{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:27:15Z","timestamp":1789748835835,"version":"4.0.1"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,15]],"date-time":"2025-02-15T00:00:00Z","timestamp":1739577600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Mandibular reconstruction poses challenges in achieving functional and aesthetic outcomes. Effective oral rehabilitation is crucial for restoring function and improving quality of life; however, the altered neomandibular anatomy complicates oral hygiene, increasing the risk of peri-implant complications and making successful rehabilitation more difficult. This study introduces a novel approach combining vestibuloplasty with patient-specific implant-retained splints to enhance oral health and improve rehabilitation outcomes. Methods: Three patients underwent mandibular reconstruction with a free vascularized fibula flap (FFF). After 6 months of osseointegration, vestibuloplasty and soft tissue refinement were performed, with a split-thickness skin graft placed on the FFF periosteum. An implant-retained splint was secured to the abutments for two weeks to support soft tissue healing. Implant survival, bone loss, and peri-implant health were evaluated over a 2-year follow-up. Results: A total of 12 implants were placed, primarily in the neomandible (83.3%), with a 100% survival rate. Implant survival was assessed. Implant survival was assessed based on established criteria for clinical success, including stability, presence of pain, bleeding on probing (BOP), pocketdepth, bone loss and lack of peri-implant radiolucency. Functional outcomes included normal mouth opening, laterotrusion, and protrusion. Pocket depths ranged from 3 to 4 mm, except for one implant in cases 1 and 2. The mean BOP was 51.7%. Conclusions: This case series introduces a surgical technique that combines CAD\/CAM and vestibuloplasty to optimize dental rehabilitation in mandibular FFF reconstructions, demonstrating safe thinning of soft tissues for improved oral hygiene and survival.<\/jats:p>","DOI":"10.3390\/jcm14041298","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T03:41:47Z","timestamp":1739763707000},"page":"1298","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Enhancing Implant Success in Mandibular Reconstruction: A Novel Approach Combining Implant-Retained Splint and Vestibuloplasty\u2014A Case Series"],"prefix":"10.3390","volume":"14","author":[{"given":"Louise","family":"Van Der Kelen","sequence":"first","affiliation":[{"name":"Department of Oral & Craniomaxillofacial Surgery, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4094-7384","authenticated-orcid":false,"given":"Matthias","family":"Ureel","sequence":"additional","affiliation":[{"name":"Department of Oral & Craniomaxillofacial Surgery, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"},{"name":"Cancer Research Institute Ghent, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8375-4139","authenticated-orcid":false,"given":"Benjamin","family":"Denoiseux","sequence":"additional","affiliation":[{"name":"Department of Oral & Craniomaxillofacial Surgery, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9438-0762","authenticated-orcid":false,"given":"Pieter-Jan","family":"Boder\u00e9","sequence":"additional","affiliation":[{"name":"Department of Dentistry, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carine","family":"Matthys","sequence":"additional","affiliation":[{"name":"Department of Dentistry, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubert","family":"Vermeersch","sequence":"additional","affiliation":[{"name":"Department of Oral & Craniomaxillofacial Surgery, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"},{"name":"Cancer Research Institute Ghent, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0580-9074","authenticated-orcid":false,"given":"Renaat","family":"Coopman","sequence":"additional","affiliation":[{"name":"Department of Oral & Craniomaxillofacial Surgery, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"},{"name":"Cancer Research Institute Ghent, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Potter, J.K. (2012). Mandibular Reconstruction. Current Therapy in Oral and Maxillofacial Surgery, Elsevier Saunders.","DOI":"10.1016\/B978-1-4160-2527-6.00060-8"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s40729-022-00413-7","article-title":"Long-Term Survival of Implant-Based Oral Rehabilitation Following Maxillofacial Reconstruction with Vascularized Bone Flap","volume":"8","author":"Ma","year":"2022","journal-title":"Int. J. Implant. Dent."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s12663-015-0766-5","article-title":"Mandibular Reconstruction: Overview","volume":"15","author":"Kumar","year":"2016","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1002\/JPER.18-0338","article-title":"Outcome of Early Dental Implant Placement versus Other Dental Implant Placement Protocols: A Systematic Review and Meta-analysis","volume":"90","author":"Bassir","year":"2019","journal-title":"J. Periodontol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1615\/JLongTermEffMedImplants.2023046364","article-title":"Evaluation of Late Implant Placement in Vertically Regenerated Sites: A Systematic Review","volume":"34","author":"Benitez","year":"2024","journal-title":"J. Long Term Eff. Med. Implant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/prd.12170","article-title":"Implant Placement Post Extraction in Esthetic Single Tooth Sites: When Immediate, When Early, When Late?","volume":"73","author":"Buser","year":"2017","journal-title":"Periodontology 2000"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/prd.12185","article-title":"Modern Implant Dentistry Based on Osseointegration: 50 Years of Progress, Current Trends and Open Questions","volume":"73","author":"Buser","year":"2017","journal-title":"Periodontology 2000"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/clr.13276","article-title":"Implant Placement and Loading Protocols in Partially Edentulous Patients: A Systematic Review","volume":"29","author":"Gallucci","year":"2018","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/ID.0b013e3181d47eaf","article-title":"Immediate Implant Placement: Positives and Negatives","volume":"19","author":"Koh","year":"2010","journal-title":"Implant. Dent."