Clinical study of alveolar bone mucosa-periosteal bone flap as horizontal bone augmentation

Clinical study of alveolar bone mucosa-periosteal bone flap as horizontal bone augmentation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical study of alveolar bone mucosa-periosteal bone flap as horizontal bone augmentation Xinghuanyu Xu, Pu Xu, Shuangxi Liu, Yanan Cheng, WenBai Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4263395/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Feb, 2025 Read the published version in BMC Oral Health → Version 1 posted 13 You are reading this latest preprint version Abstract Background The present work focused on observing the efficacy of alveolar bone mucosa- periosteal bone flap in alveolar ridge horizontal bone augmentation with dental implant placement. Methods This was a retrospective study involving 49 patients with 99 implants, which was conducted to measure the alveolar ridge widths pre- and post-operatively. The alveolar ridge widths were 4.77 ± 1.49 mm preoperatively and 7.68 ± 1.60 mm postoperatively. Results There was a significant difference in alveolar ridge width before and after operation (P < 0.05), to be specific, the alveolar ridge width increased by 2.91 ± 0.11 mm after operation. Conclusion These results suggest that alveolar bone mucosa-periosteal bone flap technique is an effective method to increase the alveolar ridge width with the simultaneous placement of dental implants, which is worthy to be recommended in clinical practice. Alveolar ridge Horizontal bone augmentation Mucosa-periosteal bone flap Dental implant Figures Figure 1 Figure 2 Background Dental implant is a common method used to restore maxillary and mandibular missing teeth [ 1 , 2 ] . To obtain the ideal osseointegration and restoration, it is required to maintain the buccal and palatal plate width of 1 mm at least [ 3 ] . Trauma, atrophy, or surgeries can result in the lack of alveolar bone in some cases, where bone augmentation is proved effective [ 4 – 6 ] . Mucosa-periosteal bone flap (MBF) is constituted by labial (buccal) mucoperiosteal flap and bone for the sake of increasing the horizontal alveolar ridge width, which cuts a trapezoid bone block penetrating the cortex from the alveolar bone along the alveolar crest and lip (buccal) bone in the alveolar bone width deficiency region, and bone splitting is performed along the alveolar crest of primary bone cutting line after 4 weeks [ 7 ] . This article aimed to assess the effect of alveolar ridge bone augmentation using MBF technique in 49 patients (99 implants), through measuring the alveolar ridge widths before and after implant placement. Materials and Methods 1. Participants The patients with narrow alveolar ridges requiring dental implantation were recruited from Oral Implantation Department, Affiliated Haikou Hospital of Central South University Xiangya Medical School & Hainan Provincial Stomatology Center from October 2013 to December 2023. Inclusion criteria: (1) Patients who received MBF surgery to operate bone increment; (2) patients without contraindication in partial or the whole body; (3) patients not taking medicines that affected bone growth within the last 12 months; and (4) patients with complete case information without loss of follow-up. All included patients gave their informed consent and participated voluntarily; in the case of minors, their parents/legal guardians also signed the consent form. All subjects filled out an epidemiologic questionnaire before undergoing a clinical examination. This study was performed by the Declaration of Helsinki and also received the approval from the Biomedical Ethics Committee at affiliated Haikou Hospital of Central South University Xiangya Medical School (reference number 2016-019). 2. Instruments and materials (1) Instruments: CBCT (New Tom, Italy), piezosurgery (SATELEC Piezotome 2, France), dental implanter (Nobel, Austria) and centrifuge (TD4Z-WS, Changsha), etc. (2) Medical appliances: mainly including Osseoset 200, Nobel Active AB, Bicon toolbox and other relevant appliances. (3) Implants: Nobel Active (Nobel, Sweden), Bicon (Bicon, America), Osstem (Osstem, Korea) and Dentis (Dentis, Korea). 3. Treatment Process (1) Periodontal non-surgical treatment: supragingival scaling, subgingival scaling and oral hygiene education were routinely carried out. (2) The PRF preparation was accomplished according to the approach introduced by Cheng Yanan , et al. 9 (3) The MBF technique was prepared and the implant was inserted using the method presented by Xu Pu , et al. 8 (4) Stage II operation and missing tooth restoration: at 3-6 months after the insertion of implants, stage II operation was performed. To be specific, the healing cap was removed, and then the healing abutments were inserted for accelerating soft tissue sulci formation. After 2 weeks, the cuffs were in healthy condition, and the missing teeth were restored after taking an impression. 4. Effect Evaluation (1) Clinical effect: Whether soft tissue of the cuff lip was full, and whether the fullness on the labial (buccal) side of the edentulous area was restored after the completion of stage II operation and prostheses. (2) Cone beam computed tomography (CT) observation: Cross-section changes of alveolar ridge, alveolar crest width and bone plate thickness on the lip (cheek) side after implantation. (3) Measurement of the alveolar ridge widths before and after implantation: The alveolar ridge widths were determined before implantation and after the final restoration using MBF technique. Then, data were compared. 