The Significance of Mylohyoid Muscle Release (MMR) in the Vertical and Horizontal Ridge Augmentation Surgeries; Clinical and Human Cadaver Analyses of the Techniques

Overview

Journal Genes (Basel)

Publisher MDPI

Date 2023 Mar 29

PMID 36980867

Authors

Nikolaos Soldatos

Jessica Immonen

Georgios Romanos

Robin Weltman

Affiliations

Soon will be listed here.

Abstract

(1) Background: Ridge augmentations either horizontal (HRA) or vertical (VRA) in the posterior mandible are very challenging regenerative procedures. To attain and retain tension-free primary closure, buccal periosteal and mylohyoid muscle releases should be performed. The purpose of the present study was to review, analyze and discuss the three different techniques for the mylohyoid muscle release (MMR) in VRA and HRA surgeries on a clinical and human cadaver level. (2) Presentation of the techniques: Three different techniques are described in the literature regarding the lingual flap management: (i) the finger sweep technique (FST), (ii) the release of the mylohyoid muscle attachment on the lingual flap (MMALF), and (iii) the mylohyoid preservation technique (MPT) in three key anatomical zones. All three techniques, even though they use a different approach, can achieve similar amount of horizontal and vertical mylohyoid muscle release although MPT showed statistically significant higher flap advancement. The human cadaver analyses revealed that all three techniques are considered safe since they do not approximate vital anatomical structures. (3) Conclusions: All three techniques are considered safe, but they are not free of limitations or complications; therefore, they should be performed only by highly experienced and trained clinicians. MPT achieved statistically significant higher flap advancement.

References

Simion M, Fontana F, Rasperini G, Maiorana C . Vertical ridge augmentation by expanded-polytetrafluoroethylene membrane and a combination of intraoral autogenous bone graft and deproteinized anorganic bovine bone (Bio Oss). Clin Oral Implants Res. 2007; 18(5):620-9. DOI: 10.1111/j.1600-0501.2007.01389.x. View

Jepsen S, Schwarz F, Cordaro L, Derks J, Hammerle C, Heitz-Mayfield L . Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration. J Clin Periodontol. 2019; 46 Suppl 21:277-286. DOI: 10.1111/jcpe.13121. View

Ronda M, Rebaudi A, Torelli L, Stacchi C . Expanded vs. dense polytetrafluoroethylene membranes in vertical ridge augmentation around dental implants: a prospective randomized controlled clinical trial. Clin Oral Implants Res. 2013; 25(7):859-66. DOI: 10.1111/clr.12157. View

Seibert J . Reconstruction of deformed, partially edentulous ridges, using full thickness onlay grafts. Part I. Technique and wound healing. Compend Contin Educ Dent (Lawrenceville). 1983; 4(5):437-53. View

Niamtu 3rd J . Near-fatal airway obstruction after routine implant placement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92(6):597-600. DOI: 10.1067/moe.2001.116503. View

Schropp L, Wenzel A, Kostopoulos L, Karring T . Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003; 23(4):313-23. View

Pikos M . Atrophic posterior mandibular reconstruction utilizing mandibular block autografts: risk management. Int J Oral Maxillofac Implants. 2003; 18(5):765-6. View

Simion M, Jovanovic S, Tinti C, Benfenati S . Long-term evaluation of osseointegrated implants inserted at the time or after vertical ridge augmentation. A retrospective study on 123 implants with 1-5 year follow-up. Clin Oral Implants Res. 2001; 12(1):35-45. DOI: 10.1034/j.1600-0501.2001.012001035.x. View

Fugazzotto P . Maintenance of soft tissue closure following guided bone regeneration: technical considerations and report of 723 cases. J Periodontol. 1999; 70(9):1085-97. DOI: 10.1902/jop.1999.70.9.1085. View

10.

Chasioti E, Chiang T, Drew H . Maintaining space in localized ridge augmentation using guided bone regeneration with tenting screw technology. Quintessence Int. 2013; 44(10):763-71. DOI: 10.3290/j.qi.a30178. View

11.

Wang H, Boyapati L . "PASS" principles for predictable bone regeneration. Implant Dent. 2006; 15(1):8-17. DOI: 10.1097/01.id.0000204762.39826.0f. View

12.

Urban I, Monje A, Wang H . Vertical Ridge Augmentation and Soft Tissue Reconstruction of the Anterior Atrophic Maxillae: A Case Series. Int J Periodontics Restorative Dent. 2015; 35(5):613-23. DOI: 10.11607/prd.2481. View

13.

Urban I, Monje A, Lozada J, Wang H . Principles for Vertical Ridge Augmentation in the Atrophic Posterior Mandible: A Technical Review. Int J Periodontics Restorative Dent. 2017; 37(5):639-645. DOI: 10.11607/prd.3200. View

14.

Wang H, Al-Shammari K . HVC ridge deficiency classification: a therapeutically oriented classification. Int J Periodontics Restorative Dent. 2002; 22(4):335-43. View

15.

Soldatos N, Stylianou P, Koidou V, Angelov N, Yukna R, Romanos G . Limitations and options using resorbable versus nonresorbable membranes for successful guided bone regeneration. Quintessence Int. 2016; 48(2):131-147. DOI: 10.3290/j.qi.a37133. View

16.

Pikos M . Atrophic posterior maxilla and mandible: alveolar ridge reconstruction with mandibular block autografts. Alpha Omegan. 2005; 98(3):34-45. View

17.

Soldatos N, Garcia M, Umoh E, Irizarry A, Weltman R . Vertical Ridge Augmentation Around Dental Implants With the Use of a Dense PTFE Membrane to Correct Previously Failed Augmentations. Clin Adv Periodontics. 2021; 12(1):51-56. DOI: 10.1002/cap.10182. View

18.

Retzepi M, Donos N . Guided Bone Regeneration: biological principle and therapeutic applications. Clin Oral Implants Res. 2010; 21(6):567-76. DOI: 10.1111/j.1600-0501.2010.01922.x. View

19.

Urban I, Lozada J, Jovanovic S, Nagursky H, Nagy K . Vertical ridge augmentation with titanium-reinforced, dense-PTFE membranes and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral: a prospective case series in 19 patients. Int J Oral Maxillofac Implants. 2014; 29(1):185-93. DOI: 10.11607/jomi.3346. View

20.

Burkhardt R, Lang N . Role of flap tension in primary wound closure of mucoperiosteal flaps: a prospective cohort study. Clin Oral Implants Res. 2010; 21(1):50-4. DOI: 10.1111/j.1600-0501.2009.01829.x. View