Implant retained prosthesis on a free fibula flap: A challenging procedure for prosthetic and soft tissue management

Linda Bouzid; Géraldine Lescaille; Benjamin Pomes; Lisa Friedlander

doi:10.1016/j.prosdent.2023.06.035

Implant retained prosthesis on a free fibula flap: A challenging procedure for prosthetic and soft tissue management

J Prosthet Dent. 2023 Aug 27:S0022-3913(23)00480-8. doi: 10.1016/j.prosdent.2023.06.035. Online ahead of print.

Authors

Linda Bouzid¹, Géraldine Lescaille², Benjamin Pomes³, Lisa Friedlander⁴

Affiliations

¹ Postgraduate student, Rare Oral and Dental Competence Center, Pitié-Salpêtrière Hospital APHP, Paris, France. Electronic address: linda.bouzid.m2dir@gmail.com.
² Department Head, Inserm U_1135, Center of Immunology and Infectious Diseases, Paris, France; Professor, Faculty of Odontology, Université Paris Cité, Paris, France.
³ Department Head, Maxillofacial Prosthodontic Department, Rare Oral and Dental Competence Center, Pitié-Salpêtrière Hospital APHP, Paris, France; Post-doctoral student, Laboratory PIMM, Arts et Métiers, ParisTech, UMR_8006, Paris, France.
⁴ Associate Professor, TETECOU Rare Diseases Health Network, Rare Malformations of the Head, Neck and Teeth, Necker Hospital, Paris, France; Researcher, Laboratory of Epidemiology and Health Economic Evaluation in Vulnerable Patients, Paris, France.

PMID: 37643940
DOI: 10.1016/j.prosdent.2023.06.035

Abstract

A 39-year-old woman who had undergone fibular flap reconstruction and simultaneous implant placement after the surgical removal of a cemento-ossifying fibroma was experiencing mild discomfort 3 years later and requested an implant-supported prosthesis to restore her edentulous left maxillary quadrant. Initially, an interim removable partial denture was provided and later duplicated with clear resin. The interim prosthesis identified the excessive thickness of the grafted cutaneous soft tissue and the inadequate emergence angle of the nonfunctioning implants. By using the interim prosthesis as a surgical guide, vestibuloplasty was performed to thin the peri-implant soft tissue and the excessive skin graft from the initial maxillofacial surgery. Concurrently, the emergence angle of the implant was corrected with angled multi-unit abutments. A tissue compression stent was then made and attached to the abutments to guide the soft tissue healing process. When the peri-implant soft tissue had stabilized, a definitive implant-supported prosthesis was provided.