5. Statistical analysis SPSS Statistics software (version 22.0) was employed for analyzing data. In addition, the alveolar ridge widths before implantation and after the final restoration were compared by paired t test, and results were expressed as M±SD. The significance level was set at P < 0.05. Results The present work recruited 49 cases (age, 17–69 years) and 99 implants. The proportions of female patients (27 patients, 55 implants) and patients with mandibular lesions (29 patients, 56 implants) were higher, while those of male patients (22 patients, 44 implants) and patients with maxillary lesions (20 patients, 43 implants) were lower (Table 1 ). Table 1 The distributions of sex and tooth position in 49 patients with insufficient width of alveolar ridge. cases (implants) group maxilla mandible total male 10(22) 12(22) 22(44) female 10(21) 17(34) 27(55) total 20(43) 29(56) 49(99) In clinical observation, the alveolar ridge was mostly triangular and its top was narrow before implantation. There were more soft tissues on cuff labial (buccal) side, thereby restoring the fullness of the edentulous area on the labial (buccal) side, and the aesthetic was available after the completion of stage II operation (Fig. 1 ). Cone beam CT examination revealed that the triangular alveolar ridge before operation turned into the trapezoidal alveolar ridge in coronal section after operation, moreover, the bone on the lip (buccal) side of the implant was significantly greater than 1 mm (Fig. 2 ). Meanwhile, the alveolar ridge crest widths were determined before implantation and after the final restoration (Fig. 2 ), and statistical analysis was carried out. According to the results, the alveolar ridge widths were 4.77 ± 1.49 mm before implantation and 7.68 ± 1.60 mm at 3–6 months after implantation. Clearly, the alveolar ridge width elevated by an average of 2.91 ± 0.11 mm. The difference was statistically significant before and after implantation (t = 13.53, P = 0.00 < 0.05) (Table 2 ). Table 2 The alveolar ridge crest widths before and after implantation Implant number Alveolar ridge width (M ± SD) P Before implantation 99 4.77 ± 1.49 0.00 After restoration 99 7.68 ± 1.60 Discussion Implant-supported restoration is an ideal approach for missing teeth, and alveolar bone quality and quantity are key factors for ensuring the correct implant position [ 8 ] . Following factors may contribute to the insufficient width of alveolar ridge that mostly occurs in female patients and mandible, compared with male patients and maxilla (Table 1 ). Asian females are petite compared with European females, besides, their skeletons including mandibles are comparatively small as well. Patients with narrow mandibular ridge are more likely to have insufficient alveolar ridge width after teeth extraction. Since the bearing area is smaller than maxilla, the mandibular alveolar ridge is more easy to be constricted and absorbed after restoration. Traditional osteotomy has a good effect on the increase in alveolar bone width, but this method is associated with the risk of fracture, necrosis and bone mass absorption. The use of MBF can achieve better outcome in the horizontal alveolar bone augmentation. After pushing the prepared trapezoid bone block onto the buccal side, the vascularization between mucoperiosteum and bone block has already been formed. This phenomenon ensues the nutrition supply of bone block, thus preventing the necrosis and absorption of bone block [ 7 ] . Tooth loss may usually be accompanied by the reduction of alveolar bone, thus causing the severe atrophy of alveolar bone and forming the blade-shaped alveolar ridge [ 9 – 11 ] . It is a common clinical problem to repair the posterior missing tooth in the atrophic alveolar ridge [ 12 – 14 ] . In the clinical observation of this study, the alveolar ridge was mostly triangular and its top was narrow before implantation. The top of the alveolar ridge increased by the MBF technique at the time of implant placement. After stage II operation, the soft tissues on the lip (buccal) side of the cuff were full, the fullness on the lip (buccal) side of the missing teeth was restored, and the aesthetic was available after the teeth restoration (Fig. 1 ). Cone beam CT examination revealed that the implant restoration cases achieved favorable clinical outcomes in this study. The alveolar ridge was obviously widened after implantation (trapezoidal in the cross section) compared with that before implantation (triangular in the cross section), and the bone on lip (buccal) side of the implant was significantly greater than 1 mm. After measurement, the alveolar ridge widths were 4.77 ± 1.49 mm before implantation and 7.68 ± 1.60 mm after implantation, which increased by 2.91 ± 0.11 mm. The alveolar crest width increased significantly after operation (Fig. 2 ). This suggests that the MBF technique achieves positive clinical effect, similar to the results obtained by other scholars 19 . Some scholars report that bone grafting can achieve preferable outcomes in alveolar bone augmentation [ 15 , 16 ] . However, it is necessary to develop the second operative areas for graft acquisition. Implant placement is postponed for 3–6 months, and the graft bone absorption rate reaches 20%-50% at 6 months later [ 17 ] . The guided bone regeneration (GBR) procedures are also linked with a risk of membrane exposure and membrane rupture, leading to infection [ 18 , 19 ] . Interpositional augmentation involves ridge split and ridge expansion, both of which have attained ideal outcomes in the maxilla [ 14 ] . But an increased risk of block fracture after osteotomy is seen in the mandible because of the thick cortical bone. Consequently, for minimizing the fracture risk in these patients, apical and vertical horizontal cuts are made. The ridge split procedure is flexible when the immature bone callus is formed at the cortical incision site. Some scholars report that ridge split can be performed when the callus is mature (3 months) at the site of the cortical incision, and the primary stability of the implants is better [ 20 ] . In general, it is difficult to cut the cortical bone with manual instruments during the MBF operation, in particular, the exact osteotomy is more difficult. The use of motor-driven equipment to cut the bone will produce extensive heat, and