Comparison of two different lingual flap advancement techniques and vascular structure identification: a human cadaver study

Abstract

Background: One of the most frequent complications in guided bone regeneration (GBR) is wound dehiscence, which compromises treatment outcomes. Thus, primary tension-free suture is essential to avoid wound dehis-cence. The purpose of this study was to compare the extension of 2 different mandibular flaps in human cadaveric specimens, and to measure the size of the supraperiosteal blood vessels. Material and Methods: Five freshly unfrozen human cadaveric specimens were used. Arteries and veins were marked and bilateral classical lingual flaps (extending from the second premolar to the retromolar area) were pre-pared. In one side, the mylohyoid muscle was detached to increase the coronal extension of the flap. An implant drill was used to measure the extension of the flap after exerting 30 g of traction, before and after detaching the mylohyoid muscle. The size of the largest vascular structures of the flap was measured using a periodontal probe. Results: The classical flap extension was 5.99 mm (95% confidence interval (CI): 5.08 to 6.90), while the coronally advanced flap extension with mylohyoid muscle detachment was 14.96 mm (95%CI: 10.81 – 19.11). A statistically significant difference was found between the 2 groups ( p= 0.0002), with a mean extension difference was 8.97 mm (95%CI: 5.02 to 12.91). The mean largest artery had 0.20 mm of diameter (95%CI: 0.15 – 0.26). Conclusions: The detachment of the mylohyoid muscle from the lingual flap allows to significantly increase its extension by 2.5 times. The superficial arteries found in the lingual flap have a small diameter (around 0.2mm).