Dermabrasion Technique for Peri-implant Soft Tissue Management in the Mandible Reconstructed by Free Osteocutaneous Flap

Abstract

Dermabrasion using a diamond bur at the cutaneous layer reconstructed by revascularized osteocutaneous flap in cases of oral cancer was used for peri-implant soft tissue management. One patient with carcinoma of the lower gingiva (case 1) who underwent tumor resection and reconstruction with free fibular flap and the other with carcinoma of the lower gingiva (case 2) who underwent tumor resection and reconstruction involving free latissimus dorsi-scapular osteomusculocutaneous flap are reported. Branemark dental implants were placed in these two cases. In case 1, free palatal mucosa graft was performed around the abutments of the implants after widening narrowed alveolar mucosa. Free skin graft after dermabrasion from the lumbar region was carried out in order to widen the narrowed floor of the mouth and the donor site was closed primarily. Two years after setting of the superstructure, reepithelization was observed in the peri-implant soft tissue and grafted floor of the mouth and the clinical course was uneventful. In case 2, dermabrasion and defatting were performed for thinning and immobilization of the flap. However, proliferation of the peri-implant tissue was observed 6 weeks after setting of the superstructure. The proliferating dermis around the dental implants was excised and free palatal mucosa graft was performed around the abutments.
In conclusion, when a lot of implants need to be placed in the case of reconstruction with free osteocutaneous flap limited size of donor site is a problem for the mucosal graft. In such a case, free palatal mucosal graft might be performed only around the abutment and free skin graft after dermabrasion is considered to be useful for plasty of the floor of the mouth and oral vestibule.