such excess heat in neighboring tissues can extend the healing time. Therefore, the piezoelectric osteotomy performed in this article exhibits two important advantages. Firstly, the cut can be secured since the ultrasound frequency induces no injury to the soft tissue. Secondly, cutting is less invasive, resulting in superior healing. A more predictable effect can be obtained with this approach [ 21 ] . Conclusion The MBF technique steadily increases the width of the alveolar bone, and cuts the bone through piezoelectric osteotomy for achieving the expected effect. When designing the "mucous bone flap", attention should be paid to the labial bone thickness to ensure osteogenesis in the lip bone of the implant, thus improving the implant restoration effect in the near and long term [ 7 ] . The MBF technique offers a new approach for solving the insufficient alveolar ridge, and its long-term effect remains to be further observed. Abbreviations MBF Mucosa-periosteal bone flap Declarations Ethics approval and consent to participate All included patients gave their informed consent and participated voluntarily; in the case of minors, their parents/legal guardians also signed the consent form. All subjects filled out an epidemiologic questionnaire before undergoing a clinical examination. This study was performed by the Declaration of Helsinki and also received the approval from the Biomedical Ethics Committee at affiliated Haikou Hospital of Central South University Xiangya Medical School (reference number 2016-019). Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due [The project is not finished] but are available from the corresponding author on reasonable request. Conflict of Interests The authors declare no competing interests. Funding The present study was funded by the National Natural Science Foundation of China (Grant no.82060194), Key Research and Development Project of Hainan Province (Grant no. ZDYF2022SHFZ119). Authors' contributions Pu Xu: New technical design, operation, and literature inquiry. Xinghuanyu Xu: New technology naming and interpretation, and writing. Shuangxi Liu: Operation, and data statistical analysis. Yanan Cheng: Surgical assistant and picture production. Wenbo Zhang: Surgical assistant. Dou Yu: Photo taking and collection. Liying Lu: Surgical instrument management and preoperative preparation. References DUONG H Y, ROCCUZZO A, STäHLI A et al. Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses [J]. Periodontol. 2000, 2022, 88(1): 201 – 37. SáENZ-RAVELLO G, OSSANDóN-ZúñIGA B, MUñOZ-MEZA V, et al. Short implants compared to regular dental implants after bone augmentation in the atrophic posterior mandible: umbrella review and meta-analysis of success outcomes [J]. Int J Implant Dent. 2023;9(1):18. LEE K J, CHA J K, SANZ-MARTIN I, et al. A retrospective case series evaluating the outcome of implants with low primary stability [J]. Clin Oral Implants Res. 2019;30(9):861–71. ARNAL H M, ANGIONI C D, GAULTIER F, et al. Horizontal guided bone regeneration on knife-edge ridges: A retrospective case-control pilot study comparing two surgical techniques [J]. Clin Implant Dent Relat Res. 2022;24(2):211–21. AMARAL, VALLADãO CA, FREITAS MONTEIRO M JR, JOLY JC. Guided bone regeneration in staged vertical and horizontal bone augmentation using platelet-rich fibrin associated with bone grafts: a retrospective clinical study [J]. Int J Implant Dent. 2020;6(1):72. ZAHEDI L, MOHAMMADI M, KALANTARI M, et al. Horizontal ridge augmentation with particulate cortico-cancellous freeze-dried bone allograft alone or combined with injectable-platelet rich fibrin in a randomized clinical trial [J]. Clin Implant Dent Relat Res; 2023. XU P, LI X N, XU X, et al. [Use of alveolar bone mucosa-periosteal bone flap in dental implantation] [J]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2016;51(11):688–90. NAENNI N, STUCKI L, HüSLER J, et al. Implants sites with concomitant bone regeneration using a resorbable or non-resorbable membrane result in stable marginal bone levels and similar profilometric outcomes over 5 years [J]. Clin Oral Implants Res. 2021;32(8):893–904. UDEABOR SE, HESELICH A, AL-MAAWI S et al. Current Knowledge on the Healing of the Extraction Socket: A Narrative Review [J]. Bioeng (Basel), 2023, 10(10). GOUDARZI F, ANBIAEE N, SHAKERI MT. Comprehensive view of the posterior mandibular ridge morphology [J]. Int J Oral Maxillofac Surg. 2024;53(2):170–7. ATWOOD DA. Reduction of residual ridges: a major oral disease entity [J]. J Prosthet Dent. 1971;26(3):266–79. TERHEYDEN H, MEIJER G J, RAGHOEBAR GM. Vertical bone augmentation and regular implants versus short implants in the vertically deficient posterior mandible: a systematic review and meta-analysis of randomized studies [J]. Int J Oral Maxillofac Surg. 2021;50(9):1249–58. ATIEH M A, ALSABEEHA N H, PAYNE A G et al. Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development [J]. Cochrane Database Syst Rev, 2021, 4(4): Cd010176. LALO J, ADOUANI H, BOURAOUI S, et al. Maxillary alveolar bone ridge width augmentation using the frame-shaped corticotomy expansion technique [J]. J Stomatol Oral Maxillofac Surg. 2020;121(2):163–71. SGHAIREEN M G, SHRIVASTAVA D, ALNUSAYRI M O, et al. Bone Grafts in Dental Implant Management: A Narrative Review [J]. Curr Pediatr Rev. 2022;19(1):15–20. GOUTAM M, BATRA N, JYOTHIRMAYEE K, et al. A Comparison of Xenograft Graft Material and Synthetic Bioactive Glass Allograft in Immediate Dental Implant Patients [J]. J Pharm Bioallied Sci. 2022;14(Suppl 1):S980–2. AL HAYDAR B, KANG P, MOMEN-HERAVI F. Efficacy of Horizontal Alveolar Ridge Expansion Through the Alveolar Ridge Split Procedure: A Systematic Review and Meta-Analysis [J]. Int J Oral Maxillofac Implants. 