Nazaryan D.N., Karayan A.S., Mokhirev M.A., Zakharov G.G., Fedosov A.V., Potapov M.B., Batyrev A.V., Yarantsev S.V., Razmadze S.S., Kyalov G.G., Weinstein A.I., Chernenkiy M.M., Kartasheva A.F. Formation of soft tissues in the oral cavity around dental structures on the neo-alveolar processes made of free revascularized fibular autograft with intraosseous dental implants.Head and neck. Russian Journal. 2022;10(3):25–36
Objective. To improve the treatment quality for patients with reconstructed jaws who underwent dental implantation and fixed prosthetics using a new method of formation of the oral vestibule and the soft tissues of the reconstructed alveolar process. To analyze the effectiveness of soft tissue formation in the oral cavity using de-epithelialized free gingival grafts with or without free split-thickness skin graft to restore full function of chewing, swallowing, breathing, speech formation and prevent polyposis under fixed prosthetic constructions in the reconstructed area of the jaw.
Material and methods. We performed surgical treatment of 80 patients (age from 26 to 64 years) with upper and lower jaws reconstructed with intraosseous dental implants (50 women and 30 men) operated on from April 2014 to May 2021. We implemented three techniques: 1 – using a de-epithelialized free gingival graft, 2 – using a free split-thickness skin flap, 3 – using a free split-thickness skin autograft in combination with a de-epithelialized free gingival graft.
Results. In group 1 (n=28) with a de-epithelialized free gingival graft, soft tissue overgrowth with partial or complete closure of the gingiva shapers began in the recipient area on the lower jaw 3 weeks after the gingiva shapers were placed. This resulted in inflammation, which led to the formation of periodontal pockets, soft tissue infection with loss of cervical bone tissue in the implant projection, and ultimately, rejection of fixed prosthetics. In the 2nd group of patients (n=19), deepening of the oral vestibule was performed using a free skin flap in the recipient area, but the sufficient volume of the attached gum around dental implants was not achieved, which resulted in the recurrent polyposis. In the 3rd group of patients (n=33) with a free split-thickness skin autograft in combination with deepithelialized free gingival grafts in the recipient area, we observed complete attachment of the skin and gingival grafts. In three cases out of 33, we observed a partial absence of free skin graft attachment after combined radiation therapy, which resulted in marginal necrosis of the skin graft, formation of pockets and polyps around dental implants. The grafts in all patients had good integration with the grafted bone. At follow-up visits, the patients showed no mobility, periodontal pockets, edema, or polyposis recurrence. Patients were satisfied with the primary stability and function of the fixed orthodontic appliances supported by dental implants.
Conclusion. The use of the new method described allows soft tissue reconstruction under fixed orthodontic appliances in the reconstructed area of the jaw in one step, and, as a result, forming the oral vestibule of the upper and lower lips, separating salivary ducts on the lower jaw from the neojaw, and performing dental restoration, while a free gingival graft combined with a skin flap allows delayed restoration of similar tissues. Key words: “skin interior”, vestibuloplasty, free split-thickness skin graft, de-epithelialized free gingival graft, keratinized mucosa, fixed prosthetics, free revascularized fibular autograft
Conflict of interest. The authors declare that there is no conflict of interest.
Funding. There was no funding for this study.