Restoration of bone defects in horizontal atrophy of the mandible using a periosteal flap with simultaneous and delayed implantation

Abstract

The periosteal layer can be used effectively as a biological membrane in guided bone regeneration in horizontal atrophies of the lower jaw with or without simultaneous implant placement. The aim of the study. Evaluation of the horizontal guided bone regeneration efficacy, using bone graft material and a periosteal flap, with or without simultaneous implant placement, in patients with mandibular horizontal atrophy. Methodology. In this study were included 79 patients aged 25–65 years with horizontal atrophy of the mandible who were divided in two groups. The first group, included patients, who underwent guided bone regeneration through periosteal pocket flap with simultaneous implants placement and in the other one were included patients who underwent guided bone regeneration through periosteal flap only. In both groups, a combination of allogeneic osteoplastic material in the form of particles measuring 300–500 µm and autologous platelet-rich fibrin, obtained by centrifuging the patient’s venous blood immediately prior to surgery, was used. The sutures in both cases were removed after 7–10 days. Antibiotic therapy, antihistamines, and analgesics were prescribed as a prophylactic measure in both groups. Patients were followed up for 4 months. The width of the alveolar ridge was measured strictly on transversal sections in the projection of the implant site. Measurements were taken before operation and 4 months after. Results and conclusion. This study included 79 participants, of whom 42 underwent bone regeneration using a periosteal flap with simultaneous implant placement, while 37 underwent bone regeneration using a periosteal flap alone. The clinical and statistical results showed positive findings, with a significant increase in bone width in both groups. In the group undergoing periosteal flap surgery with simultaneous implant placement, the mean bone width increased from 3.231±0.506 mm to 7.513 ± 0.971 mm, corresponding to a mean increase of 4.281 ± 0.515 mm (95% CI: 4.121–4.442 mm; paired t-test, p < 0.001), while in the group using a periosteal flap, the mean bone width increased from 3.078 ± 0.730 mm to 5.497 ± 0.860 mm, corresponding to a mean increase of 2.419 ± 0.235 mm (95% CI: 2.341–2.497 mm; paired t-test, p < 0.001). A comparison of the treatment methods showed that the periosteal flap with simultaneous implant placemnt group achieved a significantly greater mean bone gain than the group in which only a periosteal flap was used (4.281 ± 0.515 mm versus 2.419 ± 0.235 mm). The mean difference between the groups was 1.862 mm, and Welch’s t-test confirmed that this difference was highly statistically significant (p < 0.001).