Periosteal Releasing Incision With Diode Laser in Guided Bone Regeneration Procedure: A Case Series

Abstract

Introduction: Periosteal releasing incision (PRI) is nearly always essential to advance the flap sufficiently for a tension-free flap closure in bone augmentation procedures. However, hematoma, swelling, and pain are recognized as the main consequences of PRI with scalpel. The aim of this case series was to investigate the effectiveness of laser-assisted PRI in guided bone regeneration (GBR) procedure. In addition, postoperative hematoma, swelling, and pain and implant success were assessed. Methods: Seventeen patients needed GBR were included in this study. Diode laser (940 nm, 2 W, pulse interval: 1 ms, pulse length: 1 ms, contact mode, 400-μm fiber tip) was used in a contact mode to cut the periosteum to create a tension-free flap. Facial hematoma, swelling, pain, and the number of consumed nonsteroidal anti-inflammatory drugs (NSAIDs) were measured for the six postoperative days. Six months after implant loading, implant success was evaluated. Results: Minimal bleeding was encountered during the procedure. A tension-free primary closure of the flap was achieved in all cases. The clinical healing of the surgical area was uneventful. None of the patients experienced hematoma, ecchymosis, or intense swelling after surgery. The mean value of maximum pain (visual analogue scale -VAS) was 20.59 ± 12.10 mm (mild pain). Patients did not need to use NSAID after four postoperative days. All implants were successful and functional and none of them failed after 6 months of implant loading. Conclusion: This study revealed the effectiveness of laser-assisted PRI in GBR procedure. This technique was accompanied with minimal sequelae at the first postoperative week. All implants were successful and no complication was noted during the course of this study.

Clinical and histological sequelae of surgical complications in horizontal guided bone regeneration: a systematic review and proposal for management

“…Out of the 23 studies (Table 1), there were 11 randomised controlled clinical trials [21-24, 26, 29-32, 36, 37, 39], one prospective cohort study [34,40], three retrospective cohort studies [18,20,33], and eight case series [16,17,19,25,27,28,35,38,[41][42][43], of which two research groups independently published two follow-up papers on the same study cohort [21,22,27,28], and they have been collectively grouped under one study name for this analysis. The follow-up period after ridge augmentation or implant placement was reported in all studies except two [16,35], and it ranged from 3.1 months to 10 years.…”

“…The follow-up period after ridge augmentation or implant placement was reported in all studies except two [16,35], and it ranged from 3.1 months to 10 years. Two studies excluded smokers [30,38], 14 studies reported periodontal status of subjects [16-18, 21-23, 25-30, 35, 36, 40-43], and excluded subjects with untreated periodontal disease, or with a full mouth plaque score and full mouth bleeding score of more than 25%.…”

“…In addition, post-surgical complications are often not reported in a standardised manner, which gave rise to a reporting bias as shown in the risk of bias analysis. For example, only two studies reported post-surgical complications such as extra-oral swelling [17,38], two studies reported postsurgical bleeding [20,34], and one study reported redness as a complication without much elaboration [23]. The negative impact of tobacco smoking on wound healing has been well documented in the literature [72].…”

Efficacy of local hyaluronidase administration in guided bone regeneration surgery: a randomized controlled trial

“…To prevent these complications, tension-free primary closure is a prerequisite for successful GBR surgery 4 . A periosteal releasing incision is a predictable and easy way to advance the flap when the soft tissue is insufficient to achieve complete coverage 5 , 6 . However, as the extent of release increases, the degree of hematoma, swelling, and pain also increase which has a significant effect on the quality of life of patients after surgery and can lead to surgical results that are not ideal 6 .…”