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J Maxillofac Oral Surg. 2016 Dec;15(4):449-455. Epub 2015 Nov 23.

Sub-Periosteal Dissection with Denture-Guided Epithelial Regeneration: A Novel Method for Peri-Implant Soft Tissue Management in Reconstructed Mandibles.

Author information

Department of Surgical Oncology- Head and Neck Surgery, Majumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bengaluru, India ; Department of Oral and Maxillofacial Surgery, M.R. Ambedkar Dental College & Hospital, 37, Lazar Layout, Frazer Town, Bengaluru, 560005 India ; Department of Oral Maxillofacial and Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
Department of Prosthodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, India ; Ora-Care Dental Clinic, 81-Coles Road, Frazer Town, Bengaluru, India.
Department of Surgical Oncology- Head and Neck Surgery, Majumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bengaluru, India.



In patients with reconstructed mandibles using free fibula flaps, management of soft tissues around implants supporting dental rehabilitation, is often a clinical problem.


The aim of this paper is to describe a new technique, namely "Sub-periosteal dissection and denture-guided epithelial regeneration (SD-DGER)", as a method of peri-implant soft tissue management in these patients.


The technique consists of performing a subperiosteal dissection with creation of buccal and lingual flaps. These flaps form the buccal and lingual vestibule. Implants are placed and an interim denture is immediately loaded onto the implants to guide the regenerated epithelium. A keratinized mucosal layer is formed on the bare fibula bone in six months time.


This technique was successful in producing fixed keratinized epithelial tissue around implants in patients with mandibles reconstructed using the free fibula flap in patients who did not undergo radiotherapy.


The sub-periosteal dissection with denture guided epithelial regeneration is a predictable form of peri-implant soft tissue management in selected patients with reconstructed jaws.


Free fibula; Immediate loading; Implant; Maxillofacial rehabilitation; Peri-implant; Reconstruction; Soft tissue management

Conflict of interest statement

Vinay V. Kumar, P. C. Jacob and Moni A. Kuriakose declare that they have no conflict of interests. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent Informed consent was obtained from all individual participants included in the study.

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