Soft Tissue Management in Implant Rehabilitation After Vascularized Free Bone Flap Jaw Reconstruction: A Narrative Review

Abstract

Jaw reconstruction with a vascularized free bone flap has significantly improved outcomes for patients requiring maxillofacial rehabilitation by restoring oral function and esthetics and improving psychological well-being. However, the long-term success of dental implants in reconstructed jaws depends on the health of peri-implant soft tissues. The unique anatomical features of the donor-site paddle skin graft, including limited peri-implant keratinized mucosa, insufficient firm mucosal attachment, and frequently inadequate vestibular depth, pose challenges for maintaining peri-implant tissue health and implant survival. Various surgical and biomaterial-based techniques have been proposed to address these challenges, including flap revision, apically positioned flap or vestibuloplasty, free gingival and split-thickness skin grafts, and soft tissue substitutes. Fixation and stabilization of grafts during the early healing phase through methods such as periodontal suturing techniques and pins are critical to optimizing results. Evidence suggests that personalized approaches incorporating multiple strategies may improve peri-implant keratinized mucosa width, reduce peri-implant inflammation, and enhance patient satisfaction in these complex cases. However, as evidence on long-term outcomes remains uncertain, balancing the potential benefits against donor site morbidity can be challenging. Despite significant advances, no consensus exists on optimal protocols, and small sample sizes, heterogeneity, and a lack of standardized outcome measures limit the literature. Further high-quality, prospective research is required to establish optimal practices and foster innovation in peri-implant soft tissue management after jaw reconstruction.