Mandibular Vestibuloplasty with Alloderm.
This is a 64 year old male who originally presented to the office with complete upper and lower dentures complaining of inability to retain his lower prosthesis.
After clinical and CBCT evaluation, a treatment plan was formulated that included a mandibular bar overdenture complex.
Phase 1 treatment involved placement of 5 root form implants in the anterior mandible, 3 nonsubmerged, 2 submerged, to allow for wearing of the existing lower denture (Figure 1).
There was a relative lack of attached tissues present, and thus phase 2 treatment was formulated to include a mandibular vestibuloplasty with Alloderm and exposure of the B and D implants (Figure 2, 3).
Here you will see that a supra periosteal dissection was done with apical repositioning of the flap.
Next, Alloderm, which had been soaking initially in saline and then PRF exudate (Figure 4), was sutured to the periosteal bed (Figure 5).
A 2.5 month follow up (Figure 6) shows the typical post operative soft tissue appearance utilizing Alloderm as a vestibuloplasty material. In essence, a firm, matted mucosal looking immobile tissue is found as opposed to keratinized gingiva. Finally, Figure 7 shows the completed milled bar with locator attachments and final upper and lower prostheses (Figure 8).
As a side note, I have been using Alloderm as a vestibuloplasty soft tissue graft material for approximately 19 years now. I have found tissue stability to be extremely reliable long term except where extreme muscle pull is an issue. In these cases a free gingival graft is the reliable graft tissue to use. Typically there is a 50% relapse of the overall length of the allograft.
As a result, I will typically double the length of superperiosteal dissection in order to obtain the net result that I am after. Example – I typically like 5-6 mm of attached tissue around implants, and as a result I will apically reposition the flap 10-12 mm.
One final note. Figure 9 shows a 7 year post prosthetic completion case that was done approximately 16 years ago. Here again you will see attached tissues throughout the entire anterior mandible. This indicates excellent stability, which is what I have seen now for all of my cases even with the longest being a 9 year follow-up.
Technique, protocols, materials and more are covered at length in our Soft Tissue Grafting course.