Efficacy of Labial Split-Thickness Eversion Periosteoplasty for Soft Tissue Management in Posterior Mandibular Horizontal Ridge Augmentation Procedures: A Prospective Clinical Study.

IF 1.7 4区 医学 Q3 DENTISTRY, ORAL SURGERY & MEDICINE
Gerald Krennmair, Michael Weinländer, Forstner Thomas, Stefan Krennmair, Michael Stimmelmayr, Michael Malek
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引用次数: 0

Abstract

Purpose: To evaluate the efficacy of split-thickness labial eversion periosteoplasty (EPP) for soft tissue closure in horizontal ridge augmentation of posterior mandibular regions using a bone shell onlay grafting technique. Materials and Methods: Sixteen patients (12 female and 4 male; mean age: 46.2 ± 8.7 years) with 18 horizontal bone defects in posterior mandibular regions were included for lateral onlay bone grafting using the bone shell technique. After lateral bone augmentation, the EPP was used for soft tissue closure and was prospectively followed up for wound healing efficacy using a modified scoring index. The scoring index included dichotomous (yes: 0 / no: 1) evaluation of the following items: (1) bleeding on palpation or spontaneously, (2) tissue color difference, (3) presence of hematoma, (4) presence of granulation tissue, (5) incomplete incision margin closure, (6) dehiscence with visible augmentation material, (7) presence of exudation, and (8) presence of suppuration. In addition, a visual analog scale (VAS) was used to quantify and record the amount of pain and swelling (0 = no pain/swelling and 5 = severe pain/swelling); VAS scores of 0, 1, and 2 were rated as 1 in the dichotomous scoring index, and VAS scores of 3, 4, and 5 were rated as 0. A summarized wound healing score consisting of all 10 items was assessed at days 2, 7, and 14 and at months 1 and 4 postoperatively, including a comparison of the follow-up evaluations. Results: The summarized healing score increased significantly (P < .01) between day 2 (score: 6.6 ± 1.1) and day 7 (score: 8.9 ± 1.0) but showed little difference between day 14 (score: 9.6 ± 0.6) and the 1- and 4-month follow-ups (score: 10.0 ± 0). There was no wound dehiscence and no incomplete incision margin adaptation. For the individual parameters evaluated, bleeding on palpation, hematoma, and exudation were the most frequent side effects at day 2 at 50%, 100%, and 22.2%, respectively, and at day 7 at 16.7%, 55.6%, and 22.2%, respectively. The average pain score and the swelling/edema score were initially 4.0 ± 0 and 3.0 ± 0.77 on day 2, with a significant decrease (P < .001) by day 7 (pain: 2.0 ± 0; edema/swelling: 2.0 ± 0.59) and day 14 (pain: 1.0 ± 0.42; edema/swelling: 2.0 ± 0.79) and complete absence (score: 0) at months 1 and 4. Conclusions: Labial split-thickness EPP facilitates flap advancement and enables tight soft tissue coverage in large horizontal posterior mandibular bone augmentations as a result of offset double-layer wound closure. Although this procedure is shown to be surgically demanding, the postoperative complication rate may be reduced significantly.

下颌后水平嵴扩大术中唇侧裂厚Eversion骨膜成形术治疗软组织的疗效:一项前瞻性临床研究。
目的:评价应用骨壳内固定技术行唇侧外翻骨膜松解术(EPP)在下颌后段水平嵴隆凸术中的疗效。材料与方法:16例(女12例,男4例,平均年龄46.2±8.7岁)下颌后段水平骨缺损18例,采用骨壳技术进行侧嵌骨移植。外侧骨增强术后,EPP用于软组织闭合,并使用改良评分指数对伤口愈合效果进行前瞻性随访。评分指数包括对以下项目的二分法(是:0/否:1)评估:(1)触诊或自发出血,(2)组织色差,(3)有血肿,(4)有肉芽组织,(5)切口边缘闭合不完全,(6)有可见增强材料的裂开,(7)有渗出,(8)有化脓。此外,使用视觉模拟量表(VAS)来量化和记录疼痛和肿胀的程度(0=无疼痛/肿胀,5=剧烈疼痛/肿胀);VAS评分0、1和2在二分评分指数中被评为1,VAS评分3、4和5被评为0。在术后第2天、第7天和第14天以及第1个月和第4个月评估由所有10个项目组成的总结伤口愈合评分,包括随访评估的比较。结果:在第2天(评分:6.6±1.1)和第7天(评分为8.9±1.0)之间,总结愈合评分显著增加(P<0.01),但在第14天(评分9.6±0.6)和1个月和4个月随访(评分10.0±0)之间差异不大。没有伤口裂开,也没有切口边缘适应不完全。对于评估的个体参数,第2天触诊出血、血肿和渗出是最常见的副作用,分别为50%、100%和22.2%,第7天分别为16.7%、55.6%和22.2%。第2天的平均疼痛评分和肿胀/水肿评分最初分别为4.0±0和3.0±0.77,到第7天(疼痛:2.0±0;水肿/水肿:2.0±0.59)和第14天(疼痛:1.0±0.42;水肿/肿胀:2.0±0.79)显著下降(P<.001),第1个月和第4个月完全消失(评分:0)。结论:由于偏置双层伤口闭合,在下颌后段大的水平骨增强中,唇裂厚EPP促进了皮瓣的推进,并使软组织能够紧密覆盖。尽管这种手术要求很高,但术后并发症发生率可能会显著降低。
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来源期刊
CiteScore
3.30
自引率
5.00%
发文量
115
审稿时长
6 months
期刊介绍: Edited by Steven E. Eckert, DDS, MS ISSN (Print): 0882-2786 ISSN (Online): 1942-4434 This highly regarded, often-cited journal integrates clinical and scientific data to improve methods and results of oral and maxillofacial implant therapy. It presents pioneering research, technology, clinical applications, reviews of the literature, seminal studies, emerging technology, position papers, and consensus studies, as well as the many clinical and therapeutic innovations that ensue as a result of these efforts. The editorial board is composed of recognized opinion leaders in their respective areas of expertise and reflects the international reach of the journal. Under their leadership, JOMI maintains its strong scientific integrity while expanding its influence within the field of implant dentistry. JOMI’s popular regular feature "Thematic Abstract Review" presents a review of abstracts of recently published articles on a specific topical area of interest each issue.
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