Continuous Periosteal Strapping Sutures for Stabilization of Osseous Grafts With Resorbable Membranes for Buccal Ridge Augmentation: A Technique Report
Alveolar bone loss occurs after extraction with loss of a premolar or anterior tooth; the residual supporting alveolar bone loss averages 1.53 mm of crestal bone height and 3.87 mm of buccolingual width, with most of the bone loss occurring at the facial plate. Socket preservation does not completely preserve the original ridge contours but can be an effective means of reducing bone loss following extraction. Attempts to rebuild the alveolar ridge structure after tooth loss often employ the concept of guided bone regeneration, a technique-sensitive procedure that routinely involves placement of particulate bone with or without fixation screws and either a resorbable or a nonresorbable membrane. We present a novel technique for stabilizing a resorbable membrane and underlying particulate graft allowing for predictable bone grafting across multiple edentulous sites.
Figure 1. Membrane is sutured to the interior aspect of the lingual flap. Figure 2. The needle is advanced through the interior surface of the lingual flap outward and then looped back through the exterior surface of the lingual flap; a knot is then tied with the knot lying on top of the fixed membrane. Figure 3. The needle is then passed through the interior surface of the buccal flap crossing over the membrane and through the interior surface of the lingual flap; this action is repeated, moving from distal to mesial across the entire membrane, maintaining tension over the underlying membrane. Figure 4. The procedure is repeated until sufficient membrane stabilization is achieved. Figure 5. The final continuous periosteal strapping suture knot should be tied to the first knot (on top of the collagen membrane).
Figure 6. Failing nonrestorable canine and second premolar, the buccal osseous defect is clearly visible preoperatively. Figure 7. Midcrestal and papilla sparing incisions are made with a 15c blade; a full-thickness flap with vertical releasing incisions is reflected. Figure 8. Corticotomies are placed into the marrow space using a #1/2 or #2 round bur in the recipient bed. Figure 9. Resorbable membrane has been secured to the periosteum of the palatal flap, and osseous graft material has been placed over the recipient bed. Figure 10. Resorbable sutures are placed across the membrane that is overlaying the osseous graft to create tension and maintain the osseous graft in place, thereby preventing lateral and apical graft displacement during the healing period. Figure 11. The continuous periosteal strapping sutures maintain tension over the resorbable membrane. Figure 12. The flap has been repositioned with a tension-free closure across the underlying membrane and allogenic graft.
Figure 13. Cone-beam computed tomography at the canine region following graft maturation 6 months after guided bone regeneration presenting with an increase in ridge width. Note that the previous facial cortical plate is related to the density difference with the overlaying graft. Figure 14. Pretreatment one-beam computed tomography of the mandibular premolar area to be treated.
Figure 15. Image taken after the second premolar extraction and full-thickness flap reflection demonstrating ridge width that would be inadequate for implant placement. Figure 16. The continuous periosteal strapping sutures have been placed to retain the resorbable membrane overlaying the osseous graft that has been placed. Figure 17. Cone-beam computed tomography taken 6 months after grafting demonstrates an increase in ridge width. Figure 18. Six months after grafting, after a full-thickness flap, an increase in ridge width is noted that is sufficient to accommodate a prosthetically driven implant placement. Figure 19. Osteotomes have been created in the graft ridge, demonstrating a ridge wide enough to accommodate standard diameter implants. Figure 20. Implants have been placed into the grafted bone, which would not have been possible prior to ridge augmentation.
Contributor Notes