Sub-Periosteal Dissection with Denture-Guided Epithelial Regeneration: A Novel Method for Peri-Implant Soft Tissue Management in Reconstructed Mandibles.
BACKGROUND
In patients with reconstructed mandibles using free fibula flaps, management of soft tissues around implants supporting dental rehabilitation, is often a clinical problem.


OBJECTIVE
The aim of this paper is to describe a new technique, namely "Sub-periosteal dissection and denture-guided epithelial regeneration (SD-DGER)", as a method of peri-implant soft tissue management in these patients.


METHODS
The technique consists of performing a subperiosteal dissection with creation of buccal and lingual flaps. These flaps form the buccal and lingual vestibule. Implants are placed and an interim denture is immediately loaded onto the implants to guide the regenerated epithelium. A keratinized mucosal layer is formed on the bare fibula bone in six months time.


RESULTS
This technique was successful in producing fixed keratinized epithelial tissue around implants in patients with mandibles reconstructed using the free fibula flap in patients who did not undergo radiotherapy.


CONCLUSIONS
The sub-periosteal dissection with denture guided epithelial regeneration is a predictable form of peri-implant soft tissue management in selected patients with reconstructed jaws.
Department of Surgical Oncology- Head and Neck Surgery, Majumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bengaluru, India ; Department of Oral and Maxillofacial Surgery, M.R. Ambedkar Dental College & Hospital, 37, Lazar Layout, Frazer Town, Bengaluru, 560005 India ; Department of Oral Maxillofacial and Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
Vinay V
VV
Kumar
Department of Prosthodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, India ; Ora-Care Dental Clinic, 81-Coles Road, Frazer Town, Bengaluru, India.
P C
PC
Jacob
Department of Surgical Oncology- Head and Neck Surgery, Majumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bengaluru, India.
Moni A
MA
Kuriakose
Free fibula; Immediate loading; Implant; Maxillofacial rehabilitation; Peri-implant; Reconstruction; Soft tissue management