Sub-Periosteal Dissection with Denture-Guided Epithelial Regeneration: A Novel Method for Peri-Implant Soft Tissue Management in Reconstructed Mandibles

Abstract

Background In patients with reconstructed mandibles using free fibula flaps, management of soft tissues around implants supporting dental rehabilitation, is often a clinical problem. Aim 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 periimplant soft tissue management in these patients. Materials and methodsThe 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. ConclusionThe sub-periosteal dissection with denture guided epithelial regeneration is a predictable form of periimplant soft tissue management in selected patients with reconstructed jaws.

Masticatory efficiency of implant‐supported removable partial dental prostheses in patients with free fibula flap reconstructed mandibles: A split‐mouth, observational study

“…Peri‐implant soft tissue management was carried out at the time of interim prosthesis loading using the technique of sub‐periosteal dissection with denture guided epithelial regeneration. The above‐mentioned procedure is described in detail elsewhere (Kumar, et al, ; Kumar, Jacob, & Kuriakose, ).…”

A bar-retained overdenture as an external fixator device in a three-dimensional CAD/CAM-based surgical reconstruction of the mandible

“…3c). Kumar et al have shown the feasibility of the establishment of attached mucosa on the transplanted fibula intraorally (Kumar et al, 2014). Concerning this case, the total recovery time seems to be shorter than the two-stage fibula reconstruction proposed by Rohner et al (Rohner et al, 2002).…”

Study of Treatment Methods for Surrounding Soft Tissues of Implants Following Mandibular Reconstructions with Fibula-Free Flaps

“…These findings suggest that if the soft tissue around the implant is a skin flap, the implant installation for the mandibular reconstruction with fibula-free flap leads to a high risk of inflammation around the implant. When corrective measures to improve the soft tissues were not implemented, poor hygiene around the implants, hyperplastic peri-implant tissue, soft tissue infections and abscesses that start as peri-implant marginal bone loss were all observed, and this may eventually lead to loss of the implant and the dental rehabilitation [ 2 , 11 ]. These results are consistent with the observations reported by Sozzi et al [ 5 ] that suggest the optimal soft tissue around an implant should be immobile, thin, soft, smooth (wrinkle-free) and hairless.…”

“…Other widely investigated methods are as follows: (1) Sub-periosteal dissection with denture-guided epithelial regeneration (SD-DGER) [ 2 , 11 ]. This method promotes mucosa formation via dentures, after the removal of the skin flap.…”