Date of Award

Spring 2022

Document Type

Thesis - Restricted

Degree Name

Master of Science (MS)





First Advisor

Kofina, Vrisiis

Second Advisor

Dentino, Andrew

Third Advisor

Rawal, Swati


Introduction: Patient experiences vary following different oral surgeries. It isempirically accepted that patients experience increased swelling following guided bone regeneration (GBR) due to significant flap manipulation. However, objectively measured immediate postoperative dimensional changes have not been investigated. Therefore, the purpose of this study is to quantify post-GBR swelling during the first two weeks of healing and correlate it with patient-centered outcomes and clinical parameters such as flap advancement. Materials and Methods: Patients undergoing GBR, according to standardized surgical protocol, at a single tooth-bound site were recruited. Flap margin location, relative to reference line, was recorded before and after periosteal releasing incisions, using standardized force (calibrated dynamometer); flap advancement (mm) was calculated as the difference between the two flap margin location measurements. Intraoral scans were recorded at preop and immediate postop (IP), 2, 7 and 14 days. After scan registration, ridge width, height, and volume changes from IP were recorded. VAS for pain, swelling and difficulty of mouth opening as well as OHIP-14 were recorded at preop and 2, 7 and 14 days. Results: Thirty subjects (16 males, 58.7±2.59 years) were recruited. Flap advancement was 6.32±0.55 mm (2,13). Ridge width, height and volume increased significantly from IP to day 2 (1.79±0.39mm; 2.02 ±0.15 mm; 21±2.7% respectively). All three parameters were significantly decreased at 14 days (p≤0.01). OHIP-14 and VAS for pain, swelling and mouth opening exhibited the same trajectory, peaking at day 2 and significantly decreasing by day 14 (p≤0.01). There was no correlation between postoperative dimensional changes and patient experiences. The probability of moderate or severe swelling at postoperative day 2 increased 1.5-fold with each 1mm of flap advancement. Conclusion: Maximum swelling and most unpleasant patient experiences following GBR occur at 2 days following GBR and improve by the end of the second postoperative week. Objectively quantified post-GBR swelling does not correlate with patient-reported outcomes. Flap advancement is a determinant of postoperative swelling on postoperative day 2.


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