Releasing incisions of the buccal periosteum adjacent to the lower molar teeth can injure the facial artery: an anatomical study

Abstract

Purpose: Periosteal releasing incision (PRI) techniques are often used with guided bone regeneration procedures. As complications such as intra- and postoperative bleeding have been noticed, we aimed to study and clarify these as related to the PRI, especially on the mandibular buccal periosteum.

Methods: Fourteen sides from seven fresh-frozen Caucasian cadaveric heads were used in this study. The seven cadavers were derived from two females and five males. The mean age at the time of death was 75.9 ± 10.8 years. The PRI was made using a no. 15c blade using a surgical microscope. Subsequently, the fat tissue lateral to the periosteum was slightly dissected. The diameter of the facial artery (or its branch) and closest relationship between the tooth and position of the artery was recorded. Finally, the artery was traced back proximally to clarify its origin.

Results: On all sides, the inferior labial artery (ILA) was identified in the fat tissue lateral to and close to the periosteum. The ILA was closest to the periosteum at the midpoint of the PRI (approximately between the first and second molar teeth area or 10 mm mesial to the apex of the retromolar pad). The mean diameter of the ILA was 2.72 ± 0.26 mm.

Conclusion: This anatomical finding should encourage dentists to make the PRI incision without invading the tissue underneath the periosteum.

Keywords: Blood supply; Cadaver; Complications; Dental implants; Flap advancement; Periosteum.