Use of a partial-thickness flap for Guided Bone regeneration in the upper jaw

Abstract

Introduction: Guided bone regeneration (GBR) aims to restore adequate bone volume for the placement of implants in an ideal location. In this article, we analyze different surgical techniques for tissue management during GBR and a modified partialthickness surgical approach. Materials and methods: In a year's time span, five patients were enrolled in the study: Four women and one man (aged 44-59 years). In four patients, a GBR with simultaneous implant placement was adopted, whereas in another patient, a delayed implant placement was done. The flap was of full thickness and overturned on the side palatal with the aim of a retractor, thus exposing the bone crest. The graft material was covered and protected with a resorbable collagen membrane (Geistlich Bio- Gide®, Switzerland). The periosteal layer of the flap was then positioned above the resorbable membrane without traction. The sutures as vertical mattress were then positioned. Each patient received an intramuscular betamethasone dose (4 mg/50 kg) and antibiotic therapy for 7 days (amoxicillin + clavulanic acid 1 gm every 12 hours) and was instructed to maintain oral hygiene and appropriate wound cleaning. The patients were recalled at different times to monitor the healing. Results: No cases of tissue dehiscence were observed during the period of wound healing. One patient, however, showed a delayed exposure 4 months after surgery. This occurrence was managed without complications for the patient. Conclusion: The design of proposed flap seems to be effective in controlling the risk of dehiscence during the healing time in the GBR. The vascular supply was rarely compromised. The results we obtained are encouraging even if further studies on this technique are needed. Clinical significance: Lateral partial-thickness flaps seem to be effective in controlling tissue tension and consequently the risk of dehiscence. The incision vestibularly performed should favor the soft tissue healing.