Digital workflow for peri-implant soft tissue management following jaw reconstruction: A patient-specific CAD/CAM vestibuloplasty stent: A Preliminary Case Series

Aims: Implant-supported rehabilitation following maxillary or mandibular reconstruction with vascularized osseous free flaps is frequently compromised by inadequate peri‑implant soft tissues, vestibular obliteration, and scar contracture. This study describes a fully digital workflow for peri‑implant soft tissue management based on a patient-specific CAD/CAM vestibuloplasty stent (PSVS) and reports its preliminary clinical use. Materials and methods: Five consecutive patients who had previously undergone jaw reconstruction with vascularized osseous free flaps underwent subperiosteal vestibuloplasty followed by placement of the 3D-printed PSVS. The device was fixed to the reconstructed bone to guide soft-tissue maturation and stabilize a free gingival graft. Vestibular depth was measured at baseline, 2 months, and 6 months postoperatively. Results: Vestibular reconstruction was successful in all patients. Mean vestibular depth decreased from 10.6 ± 3.1 mm at baseline to 9.0 ± 3.9 mm after 6 months (mean reduction: 1.5 ± 1.1 mm). All free gingival grafts survived, resulting in a measurable band of keratinized mucosa, while implant-supported cases showed favourable peri‑implant clinical parameters. No implant loss, flap compromise, osteonecrosis, or major complications occurred. Conclusion: This pilot case series suggests that a patient-specific CAD/CAM vestibuloplasty stent is a feasible approach for vestibular reconstruction and peri‑implant soft tissue augmentation following jaw reconstruction with vascularized osseous free flaps. Larger prospective comparative studies are required to confirm its long-term clinical value.