Bone Augmentation

The main limitation of the free fibula flap reconstruction is bone height that is insufficient for restoring both the skeletal base and the alveolar ridge. This is especially evident when the native mandible is dentate at the unaffected site adjacent to fibula flap. In implant-borne dental rehabilitation, if the reconstructed alveolar ridge is low, we may get an inadequate crown-to-implant ratio. To overcome the high discrepancy between the reconstructed alveolar crest and the native one, some therapeutic options have been introduced: fixation of the fibula at the level of the residual alveolar crest of the healthy side, primary use of the fibula as a double-barrel graft, delayed onlay bone graft on the fibula, later vertical distraction osteogenesis and secondary osteotomies to correct malocclusion after fibula. Techniques for vertical bone augmentation in fibula flap are here discussed.