###### Abstract  
A rising demand for prosthetic-driven jaw reconstruction is encountered in maxillo-facial surgery. The free scapula flap is a workhorse of cervico-facial reconstructions, but an implant-based prosthetic rehabilitation on this flap is a debated topic. A systematic review of the papers on this subject has been conducted on Embase, MEDLINE, and Cochrane libraries following PRISMA guidelines, in order to analyze the results described in the literature. A total of nine papers were eligible for inclusion, with 83 scapula flaps overall being used for an implant-based prosthetic rehabilitation. The mandible was the reconstructed jaw in 58.0% of the cases. Overall, 249 implants were positioned (mean 3.0 implant per flap) with a 3.6% implant failure rate. In 95.2% of the cases, delayed rehabilitation was performed. Radiotherapy and the timing of implant placement did not seem to influence implant failure. Only two papers analyzed the quality of life following the rehabilitation, highlighting a functional improvement. scapula-based implant-prosthetic rehabilitation is a feasible technique that can also benefit from the new CAD/CAM technologies and digital workflows. Nonetheless, further studies focused on this topic and on its impact on the quality of life are needed in order to analyze risk factors and to optimize the outcomes.  
scapula flap; subscapular-based flaps; microsurgery; osseous flaps; dental implants; implant-prosthetic rehabilitation; occlusion-driven reconstruction +
Footnote †: journal:subsequently, the reconstruction of the head and neck with a free scapular tip flap was first described in 1988 by [PERSON] et al. [11; 12]. Only in the last two decades, by virtue of an increased focus on personalization of care and on morbidity both in demolitive and reconstructive surgeries, scapula flap has increasingly returned to the list of choices of reconstructive surgeons [13; 14; 15]. However, in the case of a scapula flap, it is possible to insert dental implants for prosthetics with the advantage that this flap also allows the simultaneous harvesting of large portions of soft tissue with low morbidity for the donor site [7; 14]. Regarding the latter point, many authors in the literature have demonstrated the low morbidity related to a slight reduction in shoulder motility and strength that hardly impacts the patients' perceived quality of life [16; 17; 18]. Moreover, the possibility of early ambulation of the patient, the low impact of atherosclerosis on the pedicle, and the non-susceptibility to peripheral obliterative arteriopathies (which might be a key problem in some flaps, such as the fibula) make it an optimal option in the treatment of elderly patients [14]. However, its use remains limited due to the location of the donor site and because some authors question the quality of the bone tissue, which can sometimes be reduced and, therefore, unsuitable for the placement of dental implants [19]. Currently, data in the literature concerning the implant-prosthetic rehabilitation of the scapula are lacking. The objectives of this systematic review are to evaluate the feasibility and results of implant-prosthetic rehabilitation in the microsurgical reconstruction of the jaws using a scapula flap, as well as long-term follow-up and possible optimization strategies for the procedure.