Mucoperiosteal Flap Healing During Vertical Bone Augmentation using Titanium Mesh: A Study in Beagle Dogs.

INTRODUCTION AND AIMS: 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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

CLINICAL RELEVANCE: The results have implications for the postoperative wound management of GBR supported by a titanium membrane.