3D printed mucocompressive surgical stent with suture-anchor system for peri-implant keratinized mucosa augmentation: A proof-of-concept prospective single-cohort study.

STATEMENT OF PROBLEM Poor peri-implant soft tissue conditions in the reconstructed jaw pose challenges to long-term implant success rates. Although several peri-implant soft tissue management techniques in reconstructed jaws have been described, studies evaluating their postoperative effectiveness are lacking.

Purpose

This prospective single cohort study aimed to optimize peri-implant keratinized mucosa augmentation (KMA) in the reconstructed jaw by using a custom set of interim implant-supported prosthesis and mucocompressive surgical stent (IISP-MCSS) combined with suture-anchor system (SAS) during secondary surgery and to evaluate its clinical effectiveness. MATERIAL AND

Methods

Four patients with mandibular reconstruction using free fibular flaps (FFF) received IISP-MCSS+SAS-assisted KMA surgery. This included an apically positioned flap or vestibuloplasty (APF/V) and a free epithelial masticatory mucosal graft (FEG). Keratinized mucosa width (KMW) and vestibular depth (VD) were recorded pre-KMA (T0), immediately post-KMA (T1), 4 weeks (T2), and 12 weeks (T3). Postoperative pain was evaluated with a visual analog scale (VAS). The KMW shrinkage rate and VD increase or recession rate were calculated and statistically analyzed using paired t tests, and a 2-way repeated measures ANOVA with Bonferroni post hoc tests was performed to evaluate the dynamic postoperative changes across time points and the effect of SAS (α=.05).

Results

This study involved 4 participants (17 implants, 8 suture-anchors on the buccal side of 7 implants). Mean KMW significantly increased from 0.14 mm (T0) to 5.40 mm (T1), 4.82 mm (T2), and 4.07 mm (T3) (P<.05 compared to T0), 24.28% shrinkage (T3). VD increased from 0 mm (T0) to 8.03 mm (T1) and 8.40 mm (T2) (P<.05 compared to the ideal 6 mm), with a recession rate of 18.30% at T2. Anchored sites showed significantly less KMW shrinkage (P=.021) and VD recession than non-anchored sites (P<.001) at T3. VAS evaluation showed that participants felt mild pain on the day of KMA, with no significant pain thereafter.

Conclusions

IISP-MCSS+SAS assisted in peri-implant keratinized tissue augmentation in the reconstructed jaw, contributing to the formation of firmly attached keratinized mucosa and stable vestibular depth.