Soft tissue flap management is of paramount importance in the implant based oral rehabilitation of patients
with oral cancer particularly if peri-implant soft tissue problems are to be prevented in the future. The ability to debulk and tailor soft tissue flaps to ensure that enough tissue is retained to allow ongoing oral function whilst providing adequate prosthetic space is a key skill in maxillofacial prosthodontics.
The case shown illustrates the procedure well with the bulking and tailoring of a significant sized ALT flap placed over the top of the mandible during primary surgery. Five dental implants were placed free-hand at the time of surgery and were subsequently uncovered during the procedure to debulk, provide keratinised tissue and to re-establish both buccal & lingual vestibules which are both important for ongoing implant hygiene.
The use of sound pre-prosthetic and mucogingival techniques can allow for very effective and nice peri-implant reconstructions which preserve oral function and provide attached keratinised mucosa around implants which both facilitates oral hygiene measures and “normalises” the tissues, removing diagnostic uncertainty where new mucosal lesions develop in the peri-implant environment.