Short-term Outcomes of Immediate Dental Implants in Free Flap Mandibular Reconstruction

Introduction: Since the early 2010s, immediate dental implants (IDI), or “jaw-in-a-day” surgery, have enabled dental rehabilitation during mandibular reconstruction with osteocutaneous free flaps through integrated digital workflows. While IDI may improve function and quality of life, population-level data evaluating short-term complications are limited.

Methods: A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2014–2021). Patients undergoing mandibular reconstruction with an osteocutaneous free flap were identified, and IDI cases were determined using CPT codes (21245-21249). The primary outcome was 30-day postoperative complications, including unplanned return to the operating room and readmission. Secondary outcomes included operative time and hospital length of stay (LOS). After 3:1 propensity score matching, multivariable regression adjusting for age, sex, preoperative mortality risk, smoking, and diabetes was performed.

Results: Among 863 patients, 40 (4.6%) underwent IDI. Cohorts did not differ significantly in age, sex, or preoperative mortality risk. IDI was associated with longer operative time (664 vs. 573 minutes, p = 0.005) and increased LOS (11 vs. 8 days, p = 0.006). Thirty-day complication rates were similar between groups (10% vs. 16%, p = 0.30). After propensity score matching, IDI was not associated with increased LOS or postoperative complications but remained associated with increased operative time (β = 70.25, SE = 33.6, p = 0.038). Operative time was not independently associated with complications.

Conclusions: Despite longer operative times, IDI does not independently increase short-term complications or hospital LOS following mandibular reconstruction. Future studies should evaluate cost-effectiveness and patient-reported outcomes. This represents the first national study assessing IDI outcomes.