.

A retrospective, noninferiority cohort study was performed comparing IDIP and non-IDIP in patients undergoing FFF reconstruction of oncologic mandibulectomy defects using computer-aided design and computer-aided manufacturing technology. Outcomes of interest included long-term complications and rates of dental rehabilitation with either an implant or nonimplant-supported resection prosthesis.

One hundred forty-eight patients were included in the study. IDIP patients (n = 86) were significantly older (p = 0.017) and had a higher BMI (p < 0.0001) than non-IDIP patients (n = 62). Median follow-up time was 2.4 and 4.9 years in the IDIP and non-IDIP groups, respectively. Complication rates were comparable between groups (p > 0.05). The IDIP cohort received 219 dental implants, whereas four patients in the non-IDIP cohort received 10 implants in a delayed setting (p < 0.0001). IDIP patients were more likely to achieve long-term dental rehabilitation (IDIP: 69.8%, non-IDIP: 25.8%; p < 0.0001) and at an earlier time point (median [interquartile range]: 120 [45, 297] days vs. 355 [243, 595] days; p = 0.0002) after reconstruction. Adjuvant radiation did not affect the likelihood of completing dental rehabilitation in IDIP patients (p = 0.818).

IDIP safely achieves dental restoration in less time and at a higher rate than non-IDIP in oncologic patients. Measurement of patient-reported outcomes is needed to bolster support for IDIP as the standard of care in oncologic patients.

*Denotes first authorship.

Received: 27 January 2025

Accepted: 22 June 2025

Accepted Manuscript online:
18 July 2025

Article published online:
14 August 2025

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