Wang Lan, Zhou Yang, Zhao Renshengjie, Xiao Keming, Zeng Maoyun, Xie Xinyu, Liu Qiqi, Yu Ke
The Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China.
The Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China.
Int Dent J. 2025 May 9;75(4):100823. doi: 10.1016/j.identj.2025.04.004.
The periosteal releasing incision (PRI) is often used in guided bone regeneration (GBR) with titanium (Ti) mesh to reduce the tension of mucoperiosteal flaps (MPF) and close the wound, but it can easily lead to keratinized gingiva (KG) narrowing and a high wound dehiscence rate. Therefore, it is necessary to explore alternative methods such as open healing. The aim of this study was to observe whether a MPF without a PRI and primary closure could heal on a titanium membrane surface in vertical bone augmentation and to measure the change in KG width.
The bilateral mandibular second, third, and fourth premolars and first molars were extracted from 6 beagle dogs. After 3 months, 4 sites were prepared on each side of the mandible to perform vertical bone augmentation and divided into 4 groups using a randomized block design. Group A: Bio-oss + Ti-membrane + Bio-gide + PRI and closing MPF; Group B: Bio-oss + Ti-membrane + Bio-oss + Bio-gide + PRI and closing MPF; Group C: Bio-oss + Ti-membrane + Bio-oss + Bio-gide + no PRI and unclosing MPF; and Group D: Ti-membrane + Bio-gide + no PRI and closing MPF. The study parameters were wound healing rate and dehiscence rate, KG widths, histologic analysis of gingiva, and analysis of the Ti-membranes surface.
The wound dehiscence rates in groups A, B, and D were 50%, 41.67%, and 8.3%, respectively, and there was no statistical difference between group A and group B (P = 1.000). And in group C, only 1 wound exhibited incomplete soft-tissue closure of the gum (8.3%). The KG width in group C increased by 1.77 ± 0.37 mm, while the KG width in group B decreased by 4.37 ± 0.45 mm, and there was a significantly statistical difference between the 2 groups (P < .001). Compared to group B, the new gingiva in group C had better histological performance.
An MPF without PRI and primary closure can heal on the clean surface of the Ti membrane during vertical bone augmentation, and the KG can widen.
The results have implications for the postoperative wound management of GBR supported by a titanium membrane.
骨膜松解切口（PRI）常用于钛（Ti）网引导骨再生（GBR），以减轻黏骨膜瓣（MPF）的张力并关闭创口，但它容易导致角化龈（KG）变窄且创口裂开率高。因此，有必要探索如开放愈合等替代方法。本研究的目的是观察在垂直骨增量术中，不做PRI且一期缝合的MPF能否在钛膜表面愈合，并测量KG宽度的变化。
从6只比格犬双侧拔除下颌第二、三、四前磨牙及第一磨牙。3个月后，在每侧下颌骨制备4个位点进行垂直骨增量，并采用随机区组设计分为4组。A组：Bio-oss + Ti膜 + Bio-gide + PRI并关闭MPF；B组：Bio-oss + Ti膜 + Bio-oss + Bio-gide + PRI并关闭MPF；C组：Bio-oss + Ti膜 + Bio-oss + Bio-gide + 不做PRI且不关闭MPF；D组：Ti膜 + Bio-gide + 不做PRI并关闭MPF。研究参数包括创口愈合率和裂开率、KG宽度测量、牙龈组织学分析以及Ti膜表面分析。
A组、B组和D组的创口裂开率分别为50%、41.67%和8.3%，A组和B组之间无统计学差异（P = 1.000）。C组仅1个创口出现牙龈软组织不完全闭合（8.3%）。C组的KG宽度增加了1.77±0.37mm，而B组的KG宽度减少了4.37±0.45mm，两组间存在显著统计学差异（P <.001）。与B组相比，C组的新生牙龈组织学表现更好。
在垂直骨增量术中，不做PRI且一期缝合的MPF可在钛膜清洁表面愈合，且KG可增宽。
本结果对钛膜支持的GBR术后创口管理具有指导意义。
