Raabe Clemens, Cafferata Emilio A, Couso-Queiruga Emilio, Chappuis Vivianne, Ramanauskaite Ausra, Schwarz Frank
Department of Oral Surgery and Implantology, Goethe University, Frankfurt am Main, Germany.
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Clin Implant Dent Relat Res. 2025 Feb;27(1):e13434. doi: 10.1111/cid.13434.
This preclinical ex vivo porcine study aimed to evaluate the effects of two flap advancement techniques and periosteal suturing (PS) on graft material displacement during primary wound closure in guided bone regeneration (GBR). Secondary objectives included assessing flap advancement and the impact of soft tissue characteristics on graft displacement.
Standardized two-walled horizontal bone defects were created in second premolar sites of pig hemimandibles. Sites were randomized to using either full-thickness flaps with modified periosteal releasing incisions (MPRI) or combination flaps using the mucosal detachment technique (MDT), both with and without PS. Cone-beam computed tomography was used to measure changes in graft material thickness (GMT) at seven incremental levels (L0-L6) relative to the implant platform, before and after primary wound closure. Keratinized mucosa width (KMW), flap thickness (FT), and flap advancement (FA) were also recorded.
Sixty-eight horizontal bone augmentation procedures were performed on 34 pig hemimandibles, divided into four groups (MDT+PS, MDT-PS, MPRI+PS, MPRI-PS). Mean overall change in GMT at L0 was -24.5% ± 14.0% for MPRI and - 23.0% ± 14.3% for MDT (p ≥ 0.085). PS reduced graft displacement (-14.2% ± 11.5%) compared with no PS (-33.2% ± 16.9%, p < 0.001). FA was 8.3 ± 1.1 mm (MPRI) and 8.3 ± 1.5 mm (MDT). The mean KMW was 6.8 ± 0.9 mm, and FT ranged from 0.8 to 1.6 mm.
PS significantly reduced graft material displacement during primary wound closure, while flap advancement techniques and soft tissue characteristics had no impact on graft stability. Both surgical techniques provided sufficient flap advancement for primary wound closure.
本临床前猪离体研究旨在评估两种皮瓣推进技术和骨膜缝合（PS）对引导骨再生（GBR）一期伤口关闭期间移植材料移位的影响。次要目的包括评估皮瓣推进情况以及软组织特征对移植材料移位的影响。
在猪半下颌骨的第二前磨牙部位制造标准化的双壁水平骨缺损。将部位随机分为使用改良骨膜松解切口（MPRI）的全厚皮瓣或使用黏膜分离技术（MDT）的联合皮瓣，两组均分为有或无PS。在一期伤口关闭前后，使用锥形束计算机断层扫描测量相对于种植体平台在七个递增水平（L0-L6）处移植材料厚度（GMT）的变化。还记录了角化黏膜宽度（KMW）、皮瓣厚度（FT）和皮瓣推进（FA）情况。
对34个猪半下颌骨进行了68次水平骨增量手术，分为四组（MDT+PS、MDT-PS、MPRI+PS、MPRI-PS）。MPRI组L0处GMT的平均总体变化为-24.5%±14.0%，MDT组为-23.0%±14.3%（p≥0.085）。与无PS组（-33.2%±16.9%）相比，PS减少了移植材料移位（-14.2%±11.5%，p<0.001）。FA为8.3±1.1mm（MPRI）和8.3±1.5mm（MDT）。平均KMW为6.8±0.9mm，FT范围为0.8至1.6mm。
PS在一期伤口关闭期间显著减少了移植材料移位，而皮瓣推进技术和软组织特征对移植稳定性没有影响。两种手术技术都为一期伤口关闭提供了足够的皮瓣推进。