2023;38(6):1083–96. SBRICOLI L, GUAZZO R, ANNUNZIATA M et al. Selection of Collagen Membranes for Bone Regeneration: A Literature Review [J]. Mater (Basel), 2020, 13(3). ZHOU Q, YANG F, LI N, et al. Healing outcomes of open versus closed flap procedures for collagen membrane coverage following immediate dental implant placements with simultaneous guided tissue regeneration [J]. J Dent. 2024;141:104735. LI X M, BAO JB, XIE ZG. [Application of two-stage ridge splitting technique in atrophic mandibular alveolar ridge] [J]. Hua Xi Kou Qiang Yi Xue Za Zhi. 2020;38(3):338–42. LI X, XU P, XU X, et al. The application of a delayed expansion technique for horizontal alveolar ridge augmentation in dental implantation [J]. Int J Oral Maxillofac Surg. 2017;46(11):1451–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Feb, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 08 Oct, 2024 Reviews received at journal 04 Oct, 2024 Reviewers agreed at journal 04 Oct, 2024 Reviews received at journal 11 Sep, 2024 Reviewers agreed at journal 23 Aug, 2024 Reviews received at journal 25 Jul, 2024 Reviewers agreed at journal 21 Jul, 2024 Reviewers agreed at journal 18 Jul, 2024 Reviewers invited by journal 01 Jul, 2024 Editor invited by journal 30 Apr, 2024 Editor assigned by journal 30 Apr, 2024 Submission checks completed at journal 22 Apr, 2024 First submitted to journal 13 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4263395","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":294099674,"identity":"6b1efe4e-83e6-46d1-a484-82ed84be3f1e","order_by":0,"name":"Xinghuanyu Xu","email":"","orcid":"","institution":"Affiliated Haikou Hospital of Central South University Xiangya Medical School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xinghuanyu","middleName":"","lastName":"Xu","suffix":""},{"id":294099675,"identity":"a84cdb48-bd67-45b5-a0d8-e3d6d9b3628b","order_by":1,"name":"Pu Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAoklEQVRIiWNgGAWjYBACAwhlw8PP30CaljQZyRkHSNNy2MagIYFILebSPWbShW3neQwYDjB++JhDhBbLOcfSpGe23eYxZ25glpy5jRiH3Ug+Js0L1GLZcICNmZc4LYltQC3neAwOJBCtBWzLAZK0pCVbzziXzCM542AzsX7JMbxdUGZnz8/ffPDDR2K0gAAzhGJsIFI9QssoGAWjYBSMAhwAAL56MwUJpmaLAAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Haikou Hospital of Central South University Xiangya Medical School","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Pu","middleName":"","lastName":"Xu","suffix":""},{"id":294099676,"identity":"d606b73b-87e0-429e-9f96-579b5c126e5a","order_by":2,"name":"Shuangxi Liu","email":"","orcid":"","institution":"Affiliated Haikou Hospital of Central South University Xiangya Medical School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shuangxi","middleName":"","lastName":"Liu","suffix":""},{"id":294099677,"identity":"9a331f93-0f74-4bce-ba18-a56e06456943","order_by":3,"name":"Yanan Cheng","email":"","orcid":"","institution":"Affiliated Haikou Hospital of Central South University Xiangya Medical School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yanan","middleName":"","lastName":"Cheng","suffix":""},{"id":294099678,"identity":"071fe9a8-ef4e-4d5e-affe-6eb46690b241","order_by":4,"name":"WenBai Zhang","email":"","orcid":"","institution":"Affiliated Haikou Hospital of Central South University Xiangya Medical School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"WenBai","middleName":"","lastName":"Zhang","suffix":""},{"id":294099679,"identity":"618b371d-8236-4496-92e1-a2b814ffcadc","order_by":5,"name":"Dou Yu","email":"","orcid":"","institution":"Affiliated Haikou Hospital of Central South University Xiangya Medical School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dou","middleName":"","lastName":"Yu","suffix":""},{"id":294099680,"identity":"d89b950e-0afd-4b07-915b-3b96e2de0171","order_by":6,"name":"Liying Lu","email":"","orcid":"","institution":"Affiliated Haikou Hospital of Central South University Xiangya Medical School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liying","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2024-04-14 02:44:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4263395/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4263395/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-025-05539-9","type":"published","date":"2025-02-08T15:57:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":55536350,"identity":"224603bf-5c8e-41ca-8cd9-86b8a2c82c8a","added_by":"auto","created_at":"2024-04-29 16:34:16","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":116080,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in alveolar ridge before and after implantation. A: Alveolar ridge before operation; B: Alveolar ridge after implantation; C: Implant cuff; D: Post-restoration.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4263395/v1/c49b91b7ad931c51e45ec3d8.jpeg"},{"id":55536348,"identity":"97d98de6-55c9-47bf-8815-2b38286b3955","added_by":"auto","created_at":"2024-04-29 16:34:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":179062,"visible":true,"origin":"","legend":"\u003cp\u003eCBCT examination of alveolar ridge before and after implantation. E: Triangular cross section before implantation; F: Trapezoidal cross section after implantation; G: The cross section of alveolar ridge with restoration at 3 months later; a, a’: the alveolar ridge widths before and after implantation.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4263395/v1/295a35f39da1e5d1fb4f5f13.png"},{"id":75930485,"identity":"52d5cf16-f7b7-4b01-92a7-4ad060db41e5","added_by":"auto","created_at":"2025-02-10 16:12:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":915614,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4263395/v1/6b7bdbf1-c9e8-46fd-b0cc-0aefa14e6104.