Gingival hyperplasia around implants in the maxilla and jaw reconstructed by fibula free flap

A recurring problem during prosthetic rehabilitation following reconstruction by means of a vascularized fibula flap, after ablation of tumors affecting the facial skeleton, is the hyperplastic granulomatous reactive tissue that forms around the prosthetic abutments of the implant. The features of this phenomenon seem to be directly related to the characteristics of the peri-implant tissue and to the material from which the prosthetic abutments are manufactured. Two main ways of avoiding this are proposed. 1) Skin grafts around implants seem to inhibit the overgrowth of granulomatous tissue. 2) Acrylic provisionals should be avoided and substituted with complete metal-ceramic restoration.