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Grewal et al. Plast Aesthet Res 2021;8:37 https://dx.doi.org/10.20517/2347-9264.2021.43 Page 13 of 14

diabetes mellitus II and hypertension.

There were no reported cases of flap failures or other surgical complications requiring re-operation.
Inclusive of all cases reported, a total of 41 implants were placed overall with a median of four implants per
patient. Of these, 3 (3.2%) were lost secondary to failed osseointegration. Centers did not report on planned
versus placed implants, so the frequency of this planning error cannot be ascertained. Of the series which
reported the number of teeth restored, a median of 8.5 teeth were restored per patient. Most of the case
series did not directly report on the spatial placement of restored dentition; however, laterality and which
exact teeth were restored were able to be determined from photographs of the provisional prostheses
included in the papers. This operation has been recorded on both sides and the arch of both the maxilla and
mandible.

[2]
In terms of dietary consistency and transition, Qaisi et al. enforced a strict puree diet for 3 months;
Runyan et al. ’s patient received tube feeds for five days post-operatively, then was transitioned to a soft
[7]
[3]
diet; Lee et al. ’s dietary protocol included two weeks of tube feeds, three weeks of liquids, and one week of
a soft diet before resumption of normal diet; and Sukato et al. maintained a 24 h soft diet protocol. The
[8]
average postoperative stay was 14 days (5-29 days). Follow-up ranged from 5-48 months. On last follow-up,
all patients demonstrated adequate occlusion, satisfactory aesthetics, and were able to tolerate a normal diet.

Costs associated with DIs, and prosthesis design and production, as well as funding sources were not
detailed in any of the series. Those that did mention cost, did so only to mention it represented a significant
impediment to wider spread implementation. Certainly, it is a limitation of the current healthcare system to
consider replacement of lost teeth as a cosmetic procedure following extensive surgery for benign and
malignant disease. To a patient, restoring the oral cavity to their original form, and function, in addition to
allowing them to smile may be the most important factor for success following this surgical reconstruction.

The review of the literature demonstrates the apparent success and growing implementation of such
procedures that can restore a patient’s oral and aesthetic jaw function in a single day. It is undoubtedly an
important and impactful treatment option to offer to select patients who meet criteria. Further, although
research is still limited, there do not appear to be immediate detrimental consequences to either flap success
or an increase in intra-operative complications. The summation of JIAD literature report only three implant
failures, for a 96.8% success rate. This compares favorably to Okay et al. , which observed an 89.3% dental
[5]
implant success rate in their 13 patients who underwent delayed DI placement with immediate prosthesis
placement (50 of 56 implants) and an 81.7% success rate of 15 patients who underwent delayed DI
placement and delayed prosthesis placement (49 of 60 implants).

However, such conclusions are dampened by the nature of the retrospective reviews. This review is limited
by inconsistencies in the reporting of demographic data, comorbidities, complications, and outcomes.
Notably, none of the current papers make an effort to describe the expense associated with such a
complicated procedure; in fact, only two mentioned the burden of cost at all.

Further research is required on patient satisfaction, and the short-term or long-term success of not only the
free flap, but the success of immediately placed DIs when compared to a delayed protocol, and immediate
versus delayed delivery of a dental prosthesis. Nonetheless, “Jaw in a Day” procedures are an
interdisciplinary feat of technological planning and surgical teamwork that, when done right, can greatly
benefit patients. It is this team’s hope that by describing the case study, and literature, and standardizing a
protocol - it will help to make this revolutionary advancement more easily achievable for other institutions