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.prosdent.2019.05.013","article-title":"Immediate versus Early or Conventional Loading Dental Implants with Fixed Prostheses: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials","volume":"122","author":"Chen","year":"2019","journal-title":"J. Prosthet. Dent."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.prosdent.2017.12.006","article-title":"Immediate versus Early Loading of Single Dental Implants: A Systematic Review and Meta-Analysis","volume":"120","author":"Pigozzo","year":"2018","journal-title":"J. Prosthet. Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.prosdent.2022.05.033","article-title":"Clinical Efficacy of Early and Delayed Loading Implants: A Systematic Review and Meta-Analysis","volume":"132","author":"Zhang","year":"2024","journal-title":"J. Prosthet. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1016\/j.ijom.2021.01.015","article-title":"Immediate Implant Placement in Edentulous Oral Cancer Patients: A Long-Term Retrospective Analysis of 207 Patients","volume":"50","author":"Wetzels","year":"2021","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1111\/clr.13008","article-title":"Costs and Clinical Outcomes of Implant Placement during Ablative Surgery and Postponed Implant Placement in Curative Oral Oncology: A Five-year Retrospective Cohort Study","volume":"28","author":"Wetzels","year":"2017","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.joms.2020.11.006","article-title":"Soft Tissue Management: A Critical Part of Implant Rehabilitation After Vascularized Free-Flap Reconstruction","volume":"79","author":"Li","year":"2021","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ritschl, L.M., Singer, H., Clasen, F.-C., Haller, B., Fichter, A.M., Deppe, H., Wolff, K.-D., and Weitz, J. (2024). Oral Rehabilitation and Associated Quality of Life Following Mandibular Reconstruction with Free Fibula Flap: A Cross-Sectional Study. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1371405"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.ijom.2008.05.021","article-title":"Rehabilitation after Mandibular Reconstruction with Fibula Free-Flap: Clinical Outcome and Quality of Life Assessment","volume":"37","author":"Hundepool","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ureel, M., Boder\u00e9, P.-J., Denoiseux, B., Corthouts, P., and Coopman, R. (2024). Mandibular Reconstruction with Osseous Free Flap and Immediate Prosthetic Rehabilitation (Jaw-in-a-Day): In-House Manufactured Innovative Modular Stackable Guide System. Bioengineering, 11.","DOI":"10.3390\/bioengineering11121254"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4695","DOI":"10.1007\/s00784-023-05096-x","article-title":"Vestibuloplasty and Its Impact on the Long-Term Survival and Success of Dental Implants in Irradiated and Non-Irradiated Patients after Head and Neck Tumor Therapy: A Retrospective Study","volume":"27","author":"Sachse","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S286","DOI":"10.1111\/jcpe.12957","article-title":"Peri-implant Diseases and Conditions: Consensus Report of Workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions","volume":"45","author":"Berglundh","year":"2018","journal-title":"J. Clin. Periodontol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1007\/s00784-016-1815-2","article-title":"Soft Tissue Augmentation Procedures at Second-Stage Surgery: A Systematic Review","volume":"20","author":"Bassetti","year":"2016","journal-title":"Clin. Oral Investig."},{"key":"ref_22","first-page":"1599","article-title":"Perimandibular Wiring (Black-Ivy Method) in the Treatment of Mandibular Fractures of the Edentulous","volume":"5","author":"Rusconi","year":"1950","journal-title":"Riv. Ital. Stomatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.ijom.2011.09.014","article-title":"Vestibuloplasty: Allograft versus Mucosal Graft","volume":"41","author":"Hashemi","year":"2012","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.coms.2018.12.005","article-title":"Maxillofacial Reconstruction Using Vascularized Fibula Free Flaps and Endosseous Implants","volume":"31","author":"Patel","year":"2019","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1001\/jamafacial.2015.2271","article-title":"Evaluation of Clinical Outcomes of Osseointegrated Dental Implantation of Fibula Free Flaps for Mandibular Reconstruction","volume":"18","author":"Jackson","year":"2016","journal-title":"JAMA Facial Plast. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/jcpe.12647","article-title":"Bleeding on Probing around Dental Implants: A Retrospective Study of Associated Factors","volume":"44","author":"Farina","year":"2017","journal-title":"J. Clin. Periodontol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1298\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:35:18Z","timestamp":1760027718000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,15]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14041298"],"URL":"https:\/\/doi.org\/10.3390\/jcm14041298","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,15]]}}}