When performing extensive GBR, we want to insure the primary closure of the flap margins over the graft and membrane. In this example, following the placement of the DALI bone graft and OsseoSeal membrane, the buccal flap was released from the periosteum for passive mobilization (Pictures 1,2,3,4). Prior to suturing the flap margins together at the crest, a periosteal-relief suture is placed in order to prevent any tension from pulling back the flaps (Picture 5). This allows the flaps to stay relaxed without needing to be pulled together. Afterwards, sutures are used to approximate the buccal and palatal flap margins to achieve primary closure that will endure throughout the initial healing period (Picture 6). We see that following 2 weeks of healing, proper primary closure allowed the grafted site to remain covered (Picture 7).
Nice presentation. I want to add a few clinical aspects:
- flap releasing/passivation better be done by “combing” aka elongating periosteum fibers not incisions. But, skill and patience is the key. Incisions means more risks.
- I would preserve the papillae of the neighbouring teeth, a better seal for the graft, minimal risks of bacterial invasion.
Best regards,
Ella
Can you explain how to do the 5th pic suture?
on the palatal of pic 6. the pic 5 periosteal-relief sutures looks like very apical horizontal mattress sutures?