J Oral Maxillofac Surg 67:624-629, 2009 Clinical Evaluation of a Modified Method of Vestibuloplasty Using an Implant-Retained Splint Susanne Heberer, DDS,* and Katja Nelson, DDS, PhD† Purpose: Oral rehabilitation of resected tumor patients often requires, besides the use of dental implants, the improvement of the soft tissue condition. In this clinical report, we describe a simple and effective surgical and prosthetic treatment procedure to achieve adequate long-term soft tissue conditions. Materials and Methods: Seventeen tumor patients were selected for this evaluation. A total of 68 implants were placed in the mandible. At implant placement, a closed impression was taken from the implants for the fabrication of an implant-retained surgical splint. At second-stage surgery, vestibuloplasty by use of a split-thickness skin graft from the upper thigh was performed and an implant-retained splint was positioned. Pocket depths at the implants and the size of the graft were monitored over a period of 2 years. Statistical analysis by use of nonparametric 2-factorial analyses for repeated measures was performed. Results: The mean mesial and distal pocket depths remained stable and measured 2.56 mm and 2.64 mm, respectively, at 24 months postoperatively. The graft showed an overall shrinkage of 18.5% in the vertical direction and 10.4% in the horizontal direction after 24 months. The shrinkage of the vertical direction compared with the horizontal direction showed a significant difference (P = .035). The shrinkage tendency was less than that described in the literature. Conclusions: The applied method described an easy, sufficient surgical procedure that minimizes shrinkage and creates a denture-bearing area that is stable over the long term, thus representing an improvement over previous methods. © 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:624-629, 2009 Tumor patients after the treatment of oral cancer often require prosthetic restoration for rehabilitation. The resection of oral cancer can result in pronounced functional interferences, due to disfigurements of the hard and soft tissue. The presence of scar tissue, functional disabilities, the absence of an adequate vestibulum, and an altered anatomy in these situations often are no longer amenable to conservative den- tistry. With the aid of implant-supported prosthetics, speech and masticatory capacities may become reha- bilitated. 1 After reconstruction of large tissue defects, attached keratinized mucosa adjacent to the implants is often missing. It is generally agreed that firmly at- tached keratinized mucosa surrounding the implant and abutment is thought to provide additional protection against mechanical trauma. 2 Furthermore, muscle at- tachment in proximity to peri-implant mucosa can be responsible for soft tissue inflammation in areas lacking attached mucosa. Inflammation of the soft tissue could result in peri-implantitis with marginal bone loss or hyperplasia of the surrounding mucosa and might be a cause of implant failure or recurrent inflammation. 3 To restore surgically compromised soft and hard tissue before implant-retained prosthetic rehabilita- tion, vestibuloplasty is often used. 4 Vestibuloplasty is a surgical procedure used to pro- vide a basis for the denture-bearing area by an ade- quately deepened vestibulum and prevents muscle pull. 3,5 In the past, different methods and modifica- tions of vestibuloplasties 6-8 in combination with sec- ondary epithelialization 9 or the use of different graft techniques with pedicled flaps and free grafts were developed 10-12 but mostly discarded because of com- plications. Healing by secondary epithelialization or simple separation of scars often results in further Received from the Department of Oral and Maxillofacial Surgery, Charité Campus Virchow Clinic, Berlin, Germany. *Assistant Professor. †Associate Professor. Address correspondence and reprint requests to Dr Heberer: Department of Oral and Maxillofacial Surgery, Charité Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; e-mail: Susanne.Heberer@charite.de © 2009 American Association of Oral and Maxillofacial Surgeons 0278-2391/09/6703-0025$36.00/0 doi:10.1016/j.joms.2008.09.029 624