The importance of mucogingival flaps in guided bone regeneration in the jaws

Abstract

Introduction. Guided bone regeneration (GBR) is a surgical method that allows the formation of new bone in areas of atrophy of the maxillary bone. The integration of the graft or the augmented bone under the mucosal flap and the primary healing of the soft tissues are essential conditions for preventing the exposure of the regeneration site and infectious complications that inevitably lead to the failure of the GBR procedure. Materials and methods. This study presents the results of a cohort study that includes 70 patients who underwent GBR. The research involved techniques for forming muco-periosteal flaps: the Modified Periosteal Releasing Incision (MPRI) according to the principle of the double flap technique (DF) and the coronal advanced lingual flap (CALF). The study group included patients who underwent GBR using perforated titanium membrane, while the second group underwent GBR using bioresorbable poly-4 hydroxybutyrate (P4HB) synthetic mesh. The patients were evaluated periodically to monitor postoperative progress, the cases of dehiscence of the area related to augmentation site were recorded, measured and classified according to Fontana. Statistical results were generated and processed by the R Studio program. Results. In the study groups, a total of 8 cases of gingival dehiscence were registered, 4 cases in each group. In two cases, partial removal of the titanium membrane was performed by milling it, and the remaining 6 cases of dehiscence were remedied with rinses with oral antiseptic solution and scheduled visits for local care until the appearance of granulation tissue and epithelization. Conclusions. Protective membrane, flap formation, thread tension and suture relaxation all play crucial roles in guided bone augmentation without dehiscence. In our study, the small number of dehiscence cases recorded as complications did not provide significant statistical results, namely due to the technique of performing the flap according to contemporary methods, a fact also described by the specialized literature.