Two studies (Fenlon et al., Burgess et al. ) reported no significant effect on implant survival in varying graft donor sites; however, three studies (Hessling et al., Shaw et al., Chiapasco et al.) reported varying implant survival rates within different autogenous bone grafts but only one study (Hessling et al.) reported that implant loss was significant with this being for implants placed into fibula bone grafts. Shaw et al,. reporting that implants placed into ‘vascularized bone graft were superior to non-vascularized bone.

In particular, those implants in composite radial forearm flaps performed badly. With the proportion of patients with implant loss in these bone flaps within their study being 27% in iliac crest, 33% in fibula, and 100% in radius and that implants placed in composite fibula and iliac crest flaps performed approximately as well as in native maxilla within their study’.

Radiotherapy and implant survival

Seven studies reported on outcomes related to implant survival in irradiated autogenous bone grafts (Barrowman et al., Fenlon et al., Ch’ng et al., Buddula et al., Fierz et al., Teoh et al., Burgess et al. ) (Table 4). One study reported solely on irradiated patients (Buddula et al.) the other six studies (Barrowman et al., Fenlon et al., Ch’ng et al., Fierz et al., Teoh et al., Burgess et al.) reported on both irradiated and non-irradiated patients. These six studies (Barrowman et al., Fenlon et al., Ch’ng et al., Fierz et al., Teoh et al., Burgess et al.) all reported higher implant failure (at an implant and a patient level (where applicable)) of implants placed into autogenous bone grafts in irradiated patients in comparison to those patients who did not received radiotherapy (Table 4).

All of these studies (Barrowman et al., Fenlon et al., Ch’ng et al., Fierz et al., Teoh et al., Burgess et al.) reported on the deleterious effect of radiotherapy on implant survival in autogenous bone grafts within their studies and was found to be statistically significant in two studies (Fenlon et al., Ch’ng et al.) with Fenlon reporting a close correspondence of implant survival (in vascularised free composite grafts) and an absence of radiotherapy using a multiple correspondence analysis and Ch’ng et al. who reported a statistical significance associated with higher implant failure in irradiated fibula free flaps in comparison to non-irradiated fibula free flaps (P = 0.041).