Vascularized free flaps based oral reconstruction: a narrative review of dental functional outcomes

Abstract

Oral soft- and hard-tissue defects resulting from oncologic resection, trauma, or other acquired conditions often require complex reconstruction to restore form and function, with vascularized free flaps providing a reliable approach for extensive tissue replacement. Despite their widespread use in oral and maxillofacial reconstruction, their implications for general dental practice remain less clearly defined, particularly regarding speech, mastication, swallowing, dental rehabilitation, and long-term maintenance. This narrative review aims to synthesize current evidence on functional and dental outcomes following vascularized free flap reconstruction, with emphasis on their clinical relevance for general dental practitioners involved in long-term care. A comprehensive literature search was conducted across major biomedical databases for English-language publications from January 2015 to March 2026. Studies reporting functional, dental rehabilitation, or patient-reported outcomes following vascularized free flap reconstruction were included, together with selected review and guideline articles providing relevant clinical recommendations. The final narrative synthesis comprised 60 primary studies and 13 review/guideline articles. Although vascularized free flaps provide reliable reconstruction of complex oral defects, functional outcomes vary according to defect characteristics, flap selection, and rehabilitation. Thin, pliable flaps facilitate reconstruction where tissue mobility is important, whereas vascularized osseous flaps provide a foundation for implant-supported dental rehabilitation. Dental implants and prosthetic rehabilitation contribute substantially to restoration of mastication and quality of life; however, altered flap anatomy, peri-implant complications, restricted hygiene access, and radiotherapy-related effects present important long-term challenges. Patient-reported outcomes further indicate that successful anatomical reconstruction does not invariably correspond with complete functional recovery. Successful free flap reconstruction extends beyond flap survival to sustained functional and dental rehabilitation. General dental practitioners have an important role in preventive care, prosthetic and peri-implant maintenance, surveillance, and long-term multidisciplinary follow-up. Standardized functional and patient-reported outcome measures are needed to strengthen future evidence and guide dental management. Not applicable.