Fabrication of mucocompressive splints for free gingival grafts via medical engineering in patients with reconstructed mandibles.

Purpose: Acquiring adequate attached mucosa is important in restoring masticatory function with a removable dental prosthesis or dental implant. In patients with inadequate attached mucosa, a free gingival graft (FGG) with a custom stent is used. However, it is challenging to apply the conventional method for fabricating a stent with a reshaped cast in patients with reconstructed mandibles because the reconstructed mandible has limitations due to a titanium mesh, skin flap, and unique bone morphology. In the present report, we have proposed a new design and fabrication process for a mucocompressive splint via medical engineering to acquire the attached mucosa for the prosthodontic treatment of reconstructed mandibles.

Methods: Three-dimensional (3D) craniomandibular models were reconstructed from a computed tomography dataset after mandibular reconstruction. The dentition region was replaced with highly precise scan data of the dental casts using a 3D scanner. The alveolar ridge mucosa and teeth were ideally designed using the 3D model while referring to the anatomical structures. The jig used to fabricate the working dental cast with artificial gum in real space was designed and fabricated using a 3D printer. The alveolar ridge was altered into a simulated configuration on the articulator using a jig. A mucocompressive splint was fabricated on an altered dental cast. The splint was immediately seated on the mandible without any major adjustments after the FGG.

Conclusion: Adequate attached mucosa for the prosthodontic treatment of a reconstructed mandible was obtained by the pre-surgical fabrication of a mucocompressive splint through medical engineering.