Guided Bone Regeneration-Associated Tissue Swelling: A Digital Three-Dimensional Assessment

Document Type

Article

Publication Date

2024

Publisher

Elsevier

Source Publication

The Journal of Prosthetic Dentistry

Source ISSN

0022-3913

Original Item ID

DOI: 10.1016/j.prosdent.2024.09.009

Abstract

Statement of problem

Postoperative swelling following guided bone regeneration (GBR) may affect the dimensions of interim restorations and/or delivery timing. However, quantitative assessment of post-GBR swelling or its evaluation for possible impact on regenerative outcomes is lacking.

Purpose

The purpose of this prospective clinical study was to quantify post-GBR swelling and correlate it with clinical parameters and outcomes.

Material and methods

Participants (n=25) undergoing standardized extraction and GBR protocol were recruited. Site-specific swelling was measured as ridge width, height, and volume changes based on intraoral scans recorded preoperatively, immediately postoperatively (IP), and at 2 days, 7 days, 14 days, and 4 months. The parameters and outcomes assessed were gingival and mucosal thickness, flap advancement, surgery duration, wound opening, and bone gain. The Friedman 2-way analysis of variance by ranks was performed, and the Spearman correlation coefficients (ρ) were computed (α=.05).

Results

Ridge width and height peaked at 2 days (2.1 mm for both from IP; P>.999 and P=.888, respectively). At 4 months, both decreased significantly compared with IP (−4.2 mm and −1.9 mm respectively, P=.043), mucosal thickness (ρ=0.51, P=.021), and flap advancement (ρ=0.58, P=.008).

Conclusions

Following GBR, site-specific swelling peaked on postoperative day 2 and subsided by day 7 (width) or 14 (height). Soft tissue thickness and flap advancement affected post-GBR bone width. Months after guided bone regeneration (GBR) with particulate bone allograft and resorbable membrane, horizontal bone gain has been reported to reach approximately 3.5 mm. Dimensional change can be seen immediately after surgery because of the added bone graft material. However, during early healing, GBR sites exhibit additional dimensional changes attributable to soft tissue swelling. Swelling, a common cardinal inflammation sign, may be exacerbated by more traumatic interventions2. Compared with simple flap elevation, GBR surgery leads to increased swelling because of the vertical and periosteal releasing incisions for flap advancement and tension-free closure, introduction of biomaterials, and increased surgery duration. Significant swelling may increase the probability of wound dehiscence or membrane exposure, a complication associated with decreased post-GBR bone gain. Although post-GBR swelling has been documented as a patient-reported outcome, its clinical quantification and its potential relationship with specific clinical parameters (surgery duration, flap advancement, soft tissue thickness) or with surgical outcomes (wound opening, bone gain) is unknown. Therefore, the primary purpose of this clinical study was to quantify post-GBR swelling (ridge height and width changes). Its secondary purpose was to correlate post-GBR swelling with surgery- and site-specific clinical parameters (duration of surgery, soft tissue thickness, flap advancement) and relevant outcomes (wound opening, bone gain). The null hypothesis was that no significant changes in ridge dimensions from IP would be found at the postoperative follow-up.

Comments

The Journal of Prosthetic Dentistry, online before print. DOI.

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