Background objectives: Implant supported over dentures vastly improve oral functions in patients with reconstructed mandibles. However, the quality of the peri-implant soft tissues is often not optimal. The aim of this study was to evaluate and describe corrective techniques used to improve peri-implant soft tissues in patients with resected mandibles reconstructed with free fibula flaps.
Methods: All patients with ablative mandibular defects reconstructed using free fibula flap who underwent endosseous implant rehabilitation from August 2011 to March 2013 in two tertiary care hospitals were included in the study. The reconstructed mandible was described based upon: site of the reconstructon, single/double barrel fibula and thickness of soft tissue. Soft tissue complications were described as soft tissue hyperplasia, inadequate attached mucosa and inadequate vestibular depth. The procedures done to improve the peri-implant soft tissue include extended vestibuloplasty, split thickness skin grafting, palatal connective tissue grafting either alone or in combination with or without prosthetic splints.
Results: Eighteen patients with a total of 59 implants were included in the study. Most soft tissue complications were seen in patients with a single barrel fibula replacing the lateral segment followed by single barreled fibula in the anterior segment. Patients rehabilitated with double barrel fibula had the least amount of soft tissue problems. All patients benefited from secondary soft tissue corrective surgeries. A combination of extended vestibuloplasty with split thickness skin graft, immobilized with a prosthetic splint seemed to be the most effective strategy to improve the quality of peri-implant soft tissues.
Conclusion: This paper presents a descriptive review of various methods to improve peri-implant soft tissue characteristics in reconstructed mandible. Disclosure: This project is a part of a larger study that is supported by a grant from ITI Foundation for the Promotion of Implantology, Switzerland.