Oral health and rehabilitation in face transplant recipients - a systematic review

Background: Facial transplantation (FT) provides advanced solutions for severe facial defects by incorporating complex tissues such as bone, skin, oral mucosa and nerves. Oral health plays a critical role in FT, impacting both functional outcomes and transplant prognosis. Despite its importance, literature on oral health in FT recipients remains sparse.

Methods: This systematic review adhered to PRISMA guidelines. We searched PubMed, EMBASE, Web of Science, and CENTRAL for studies on oral health in FT patients up to August 4, 2024. Eligible studies were evaluated using the Newcastle-Ottawa Scale (NOS) and Level of Evidence (LOE). Data extracted included study design, general information on FT, patient demographics, oral examination techniques, and outcomes.

Results: Out of 6,984 articles reviewed, 19 met the inclusion criteria, all consisting of case reports or case series involving 48 FT cases. Of these, 25 cases provided relevant oral health and rehabilitation data. All studies showed a LOE of IV, with an average NOS score of 4.3 ± 0.5. Most FT cases involved male recipients (n = 20, 80%), while the majority of FTs were conducted in the United States (n = 10, 40%) and France (n = 7, 28%). Oral mucosa biopsy was the most common examination method (n = 11, 44%). Malocclusion was reported in 48% (n = 12) of cases, with revision surgeries occurring in 36% (n = 9). Post-FT dental treatments included tooth extractions (n = 7, 28%), fillings (n = 3, 12%), and endodontic treatments (n = 2, 8%). Dental implants were placed in 32% (n = 8) of cases, with one case (4%) reporting failed osseointegration.

Conclusion: Routine oral health assessments are essential for FT patients to prevent complications and improve clinical outcomes. However, there is a lack of high-quality research on oral health in FT recipients, underscoring the need for further studies to establish standardized care protocols.

Clinical relevance: This review emphasizes the urgent need for standardized oral health protocols in FT patients to minimize infection risks and optimize long-term transplant success and overall patient health.