Prospective clinical evaluation of a vestibuloplasty in tumor patients

Purpose: The resection of oral cancer can result in pronounced functional interferences; due to disfigurements of the hard and soft tissue. Oral rehabilitation of resected tumor patients often requires besides the use of dental implants the improvement of the soft tissue condition. The long-term success is influenced by the situation of the peri-implant soft tissue. In this clinical report we demonstrate a simple and effective surgical and prosthetic treatment procedure to achieve adequate long-term soft tissue conditions.

Material and methods: After the surgical removal of a malignant tumor 17 patients were selected for this evaluation. For these patients a total of 68 implants were placed in the mandible. At implant placement a closed impression was taken from the implants for the fabrication of an implant retained splint. At second stage surgery a modified method of vestibuloplasty using split-skin graft from the upper thigh was performed to enhance tongue mobility and gain attached gingiva. After proper placement of the graft the modified surgical splint is screwed to the implants to allow pressure on the graft and to avoid shrinkage. The splint is removed when the definitive restoration is placed. Different parameter like pocket depth and size of the graft were monitored over a period of two years. Statistical analysis was performed using Wilcoxon signed rank test and Kruskal- Wallis Test.

Results: After insertion of the superstructure all patients showed an improvement in speech, deglutition and oral competence. Soft tissue inflammation as well as peri-implantitis were prevented, as the mean pocket depths remained stable and measured 24 months postoperatively mesial 2.34mm and distal 2,4mm. The tendency of shrinkage in length and width was significant up to 18 month postoperatively, and showed no significant difference after a period of 24 month.

Conclusion: Shrinkage of the transplant was detected up to 24 month.