An Osteoplastic Advancement Flap, “Sandwich” Osteotomy and Application of a Skin Regeneration Template Prior to Implant Placement

Abstract

Introduction: Following oral cancer resection patients will have differing degrees of morbidity with regards to mastication, speech and aesthetics and this can be a difficult problem to manage. We present a case that describes an innovative technique involving implant placement and deepening of the labial sulcus in the atrophic mandible of a post-operative oral cancer patient to facilitate partial denture retention. Methods: a 70-year-old female patient presented with significant vertical and horizontal bone atrophy and a shallow, tethered labial sulcus in the anterior mandible, following cancer resection of the floor of mouth and alveolar ridge. She was unable to retain a partial denture. An initial procedure included an osteoplastic advancement flap and a horizontal "sandwich" osteotomy as a combined approach that improved the bone volume from a Cawood & Howell classification grade V to grade II. A sulcoplasty and insertion of Integra@ skin regeneration system improved sulcus depth in a second procedure. Dental implants were successfully placed 4 months after bone augmentation to allow retention of a lower partial denture. Results: These staged procedures were carried out with excellent healing and no complications in the post-operative 6 months. Conclusion: This technique for gaining bony height and width, with improved sulcus depth in an atrophic mandible is a useful adjunct in the rehabilitation of post-operative oral cancer cases. Maintaining the periosteal attachment in the osteoplastic flap promotes excellent healing in patients who have received adjunctive radiotherapy treatment in this safe and effective osteotomy procedure.