Reliability of implant-supported rehabilitations after mandibular reconstruction with vascularized fibula free flaps: A systematic review and meta-analysis

Statement of problem: Mandibular reconstruction with a vascularized fibular free flap (VFFF) is well established, but information on implant survival rates, prosthesis survival and associated complications, and their impact on patient quality of life (QoL) remains limited. Purpose: The purpose of this systematic review and meta-analysis was to evaluate the reliability of implant-supported rehabilitation after mandibular reconstruction with a VFFF in terms of implant survival, prosthesis survival and associated technical, biological, and esthetic complications, and patient-reported QoL measures. Material and methods; Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 4 electronic databases, PubMed, Embase, Scopus, and Web of Science, were systematically searched for articles in the English language up to August 2025 to identify studies reporting on implant-supported rehabilitation after mandibular reconstruction. Data on clinical outcome variables were pooled and analyzed using a proportional risk meta-analysis with 95% confidence intervals (CIs). The quality of the included observational studies was assessed using the Newcastle-Ottawa scale (NOS), while randomized controlled trials (RCTs) were evaluated using the risk of bias (ROB 2.0) tool. Results: From 2712 studies identified, 26 were included, of which 21 were retrospective studies, 4 were prospective studies, and only 1 was an RCT. The pooled survival rate for implants with less than 5 years of follow-up was 96% (95% confidence interval (CI) ranging from 0.92 to 0.98) based on 1260 implants across 17 studies. In contrast, implants with more than 5 years of follow-up demonstrated a slightly reduced pooled survival rate of 92% (95% CI: 0.86 to 0.97), based on 936 implants across 9 studies, with no significant differences between short-term and long-term follow-up. This study showed a pooled prosthesis survival rate of 100% (95% CI: 0.98 to 1.00) at a mean ±standard deviation follow-up of 30 ±12 months. Prosthesis-related complications were poorly reported across studies. QoL was significantly improved, particularly in speech, mastication, and overall patient satisfaction with implant-supported rehabilitation. Conclusions: Implant-supported rehabilitation after VFFF reconstruction showed high implant and prosthesis survival and contributed to improved functional outcomes and QoL. Standardized protocols and validated outcomes are needed to enhance evidence quality and support consistent clinical decision-making.