Modified Periosteal Releasing Incision (MPRI) for Primary Closure: Visualization of the Mental Nerve
Periodontal surgery often requires flap advancement for adequate coverage of the surgical site with tension-free primary closure essential for successful outcomes. Although the periosteal releasing incision is frequently performed, it may necessitate deeper or more incisions, which could result in consequences such as edema, bleeding, paresthesia, and discomfort for the patient. To address these issues, the modified periosteal releasing incision was proposed to minimize trauma into the submucosa. In this paper, we update the technique, emphasizing its application in visualizing the mental nerve to avoid nerve damage during significant flap advancement in the posterior mandible. The technique provides an alternative approach to traditional techniques, ensuring patient safety and improving surgical outcomes. Future research is needed to explore its benefits and applications in various clinical scenarios.
Sequence of modified periosteal releasing incision. (a) Initial incision: coronal segment—the portion of the flap above the incision line; apical segment—the portion below the incision line. (b) Lateral stretching incision. (c) Apical detaching incision. (d) Further application of lateral stretching.
Clinical sequence of modified periosteal releasing incision. (a) Initial presentation. (b) Midcrestal incision with a mesial vertical incision. (c) Occlusal view with a mesiolingual vertical incision. (d) Initial incision (0.5 mm). (e) Lateral stretching. (f) Apical detaching incision. (g) Further application of lateral stretching. (h) 10+mm of flap advancement. (i) Primary closure with horizontal mattress and simple interrupted sutures.
Surgical steps of visualization. (a) A full-thickness flap is created to expose the roof of the mental foramen. (b) An initial incision is made into the submucosa to a depth of less than 0.5. (c) Lateral stretching moves the mucosa upward over the main branch of the mental nerve to visualize the nerve through the thin layer of the mucosal flap. (d) The flap is being stretched further for confirmation of the nerve. (e) Apical detaching incision parallel to the flap provides additional flap advancement. (f) A lateral peeling or push motion of the modified periosteal releasing incision finalizes visualization of the mental nerve.
(a) The 20+mm flap advancement with the modified periosteal releasing incision (MPRI). (b) Internal cutout to relieve tension from the base of MPRI.
(a) Visualization of the terminal branch of lingual artery following an application of the modified periosteal releasing incision (MPRI). (b) Careful execution of lateral stretching 3 mm above the roof of the mental foramen. (c) Clinical presentation of mental nerve with MPRI. (d) Advanced application of MPRI for significant flap advancement in a severely resorbed alveolar ridge.
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