Double flap incision design for guided bone regeneration: a novel technique and clinical considerations

Premature membrane exposure for guided bone regeneration may result in complications, such as inadequate bone regeneration, inflammatory reactions, and wound infection. This paper presents a clinical case of a novel incision-flap design used to advance the flap to enhance tension-free primary closure for the vertical ridge augmentation.

A 61-year-old white man presented with the chief complaint of wanting to replace his posterior mandibular teeth. A severe alveolar bone deformity vertically and horizontally (Seibert Class III) was noticed, especially over the mental foramen area. A staged guided bone regeneration procedure prior to the implant installation was chosen as the most optimal treatment. A partial-thickness flap, separating the mucosal flap from the periosteum overlying the alveolar bone, was used to advance the flap.

During the healing period, neither soft tissue dehiscence nor membrane exposure were noted. Clinical and radiographic evaluation revealed a 4- to 5-mm gain in vertical height and a noticeable increase in horizontal thickness. After the 6 to 8 months of healing for both sites, two implants were placed on each side with good primary stability and without complications.

This technique facilitates flap advancement by the tension-free nature of the design and enhances soft tissue maintenance during the course of regeneration. This approach, the separation of the periosteal layer and the mucosal layer, can be used as an alternative to overcome some of the limitations with conventional technique.