Effect of trapezoidal and modified triangular flaps on mucosal blood supply and osteogenesis after guided bone regeneration

doi:10.7518/hxkq.2025.2024449

Abstract

Abstract:

Objective Color doppler flow imaging (CDFI) and cone-beam computed tomography (CBCT) were utilized to evaluate changes in mucosal vascular parameters and the osteogenic effects following guided bone regeneration (GBR) in the maxillary anterior region using trapezoidal or modified triangular flaps. Methods Patients undergoing single maxillary anterior dental implant surgery with GBR were randomly allocated into two groups: a trapezoidal flap group and a modified triangular flap group. After GBR surgery, the mucosal vascular parameters at the surgical site were assessed at various time intervals (preoperative, 2 h, 1 and 3 days, and 1, 2, and 4 weeks postoperative) using CDFI. In addition, the effects of bone augmentation were evaluated through the analysis of CBCT images obtained preoperatively, 2 h, and 6 months postoperative. Results The buccal mucosa in the edentulous area had a lower blood flow rate than the corresponding tooth in the same jaw, and the difference was statistically significant (P<0.001). The mucosal blood flow rate in the surgical area increased compared with that in the preoperative period. The peak flow rate was recorded at 2 weeks postoperatively and then decreased to levels comparable to those of the reference tooth. A statistically significant difference was observed between the two groups (P<0.05). The buccal alveolar ridge width of the implant platform was reduced by (1.3±0.9) mm in the trapezoidal flap group and (0.9±0.7) mm in the modified triangular flap group, respectively, at 6 months postoperatively, compared with 2 h postoperative. The buccal alveolar ridge width of the 5 mm from the implant platform was reduced by (0.9±0.6) mm and (0.3±0.6) mm, respectively. The buccal alveolar ridge width of the 10 mm from the implant platform was reduced by (0.6±0.8) mm and (0.2±0.6) mm, respectively. The height of the alveolar ridge was reduced by (1.9±1.4 ) mm and (1.4±1.3) mm. The change in graft volume was (136±78 ) mm³ and (114±85) mm³. However, the differences between the two groups were not statistically significant (P>0.05). Conclusion When a tooth is missing, blood flow to the buccal mucosa on the side of the missing tooth is reduced. The modified triangular flap group demonstrated superior microcirculation of blood flow in the operative area after GBR of the maxillary anterior teeth. Trapezoidal and modified triangular flaps achieved the anticipated bone augmentation during bone augmentation surgery in the maxillary anterior region, with no considerable effect on the changes in alveolar bone size parameters.

Key words: guided bone regeneration, color doppler flow imaging, trapezoidal flap, modified triangular flap

CLC Number:

R783

Chen Shuangzhen, Zhang Xianyue, Jia Xiaofeng, Xia Rong, Jiang Fan. Effect of trapezoidal and modified triangular flaps on mucosal blood supply and osteogenesis after guided bone regeneration[J]. West China Journal of Stomatology, 2025, 43(5): 679-688.

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特征		梯形瓣组	角形瓣组	P值
年龄/岁		36.1±14.1	34.8±13.0	0.828
性别	男	4（36.4%）	6（54.5%）	0.392
	女	7（63.6%）	5（45.5%）
缺失位置	中切牙	7（63.6%）	7（63.6%）	0.565
	侧切牙	3（27.3%）	4（36.4%）
	尖牙	1（9.1%）	0（0%）
牙龈生物型	厚龈生物型	4（36.4%）	3（27.3%）	0.647
	薄龈生物型	7（63.6%）	8（72.7%）
缺牙原因	外伤	5（54.5%）	6（54.5%）	0.700
	先天缺失	3（27.3%）	1（9.1%）
	龋病	1（9.1%）	2（18.2%）
	根尖周疾病	2（18.2%）	2（18.2%）
缺牙时间/年		3.7±6.4	4.4±7.8	0.809
种植体尺寸	3.4 mm×12 mm	9（81.8%）	9（81.8%）	1.000
	3.4 mm×14 mm	2（18.2%）	2（18.2%）
唇侧骨壁厚度/mm		0.41±0.32	0.55±0.22	0.345

指标	总体	缺失牙	参照牙	平均差值	95%置信区间
Vm/（cm/s）	4.42±2.43	3.14±1.00	5.71±2.77	-2.57±2.78*	1.30，3.84
Vmax/（cm/s）	7.22±3.61	5.02±1.52	9.41±3.79	-4.39±3.88*	2.64，6.15
S/D	2.60±0.73	2.43±0.40	2.77±0.93	-0.34±0.77	-0.09，0.78
PI	1.02±0.37	0.96±0.23	1.09±0.46	-0.13±0.34	-0.09，0.36
RI	0.59±0.08	0.58±0.06	0.61±0.08	-0.03±0.08	-0.01，0.08

组别	时间	Vm/（cm/s）	Vmax/（cm/s）	S/D	PI	RI
梯形瓣	T0	3.08±1.16	4.93±1.77	2.51±0.53	0.99±0.30	0.59±0.08
	T1	3.92±2.10	6.60±3.04	2.52±0.43	1.09±0.34	0.59±0.07
	T2	4.97±1.20	7.63±1.62	2.32±0.31	0.86±0.16	0.56±0.05
	T3	6.96±2.10	10.74±2.95	2.35±0.64	0.87±0.25	0.55±0.10
	T4	8.19±5.79	11.93±7.32	2.40±0.24	0.89±0.13	0.58±0.05
	T5	8.41±3.43	13.41±4.99	2.29±0.46	0.85±0.18	0.55±0.07
	T6	5.44±1.34	8.49±2.08	2.39±0.28	0.91±0.14	0.58±0.05
角形瓣	T0	3.19±0.87	5.12±1.31	2.35±0.23	0.93±0.13	0.57±0.04
	T1	6.16±2.82	9.91±4.51	2.70±0.51	1.02±0.21	0.62±0.06
	T2	6.87±2.36	10.74±2.53	2.55±0.59	0.97±0.27	0.59±0.09
	T3	7.56±2.22	11.57±2.67	2.50±0.36	0.96±0.21	0.59±0.06
	T4	8.26±2.74	12.61±4.16	2.43±0.50	0.91±0.24	0.57±0.07
	T5	8.44±1.70	12.53±2.68	2.24±0.26	0.83±0.13	0.54±0.05
	T6	6.39±2.35	10.04±3.38	2.50±0.39	0.96±0.17	0.59±0.07

测量参数及时间点		梯形瓣组	角形瓣组	P值
A-EA/mm	T1	3.4±0.8	3.2±0.9	0.850
	T7	2.9±0.7	3.0±0.8	0.468
	T7-T1	-0.6±0.8	-0.2±0.6	0.347
M-EM/mm	T1	4.4±0.8	4.1±0.8	0.390
	T7	3.6±0.3	3.8±0.9	0.587
	T7-T1	-0.9±0.6	-0.3±0.6	0.075
B-EB/mm	T1	3.6±0.9	3.6±0.6	0.618
	T7	2.3±0.7	2.6±1.0	0.645
	T7-T1	-1.3±0.9	-0.9±0.7	0.303
C-P/mm	T1	3.8±1.5	3.3±1.2	0.449
	T7	1.9±0.5	1.9±0.6	1.000
	T7-T1	-1.9±1.4	-1.4±1.3	0.460
体积/mm³	T1-T0	448±48	418±120	0.521
	T7-T0	312±70	304±141	0.884
	T7-T1	-136±78	-114±85	0.601