Yong Hur

Double Flap Incision Design for Guided Bone Regeneration: A Novel Technique and Clinical Considerations

BACKGROUND Premature membrane exposure for guided bone regeneration may result in complications, such as inadequate bone regeneration, inflammatory reactions, and wound infection. This paper presents a clinical case of a novel incision-flap design used to advance the flap to enhance tension-free primary closure for the vertical ridge augmentation. METHODS A 61-year-old white man presented with the chief complaint of wanting to replace his posterior mandibular teeth. A severe alveolar bone deformity vertically and horizontally (Seibert Class III) was noticed, especially over the mental foramen area. A staged guided bone regeneration procedure prior to the implant installation was chosen as the most optimal treatment. A partial-thickness flap, separating the mucosal flap from the periosteum overlying the alveolar bone, was used to advance the flap. RESULTS During the healing period, neither soft tissue dehiscence nor membrane exposure were noted. Clinical and radiographic evaluation revealed a 4- to 5-mm gain in vertical height and a noticeable increase in horizontal thickness. After the 6 to 8 months of healing for both sites, two implants were placed on each side with good primary stability and without complications. CONCLUSIONS This technique facilitates flap advancement by the tension-free nature of the design and enhances soft tissue maintenance during the course of regeneration. This approach, the separation of the periosteal layer and the mucosal layer, can be used as an alternative to overcome some of the limitations with conventional technique.

Comparison of double-flap incision to periosteal releasing incision for flap advancement: a prospective clinical trial.

PURPOSE The aim of this study was to evaluate the efficacy and morbidity of two periodontal releasing incision techniques in vertical ridge augmentation. MATERIALS AND METHODS Twenty-three vertical and horizontal defects (Seibert Class III) were selected to compare the double-flap incision (DFI) to the conventional periosteal releasing incision (PRI). An incision technique was randomly assigned for flap advancement. The amount of flap advancement, the incidence of postsurgical complications, and the level of patient discomfort were compared. Flap advancement was measured with a UNC-15 probe as the difference between the initial elevated flap and the final advanced flap. Postsurgical complications including premature membrane exposure, infection, paresthesia, and continuous discomfort were noted at follow-up visits. A visual analog scale (VAS) was used to quantify the amount of pain, swelling, and bleeding in the patients. RESULTS An average of 9.64 ± 0.92 mm flap advancement was accomplished for DFI, whereas PRI advancement averaged 7.13 ± 1.45 mm (P < .001). Premature membrane exposures occurred in two sites in the PRI group and one site in the DFI group. Paresthesia, infection, and continuous discomfort were noted in one site each in the PRI group. The difference between groups in the incidence of postoperative complications (PRI, 5; DFI, 1) was not significant (P < .082). The mean pain, swelling, and bleeding scores for DFI (1.55 ± 1.21, 1.91 ± 0.94, and 0.40 ± 0.12, respectively) were lower than those of the PRI group (3.75 ± 2.63, 3.25 ± 1.29, and 1.16 ± 0.34, respectively) (P = .019, P = .010, and P = .061, respectively). CONCLUSIONS Flap advancement was facilitated and morbidity was decreased in the DFI group. The technique may have potential to serve as an alternative to PRI to overcome some of the latters limitations.

Association Between Sinus Membrane Thickness and Membrane Perforation in Lateral Window Sinus Augmentation: A Retrospective Study

BACKGROUND Association between Schneiderian membrane thickness and membrane perforation is examined in lateral window sinus augmentation. METHODS This retrospective study reviewed records of 551 patients who underwent lateral sinus augmentation at Tufts University School of Dental Medicine, Boston, Massachusetts, from June 1, 2006 to May 31, 2015. Preoperative cone-beam computed tomography images were analyzed to evaluate possible association among membrane thickness, residual bone height, and membrane perforation. Data were evaluated using Mann-Whitney U test at P <0.05. RESULTS Total 167 patients (95 males and 72 females) met the eligibility criteria and were included in the study. Among them, 47 patients had Schneiderian membrane perforation (perforation group). Mean membrane thickness was 0.84 ± 0.67 mm in the perforation group and 2.65 ± 4.02 mm in the non-perforation group. There was a statistically significant difference in membrane thickness between groups (P <0.001). Mean residual ridge thickness was 2.78 ± 1.37 mm in the perforation group and 4.21 ± 2.09 mm in the non-perforation group. There was a statistically significant difference in residual alveolar bone height (P <0.001). CONCLUSIONS Patients who experienced membrane perforation had a thinner membrane compared with patients without membrane perforation. Schneiderian membrane perforation was associated with decreased residual bone height.

Use of Allograft with Platelet Concentrate in the Treatment of Multiple Miller Class III Gingival Recession Defects: Report of Three Cases

Three patients with multiple Miller Class III recession defects with substantial bone loss were treated with hard tissue augmentation with the goal to prevent future recessions. The surgery involved a full-thickness mucoperiosteal coronally advanced flap, bone grafting, and primary flap closure. Freeze-dried bone allograft (FDBA) in combination with plasma rich in growth factors (PRGF) was grafted during the procedure. After more than 6 months, the treated sites showed soft tissue maturation and esthetic tissue blending. Clinically, an increase in convexity of alveolar ridge and soft tissue was observed, as well as a marked reduction in recession depth and gain in width of keratinized mucosa. Cone beam computed tomography showed a gain in buccal bone thickness. The use of FDBA in combination with PRGF appears to have potential for the treatment of Miller Class III defects by providing improved hard and soft tissue profiles.

Bone Resorption During Submerged Healing After Guided Bone Regeneration: A Prospective Case Series

Objective: The aim of this study was to evaluate bone resorption quantitatively during the healing period subsequent to ridge augmentation. Materials and Methods: Sixteen patients requiring vertical ridge augmentation before implant placement were recruited in the study. The study used an allograft and nonresorbable membrane. A custom acrylic stent was used to measure changes in bone volume. Augmented bone was compared with remaining bone 6 months after guided bone regeneration (&agr; = 0.05 by means of the paired t test). Results: All sites following the six months post-surgery were analyzed. Overall changes in alveolar bone were observed with a mean resorption rate of 19.8% (p<0.001). The vertical bone measurement indicated a mean resorption rate of 22.8% (range = 18.5% – 26.5%). The horizontal measurement indicated a mean resorption rate of 18.7% (range = 12.6% – 26.0%). Among the sixteen sites, four sites with post-operative complications including membrane exposure showed an average of 42.1% resorption rates. Conclusion: Loss in graft quantity was observed after ridge augmentation using an allograft and nonresorbable membrane during submerged healing before implant placement. Further studies with larger sample sizes are recommended to confirm its findings.

A higher incidence of dry socket may be related to the use of oral contraceptives after impacted mandibular third-molar extraction

Clinical question. In female patients undergoing impacted mandibular third-molar extraction, does the use of oral contraceptives increase the incidence of alveolar osteitis (also known as dry socket [DS]) compared with female patients who do not use oral contraceptives? Review methods. The authors searched 3 electronic databases (MEDLINE via PubMed, the Cochrane Library, and Elsevier ScienceDirect) for relevant articles published up to April 2014 without language restriction. Included studies were cohort studies in humans whose investigators reported full-text data to evaluate the effect of oral contraceptive use as a risk factor for the development of DS. Two reviewers independently performed data extraction. The primary outcome was the incidence of DS. Two reviewers independently conducted quality assessments of the included studies by