Dental Implants on Free Deep Circumflex Iliac Artery (DCIA) Flaps: A Contemporary Systematic Review

Background: Implant-driven reconstruction has become a key objective in contemporary maxillofacial surgery. While the fibula flap is considered the standard option, the deep circumflex iliac artery (DCIA) flap has gained renewed interest due to its favorable bone characteristics. This study aimed to evaluate the outcomes of implant-prosthetic rehabilitation in patients reconstructed with DCIA flaps. Methods: A systematic review was conducted according to PRISMA guidelines. The MEDLINE, Embase, and Cochrane Library databases were searched up to June 2026. Studies reporting DCIA flap reconstruction associated with dental implant placement were included. A pooled descriptive analysis of implant-related outcomes was performed. Results: Sixteen studies were included, accounting for 348 DCIA flaps and 543 implants with complete datasets. Reconstruction most frequently involved the mandible and was predominantly performed in a primary setting. The pooled implant failure rate was 5.0%, although this rate is not equivalent to a time-dependent implant survival estimate. CAD/CAM technologies were reported in 35% of cases. Conclusions: The DCIA flap represents a reliable option for implant-driven jaw reconstruction, offering favorable bone volume, adaptable height, and anatomical curvature suitable for prosthetic rehabilitation. Implant survival rates are comparable to those of other vascularized bone flaps. The integration of digital technologies may further enhance surgical precision and expand its clinical indications. Careful patient selection remains essential to optimize outcomes.