(56) The Use of Integra Dermal Regeneration System Intraorally for Treatment of Peri-Implantitis and Mucositis: A Case Report

Abstract

Introduction: Skin autografts have traditionally been the treatment of choice for small intraoral soft-tissue defects. However, in recent years artificial dermis, such as Integra, has been used in oral reconstruction for patients undergoing surgery for oral cancer. This is the first case report for oral reconstruction using Integra for a patient with peri-implantitis associated with a fibula graft.Materials and methods: A 57-year-old female with a history of medication-related osteonecrosis of the jaw, which was treated by segmental resection of the right mandible and reconstruction with a microvascular fibula free graft. The patient underwent a subsequent debulking of the soft tissues and endosteal implant placement. Four years later she presented for evaluation of chronic right-sided intraoral pain and swelling associated with her dental endosteal implants, which were stable and pending restorations. The intraoral swelling was excised, and histopathologic analysis was significant for pyogenic granuloma. The lesion recurred, and it was decided to reconstruct the peri-implant soft tissues using an Integra graft.A surgical stent was fabricated using Triad custom tray material. Care was taken to leave space for the Integra matrix. The hyperplastic mucosa and granulation tissue was excised, exposing the 4 endosteal implants at the right neomandible. An Integra mesh bilayer wound matrix was adapted and placed into the stent. The stent was secured into place using Prolene circummandibular sutures.

Results: At postoperative day 12 the surgical stent was removed with well-healed peri-implant keratinized soft tissues.1 The patient was prescribed Peridex mouth rinse and educated in the importance of prosthodontic restoration of her implants.

Conclusion: The preliminary results of this case report illustrate the efficacy for Integra as a peri-implant graft. Advantages of Integra include excellent mechanical resistance and it is not affected by oral infection. Other advantages are reduced donor site morbidity, decreased operative time, and theoretically decreased surgical expenses.2,3 Further research is necessary to validate the efficacy of Integra matrix for patients who undergo reconstruction with fibula grafts and dental implants.References1. Srivastava, Akanksha et al. “Reconstruction of intraoral oncologic surgical defects with Integra® bilayer wound matrix.” Clinical case reports vol. 9,1 213-219. 12 Nov. 2020, doi:10.1002/ccr3.35012. Rúa Gonzálvez, L et al. “Use of Integra in oral reconstruction: a case series.” Oral surgery, oral medicine, oral pathology and oral radiology vol. 125,3 (2018): e72-e75. doi:10.1016/j.oooo.2017.11.0033. Mansour, Jobran et al. “The Feasibility and Outcome of Integra® Bilayer Matrix in the Reconstruction of Oral Cavity Defects.” Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery vol. 170,2 (2024): 373-379. doi:10.1002/ohn.531

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Splint in place
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