AIMS This study aims to evaluate the influence of soft tissue adjunctive procedures in composite free flaps on overall implant survival. - Primary objectives Do soft tissue adjunctive procedures significantly increase implant survival in head and neck reconstruction cases? > Vestibuloplasty – mucosal vs split thickness skin graft vs full thickness skin graft > Flap debulking > Mucosa – native vs granulated muscle - Secondary objectives What other factors influence implant survival in head and neck reconstruction cases? > Flap components and donor site > Pathology – benign vs malignant > Location of flap – maxilla vs mandible, anterior vs posterior oral cavity > Adjuvant treatment > Risk factors > Demographic factors METHODOLOGY The study design is a retrospective observational evaluation of single-centre composite free flap cases that underwent oral implant rehabilitation. A retrospective analysis of patient records is selected to analyse patients that had already completed treatment and identify factors that contributed to either implant success or failure. Inclusion criteria · Undergo reconstruction of the mandible or maxilla with a vascularised free flap · One or more dental implants inserted into a vascularised free flap Exclusion criteria · Non-vascularised grafts · Incomplete recorded follow-up data RESULTS Overall implant survival was significantly increased in cases that underwent soft tissue adjunctive procedures. Overall implant survival was significantly increased with keratinised peri-implant tissue compared to non-keratinised peri-implant tissue. Type and location of flap, adjuvant therapy, risk factors and gender had a significant impact on overall implant survival. CONCLUSION This research determined that adjunctive soft tissue procedures significantly increased the overall survival rate and prosthodontic success relating to implants placed in composite free flaps to reconstruct head and neck oncological defects.