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical study of alveolar bone mucosa-periosteal bone flap as horizontal bone augmentation","fulltext":[{"header":"Background","content":"\u003cp\u003eDental implant is a common method used to restore maxillary and mandibular missing teeth\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. To obtain the ideal osseointegration and restoration, it is required to maintain the buccal and palatal plate width of 1 mm at least\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Trauma, atrophy, or surgeries can result in the lack of alveolar bone in some cases, where bone augmentation is proved effective \u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMucosa-periosteal bone flap (MBF) is constituted by labial (buccal) mucoperiosteal flap and bone for the sake of increasing the horizontal alveolar ridge width, which cuts a trapezoid bone block penetrating the cortex from the alveolar bone along the alveolar crest and lip (buccal) bone in the alveolar bone width deficiency region, and bone splitting is performed along the alveolar crest of primary bone cutting line after 4 weeks\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. This article aimed to assess the effect of alveolar ridge bone augmentation using MBF technique in 49 patients (99 implants), through measuring the alveolar ridge widths before and after implant placement.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e1. Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients with narrow alveolar ridges requiring dental implantation were recruited from \u003cem\u003eOral Implantation Department, Affiliated Haikou Hospital of Central South University Xiangya Medical School \u0026amp; Hainan Provincial Stomatology Center\u003c/em\u003e from October 2013 to December 2023. Inclusion criteria: (1) Patients who received MBF surgery to operate bone increment; (2) patients without contraindication in partial or the whole body; (3) patients not taking medicines that affected bone growth within the last 12 months; and (4) patients with complete case information without loss of follow-up. All included patients gave their informed consent and participated voluntarily; in the case of minors, their parents/legal guardians also signed the consent form. All subjects filled out an epidemiologic questionnaire before undergoing a clinical examination. This study was performed by the Declaration of Helsinki and also received the approval from the Biomedical Ethics Committee at affiliated Haikou Hospital of Central South University Xiangya Medical School (reference number 2016-019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Instruments and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) Instruments: CBCT (New Tom, Italy), piezosurgery (SATELEC Piezotome 2, France), dental implanter (Nobel, Austria) and centrifuge (TD4Z-WS, Changsha), etc.\u003c/p\u003e\n\u003cp\u003e(2) Medical appliances: mainly including Osseoset 200, Nobel Active AB, Bicon toolbox and other relevant appliances.\u003c/p\u003e\n\u003cp\u003e(3) Implants: Nobel Active (Nobel, Sweden), Bicon (Bicon, America), Osstem (Osstem, Korea) and Dentis (Dentis, Korea).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Treatment Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) Periodontal non-surgical treatment: supragingival scaling, subgingival scaling and oral hygiene education were routinely carried out.\u003c/p\u003e\n\u003cp\u003e(2) The PRF preparation was accomplished according to the approach introduced by \u003cem\u003eCheng Yanan\u003c/em\u003e, et al. \u003csup\u003e9\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(3) The MBF technique was prepared and the implant was inserted using the method presented by \u003cem\u003eXu Pu\u003c/em\u003e, et al.\u003csup\u003e\u0026nbsp;8\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e(4) Stage II operation and missing tooth restoration: at 3-6 months after the insertion of implants, stage II operation was performed. To be specific, the healing cap was removed, and then the healing abutments were inserted for accelerating soft tissue sulci formation. After 2 weeks, the cuffs were in healthy condition, and the missing teeth were restored after taking an impression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Effect Evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) Clinical effect:\u0026nbsp;Whether soft tissue of the cuff lip was full, and whether the fullness on the labial (buccal) side of the edentulous area was restored after the completion of stage II\u0026nbsp;operation and prostheses.\u003c/p\u003e\n\u003cp\u003e(2) Cone beam computed tomography (CT) observation: Cross-section changes of alveolar ridge, alveolar crest width and bone plate thickness on the lip (cheek) side after implantation.\u003c/p\u003e\n\u003cp\u003e(3) Measurement of the alveolar ridge widths before and after implantation: The alveolar ridge widths were determined before implantation and after the final restoration using MBF technique. Then, data were compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS Statistics software (version 22.0) was employed for analyzing data. In addition, the alveolar ridge widths before implantation and after the final restoration were compared by paired t test, and results were expressed as M\u0026plusmn;SD. The significance level was set at P \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe present work recruited 49 cases (age, 17\u0026ndash;69 years) and 99 implants. The proportions of female patients (27 patients, 55 implants) and patients with mandibular lesions (29 patients, 56 implants) were higher, while those of male patients (22 patients, 44 implants) and patients with maxillary lesions (20 patients, 43 implants) were lower (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eThe distributions of sex and tooth position in 49 patients with insufficient width of alveolar ridge.