## 3 Results  
A total of 483 records were identified from the PubMed, Scholar, and Cochrane databases. After the removal of duplicates and the addition of an additional 7 articles through an additional search of the MEDLINE database, 391 articles were reviewed. After a complete review of abstracts, 374 papers were excluded because they were not relevant to the topic of this systematic review. A full-text review was performed for 17 articles. Of those, nine studies met the inclusion criteria and were included in the systematic review. On the contrary, eight papers were excluded: two because they were not relevant to the topic of this review, three because they did not specifically report data regarding scapula flaps, and three because no data regarding dental implants were encountered. A flow chart illustrating all the steps of the screening procedure is shown in Figure 1.  
All the studies were single-center retrospective reviews or case series and were published from 2000 to 2024. A total of 483 cases were reported, of which 191 were reconstructed with a free scapula flap, but only in 83 cases one or more dental implants were positioned  
Figure 1: Search and screening strategy according to PRISMA guidelines ([PERSON] et al., 2009 [20]).  
and the data regarding these patients were extracted. Each patient was reconstructed with a single scapula flap and no flap failures were encountered. Of the latter patient cohort, 43 were men and 30 women, while the sex was not specified for 10 patients. The mean age was 58.2 years, of which 75% of the patients were older than 55 years. A total of 47 patients received primary reconstruction (61.9% valid), while 29 received delayed reconstruction (38.1% valid); in 7 patients the reconstructive timing was not specified. A total of 49 out of 78 patients underwent radiotherapy (62.8% valid), while in 5 patients the figure was missing. A total of 249 implants were placed with an average of 3.00 implants per patient. The reconstructive site was specified for 69 out of 83 patients; in particular, the rehabilitation involved the mandible in 40 patients and the maxilla in 29 cases. Regarding the timing of implant placement, only four patients received implant rehabilitation at the same time as surgery (4.8%), while the others received delayed rehabilitation (95.2%) with a minimum delay of 5 months from flap reconstruction. The implant failure rate was 3.6% (9 cases out of 249 total implants). The Chi-Square test showed no statistically significant correlations between implant failure rate and timing of placement (\(p>0.01\)) or between implant failure rate and radiotherapy treatment (\(p>0.01\)). The mean follow-up was specified in 59 patients and, according to these data, the overall mean follow-up was 33.3 months. In the remainder, a minimum follow-up of 12 months was assessed, except for the two case reports where no follow-up details were encountered. The results are summarized in Table 1. The risk of bias has been assessed using the Newcastle-Ottawa Quality Assessment Scale. Four papers were rated high-quality studies [6; 22; 23; 24], while the others ranked as medium-quality studies.  
Only in two papers, the results regarding the quality of life were collected. [PERSON] et al. analyzed the results in terms of deglutition and speech with good outcomes [6]. [PERSON] et al. analyzed the quality of life results using the FACT Head and Neck Symptoms Index (FHNSI) questionnaire, showing an improvement [25].