Dental Rehabilitation for Free Fibula Flap-Reconstructed Mandible with Scar Contracture: A Technical Note

Dental rehabilitation with osseointegrated implants in reconstructed mandibles is a common procedure, but the technique still requires improvement, especially in its reliability and technical simplification. We herein report dental rehabilitation of a free fibula-reconstructed mandible with scar contracture. A vestibuloplasty technique with application of a polyglycolic acid (PGA) sheet is described. The implants were inserted into a viable fibula flap with severe scar contracture of the overlying epithelium resulting from vascular instability in skin paddle. Only the fibula periosteum was sutured after implant insertion; exposed surfaces were covered with a combination of PGA sheet and fibrin sealant. The area with PGA sheet coverage gradually healed with moderate contracture. The epithelium around the almost implants became immobilized. The implant-supported removable partial denture with custom titanium bar was acceptable. Dental rehabilitation is possible for reconstructed mandibles with severe scar contracture. Application of a PGA sheet may be useful for vestibuloplasty in patients with reconstructed mandibles.

[1]  I. Asahina,et al.  Clinical complications in the application of polyglycolic acid sheets with fibrin glue after resection of mucosal lesions in oral cavity. , 2017, Oral surgery, oral medicine, oral pathology and oral radiology.

[2]  S. Rokutanda,et al.  Experimental study and clinical application of polyglycolic acid sheet with fibrin glue for oral soft tissue surgery , 2017 .

[3]  J. Kwok,et al.  New approach to improve the keratinised peri-implant soft tissues in patients with intraoral osteocutaneous reconstruction using a free flap. , 2017, The British journal of oral & maxillofacial surgery.

[4]  T. Taguchi,et al.  Examination of the early wound healing process under different wound dressing conditions. , 2017, Oral surgery, oral medicine, oral pathology and oral radiology.

[5]  Jonathan R. Clark,et al.  Osseointegrated implants into a variety of composite free flaps: A comparative analysis , 2017, Head & neck.

[6]  F. Hölzle,et al.  Intraosseous stability of dental implants in free revascularized fibula and iliac crest bone flaps. , 2016, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[7]  A. Sculean,et al.  Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review , 2016, Clinical Oral Investigations.

[8]  N. Hedne,et al.  Implants in free fibula flap supporting dental rehabilitation - Implant and peri-implant related outcomes of a randomized clinical trial. , 2016, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[9]  M. Kuriakose,et al.  Sub-Periosteal Dissection with Denture-Guided Epithelial Regeneration: A Novel Method for Peri-Implant Soft Tissue Management in Reconstructed Mandibles , 2016, Journal of Maxillofacial and Oral Surgery.

[10]  F. Lolli,et al.  Guided implant surgery after free-flap reconstruction: Four-year results from a prospective clinical trial. , 2015, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[11]  S. Rokutanda,et al.  Application of polyglycolic acid sheets and fibrin glue spray to bone surfaces during oral surgery: a case series. , 2015, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[12]  R. Grassi,et al.  Successful mandible rehabilitation of lower incisors with one-piece implants , 2014, Journal of Medical Case Reports.

[13]  T. Komori,et al.  Clinical evaluation of application of polyglycolic acid sheet and fibrin glue spray for partial glossectomy. , 2013, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[14]  S. Yamada,et al.  Effect of polyglycolic acid sheets with fibrin glue (MCFP technique) on the healing of wounds after partial resection of the border of the tongue in rabbits: a preliminary study. , 2012, The British journal of oral & maxillofacial surgery.

[15]  Wei Ma,et al.  A new submerged split-thickness skin graft technique to rebuild peri-implant keratinized soft tissue in composite flap reconstructed mandible or maxilla. , 2012, Oral surgery, oral medicine, oral pathology and oral radiology.

[16]  M. Kusama,et al.  Bare bone graft with vascularised iliac crest for mandibular reconstruction. , 2012, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[17]  F. Wei,et al.  Dental Implant Outcome after Primary Implantation into Double-Barreled Fibula Osteoseptocutaneous Free Flap–Reconstructed Mandible , 2011, Plastic and reconstructive surgery.

[18]  Bodard Anne-Gaëlle,et al.  Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions. , 2011, Oral oncology.

[19]  J. Koebke,et al.  Comparisons of bone volumes and densities relating to osseointegrated implants in microvascularly reconstructed mandibles: a study of cadaveric radius and fibula bones. , 2000, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.