\u003c/b\u003e cases (implants)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003egroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emaxilla\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003emandible\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27(55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49(99)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn clinical observation, the alveolar ridge was mostly triangular and its top was narrow before implantation. There were more soft tissues on cuff labial (buccal) side, thereby restoring the fullness of the edentulous area on the labial (buccal) side, and the aesthetic was available after the completion of stage II operation (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCone beam CT examination revealed that the triangular alveolar ridge before operation turned into the trapezoidal alveolar ridge in coronal section after operation, moreover, the bone on the lip (buccal) side of the implant was significantly greater than 1 mm (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMeanwhile, the alveolar ridge crest widths were determined before implantation and after the final restoration (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), and statistical analysis was carried out. According to the results, the alveolar ridge widths were 4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49 mm before implantation and 7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60 mm at 3\u0026ndash;6 months after implantation. Clearly, the alveolar ridge width elevated by an average of 2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11 mm. The difference was statistically significant before and after implantation (t\u0026thinsp;=\u0026thinsp;13.53, P\u0026thinsp;=\u0026thinsp;0.00\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe alveolar ridge crest widths before and after implantation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplant number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlveolar ridge width (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore implantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter restoration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eImplant-supported restoration is an ideal approach for missing teeth, and alveolar bone quality and quantity are key factors for ensuring the correct implant position\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Following factors may contribute to the insufficient width of alveolar ridge that mostly occurs in female patients and mandible, compared with male patients and maxilla (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Asian females are petite compared with European females, besides, their skeletons including mandibles are comparatively small as well. Patients with narrow mandibular ridge are more likely to have insufficient alveolar ridge width after teeth extraction. Since the bearing area is smaller than maxilla, the mandibular alveolar ridge is more easy to be constricted and absorbed after restoration.\u003c/p\u003e \u003cp\u003eTraditional osteotomy has a good effect on the increase in alveolar bone width, but this method is associated with the risk of fracture, necrosis and bone mass absorption. The use of MBF can achieve better outcome in the horizontal alveolar bone augmentation. After pushing the prepared trapezoid bone block onto the buccal side, the vascularization between mucoperiosteum and bone block has already been formed. This phenomenon ensues the nutrition supply of bone block, thus preventing the necrosis and absorption of bone block\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTooth loss may usually be accompanied by the reduction of alveolar bone, thus causing the severe atrophy of alveolar bone and forming the blade-shaped alveolar ridge\u003csup\u003e[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. It is a common clinical problem to repair the posterior missing tooth in the atrophic alveolar ridge\u003csup\u003e[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. In the clinical observation of this study, the alveolar ridge was mostly triangular and its top was narrow before implantation. The top of the alveolar ridge increased by the MBF technique at the time of implant placement. After stage II operation, the soft tissues on the lip (buccal) side of the cuff were full, the fullness on the lip (buccal) side of the missing teeth was restored, and the aesthetic was available after the teeth restoration (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCone beam CT examination revealed that the implant restoration cases achieved favorable clinical outcomes in this study. The alveolar ridge was obviously widened after implantation (trapezoidal in the cross section) compared with that before implantation (triangular in the cross section), and the bone on lip (buccal) side of the implant was significantly greater than 1 mm. After measurement, the alveolar ridge widths were 4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49 mm before implantation and 7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60 mm after implantation, which increased by 2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11 mm. The alveolar crest width increased significantly after operation (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This suggests that the MBF technique achieves positive clinical effect, similar to the results obtained by other scholars\u003csup\u003e19\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSome scholars report that bone grafting can achieve preferable outcomes in alveolar bone augmentation\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. However, it is necessary to develop the second operative areas for graft acquisition. Implant placement is postponed for 3\u0026ndash;6 months, and the graft bone absorption rate reaches 20%-50% at 6 months later\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The guided bone regeneration (GBR) procedures are also linked with a risk of membrane exposure and membrane rupture, leading to infection\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Interpositional augmentation involves ridge split and ridge expansion, both of which have attained ideal outcomes in the maxilla\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. But an increased risk of block fracture after osteotomy is seen in the mandible because of the thick cortical bone. Consequently, for minimizing the fracture