Objective: The main advantage of primary oromandibular reconstruction using free vascularized bone-containing flaps is improved oral function from (1) the maintenance of mandibular and soft tissue architecture and (2) dental rehabilitation through osseointegrated implants. Bone dimensions, volume, quality, and the ability of the bone to withstand masticatory forces are important factors in achieving successful osseointegration. Previous studies have objectively examined the dimensions of bones used in oromandibular reconstruction, but few have addressed their biomechanical properties. The purpose of this study was to compare the dimensional and biomechanical properties of the bones commonly used in oromandibular reconstruction with those of the mandible.
Methods: Eleven formalin-fixed cadavers were used. The mandibles, fibulae, iliac crests, scapulae, clavicles, second metatarsals, radii, and anterior ribs were harvested. Measurements of the dimensions of the bones were made with calipers at multiple sites. Three-point break strength and screw pulling force tests were then performed on all of the bones.
Results: The fibulae, iliac crests, and clavicles had dimensions that best matched those of the mandible. The three-point break strength and screw pulling force tests were consistently the highest for the mandibles and fibulae, followed by the clavicles, scapulae, iliac crests, metatarsals, radii, and ribs, in that order.
Conclusions: The fibula is the bone that best matches the properties of the mandible.