Soft Tissue Management: A Critical Part of Implant Rehabilitation after Vascularized Free-flap Reconstruction

Abstract Purpose Implant rehabilitation after jaw reconstruction is challenging and postoperative peri-implantitis is common. Our aim was to present our management protocol for implant rehabilitation after vascularized free-flap reconstruction and report the outcomes of soft tissue management. Methods This retrospective cohort study included patients who received vascularized free-flap reconstruction, implant rehabilitation, apical reposition flaps (ARF), and free gingival grafts (FGG) at Peking University School and Hospital of Stomatology from January 1st, 2009, to January 1st, 2020. We assessed the association of age, sex, primary disease, flap choice, number and position of implants, timing of ARF and FGG, fixation stent use and restoration type with the occurrence of peri-implantitis. Probing pocket depth (PPD), bleeding-on-probing (BoP), and marginal bone loss (MBL) of the implants were measured as well. The data were analyzed by descriptive statistics, Kaplan-Meier statistics, and Cox regression analysis. Results In total, 19 patients with 65 implants were included. The implants were placed immediately or 7–44 months after reconstruction of the jaw with fibular (n=17) or iliac flaps (n=2). ARF and FGG were performed 0–11 months later. No implants were lost. The mean PPD, BoP, and MBL at 26.6 ± 16.8 months were 3.5 ± 0.9-mm, 70.4 ± 35.1%, and 0.6 ± 0.4-mm, respectively. The incidence of peri-implantitis was 32.3%, showing no significant associations with the sex, age, primary disease, flap choice, number and position of implants, timing of ARF and FGG, use of a fixation stent and type of restoration based on the adjusted multivariate model (p>0.05). Conclusion Soft tissue management helps generate firmly-attached keratinized mucosa around the implants, leads to a more precise impression, and reduces peri-implant bone loss. It should be considered as a critical part of implant rehabilitation after vascularized free-flap reconstruction.