risk in these patients, apical and vertical horizontal cuts are made. The ridge split procedure is flexible when the immature bone callus is formed at the cortical incision site. Some scholars report that ridge split can be performed when the callus is mature (3 months) at the site of the cortical incision, and the primary stability of the implants is better\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn general, it is difficult to cut the cortical bone with manual instruments during the MBF operation, in particular, the exact osteotomy is more difficult. The use of motor-driven equipment to cut the bone will produce extensive heat, and such excess heat in neighboring tissues can extend the healing time. Therefore, the piezoelectric osteotomy performed in this article exhibits two important advantages. Firstly, the cut can be secured since the ultrasound frequency induces no injury to the soft tissue. Secondly, cutting is less invasive, resulting in superior healing. A more predictable effect can be obtained with this approach\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe MBF technique steadily increases the width of the alveolar bone, and cuts the bone through piezoelectric osteotomy for achieving the expected effect. When designing the \"mucous bone flap\", attention should be paid to the labial bone thickness to ensure osteogenesis in the lip bone of the implant, thus improving the implant restoration effect in the near and long term\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. The MBF technique offers a new approach for solving the insufficient alveolar ridge, and its long-term effect remains to be further observed.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eMBF\u0026nbsp;\u003c/strong\u003eMucosa-periosteal bone flap\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll included patients gave their informed consent and participated voluntarily; in the case of minors, their parents/legal guardians also signed the consent form. All subjects filled out an epidemiologic questionnaire before undergoing a clinical examination. This study was performed by the Declaration of Helsinki and also received the approval from the Biomedical Ethics Committee at affiliated Haikou Hospital of Central South University Xiangya Medical School (reference number 2016-019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due [The project is not finished] but are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was funded by the National Natural Science Foundation of China (Grant no.82060194), Key Research and Development Project of Hainan Province (Grant no. ZDYF2022SHFZ119).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePu Xu: New technical design, operation, and literature inquiry. Xinghuanyu Xu: New technology naming and interpretation, and writing. Shuangxi Liu: Operation, and data statistical analysis. Yanan Cheng: Surgical assistant and picture production. Wenbo Zhang: Surgical assistant. Dou Yu: Photo taking and collection. Liying Lu: Surgical instrument management and preoperative preparation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDUONG H Y, ROCCUZZO A, ST\u0026auml;HLI A et al. Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses [J]. Periodontol. 2000, 2022, 88(1): 201\u0026thinsp;\u0026ndash;\u0026thinsp;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026aacute;ENZ-RAVELLO G, OSSAND\u0026oacute;N-Z\u0026uacute;\u0026ntilde;IGA B, MU\u0026ntilde;OZ-MEZA V, et al. Short implants compared to regular dental implants after bone augmentation in the atrophic posterior mandible: umbrella review and meta-analysis of success outcomes [J]. Int J Implant Dent. 2023;9(1):18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLEE K J, CHA J K, SANZ-MARTIN I, et al. A retrospective case series evaluating the outcome of implants with low primary stability [J]. Clin Oral Implants Res. 2019;30(9):861\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eARNAL H M, ANGIONI C D, GAULTIER F, et al. Horizontal guided bone regeneration on knife-edge ridges: A retrospective case-control pilot study comparing two surgical techniques [J]. Clin Implant Dent Relat Res. 2022;24(2):211\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAMARAL, VALLAD\u0026atilde;O CA, FREITAS MONTEIRO M JR, JOLY JC. Guided bone regeneration in staged vertical and horizontal bone augmentation using platelet-rich fibrin associated with bone grafts: a retrospective clinical study [J]. Int J Implant Dent. 2020;6(1):72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZAHEDI L, MOHAMMADI M, KALANTARI M, et al. Horizontal ridge augmentation with particulate cortico-cancellous freeze-dried bone allograft alone or combined with injectable-platelet rich fibrin in a randomized clinical trial [J]. Clin Implant Dent Relat Res; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXU P, LI X N, XU X, et al. [Use of alveolar bone mucosa-periosteal bone flap in dental implantation] [J]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2016;51(11):688\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNAENNI N, STUCKI L, H\u0026uuml;SLER J, et al. Implants sites with concomitant bone regeneration using a resorbable or non-resorbable membrane result in stable marginal bone levels and similar profilometric outcomes over 5 years [J]. Clin Oral Implants Res. 2021;32(8):893\u0026ndash;904.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUDEABOR SE, HESELICH A, AL-MAAWI S et al. Current Knowledge on the Healing of the Extraction Socket: A Narrative Review [J]. Bioeng (Basel), 2023, 10(10).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGOUDARZI F, ANBIAEE N, SHAKERI MT. Comprehensive view of the posterior mandibular ridge morphology [J]. Int J Oral Maxillofac Surg. 2024;53(2):170\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eATWOOD DA. Reduction of residual ridges: a major oral disease entity [J]. J Prosthet Dent. 1971;26(3):266\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTERHEYDEN H, MEIJER G J, RAGHOEBAR GM. Vertical bone augmentation and regular implants versus short implants in the vertically deficient posterior mandible: a systematic review and meta-analysis of randomized studies [J]. Int J Oral Maxillofac Surg. 2021;50(9):1249\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eATIEH M A, ALSABEEHA N H, PAYNE A G et al. Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development [J]. Cochrane Database Syst Rev, 2021, 4(4): Cd010176.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLALO J, ADOUANI H, BOURAOUI S, et al. Maxillary alveolar bone ridge width augmentation using the frame-shaped corticotomy expansion technique [J]. J Stomatol Oral Maxillofac Surg. 2020;121(2):163\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSGHAIREEN M G, SHRIVASTAVA D, ALNUSAYRI M O, et al. Bone Grafts in Dental Implant Management: A Narrative Review [J]. Curr Pediatr Rev. 2022;19(1):15\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGOUTAM M, BATRA N, JYOTHIRMAYEE K, et al. A Comparison of Xenograft Graft Material and Synthetic Bioactive Glass Allograft in Immediate Dental Implant Patients [J]. J Pharm Bioallied Sci. 2022;14(Suppl 1):S980\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAL HAYDAR B, KANG P, MOMEN-HERAVI F. Efficacy of Horizontal Alveolar Ridge Expansion Through the Alveolar Ridge Split Procedure: A Systematic Review and Meta-Analysis [J]. Int J Oral Maxillofac Implants. 2023;38(6):1083\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSBRICOLI L, GUAZZO R, ANNUNZIATA M et al. Selection of Collagen Membranes for Bone Regeneration: A Literature Review [J]. Mater (Basel), 2020, 13(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHOU Q, YANG F, LI N, et al. Healing outcomes of open versus closed flap procedures for collagen membrane coverage following immediate dental implant placements with simultaneous guided tissue regeneration [J]. J Dent. 2024;141:104735.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLI X M, BAO JB, XIE ZG. [Application of two-stage ridge splitting technique in atrophic mandibular alveolar ridge] [J]. Hua Xi Kou Qiang Yi Xue Za Zhi. 2020;38(3):338\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLI X, XU P, XU X, et al. The application of a delayed expansion technique for horizontal alveolar ridge augmentation in dental implantation [J]. Int J Oral Maxillofac Surg. 2017;46(11):1451\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Alveolar ridge, Horizontal bone augmentation, Mucosa-periosteal bone flap, Dental implant","lastPublishedDoi":"10.21203/rs.3.rs-4263395/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4263395/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eBackground\u003c/b\u003e The present work focused on observing the efficacy of alveolar bone mucosa- periosteal bone flap in alveolar ridge horizontal bone augmentation with dental implant placement.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e This was a retrospective study involving 49 patients with 99 implants, which was conducted to measure the alveolar ridge widths pre- and post-operatively. The alveolar ridge widths were 4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49 mm preoperatively and 7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60 mm postoperatively.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e There was a significant difference in alveolar ridge width before and after operation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), to be specific, the alveolar ridge width increased by 2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11 mm after operation.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e These results suggest that alveolar bone mucosa-periosteal bone flap technique is an effective method to increase the alveolar ridge width with the simultaneous placement of dental implants, which is worthy to be recommended in clinical practice.\u003c/p\u003e","manuscriptTitle":"Clinical study of alveolar bone mucosa-periosteal bone flap as horizontal bone augmentation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-29 16:34:11","doi":"10.21203/rs.3.rs-4263395/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-08T11:47:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-04T07:42:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192685055581546925572448277104670413459","date":"2024-10-04T07:32:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-11T15:24:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126904791663132627810489910999209790185","date":"2024-08-23T14:19:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-25T12:08:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188823695702379267111076961881139382227","date":"2024-07-21T15:39:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168290101156623406325831289634438938920","date":"2024-07-18T14:49:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-01T14:52:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-30T06:43:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-30T06:32:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-22T13:13:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2024-04-14T02:38:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a2c7483b-6703-46ce-9822-b40ff30f2f95","owner":[],"postedDate":"April 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-10T16:03:38+00:00","versionOfRecord":{"articleIdentity":"rs-4263395","link":"https://doi.org/10.1186/s12903-025-05539-9","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-02-08 15:57:53","publishedOnDateReadable":"February 8th, 2025"},"versionCreatedAt":"2024-04-29 16:34:11","video":"","vorDoi":"10.1186/s12903-025-05539-9","vorDoiUrl":"https://doi.org/10.1186/s12903-025-05539-9","workflowStages":[]},"version":"v1","identity":"rs-4263395","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4263395","identity":"rs-4263395","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}