A new subgingival sling suture technique for periodontally accelerated osteogenic orthodontics

Abstract

This study aimed to design a modified subgingival sling suture for periodontally accelerated osteogenic orthodontics (PAOO) as well as evaluate postoperative effects including gingival recession (GR), alveolar bone crest resorption, dental plague accumulation on sutures and alveolar bone augmentation. Twelve patients with bone defects in the anterior alveolar region of the mandible were included in this study. Subgingival sling suture, developed from traditional sling suture, was applied in modified PAOO operation. Probing depth, bleeding index, and GR were assessed, and cone-beam computerized tomography and laser microscope for thread surface were evaluated at baseline, postoperative 1 and 3 months to analyze the effects. Alveolar bone thickness on the labial side at the midpoint of the middle third of the root increased from 0.96 ± 0.28 mm to 3.38 ± 0.61 mm (P < .01), and that of the apical third advanced from 1.26 ± 0.33 mm to 3.61 ± 1.02 mm (P < .01), both exhibiting significant increase. No significant alveolar bone crest loss, probing depth increase, GR, and attachment loss was observed. This modified PAOO operation, associated with novel subgingival sling suture, productively augments alveolar bone volume and addresses problems in terms of GR and vertical loss of alveolar bone.

Figure 1.

Modified PAOO operation. (A) A scalloped incision was adapted to protect the alveolar crest and prevent gingival recession; (B) flap reflection; (C) exposure of labial alveolar bone in the surgical area; (D) based on CBCT results, vertical corticotomies were positioned in the inter-radicular area and then connected with horizontal corticotomies placed 2 mm beyond the root apex, punctate decortications were subsequently performed; (E) bone graft materials was placed on recipient sites; (F) flap reposition and subgingival sling suture; (G) completed sutures. CBCT = cone-beam computerized tomography, PAOO = periodontally accelerated osteogenic orthodontics.

Figure 2.

Modified subgingival sling suture technique for PAOO. (A1 and A2) The suture needle penetrates the papilla of the free flap; (B1 and B2) the needle is inserted below the buccal papilla and extracted from the gingival sulcus on the lingual aspect; (C1 and C2) the needle penetrates the adjacent interdental papilla and the outer-surface of the initial flap; (D1 and D2) the suture is reinserted below the second papilla; (E1 and E2) the suture is brought round the tooth lingually and allowed to exit the initial papilla buccally; tie the knot; (F1 and F2) merely limited segments of suture are exposed. PAOO = periodontally accelerated osteogenic orthodontics.

Figure 3.

PAOO operation with modified sling suture. (A) Scalloped incision; (B) flap reflection and exposure of buccal alveolar bone; (C) corticotomies and punctate decortications; (D) bone graft material was placed on operation area; (E and F) intraoral photograph after completed sutures. Merely limited segments at both ends of the suture were exposed and the bulk of it was covered subgingivally. PAOO = periodontally accelerated osteogenic orthodontics.

Figure 4.

Evaluation of bone thickness augmentation after osseous grafting in PAOO. Changes of BTRC1/3, BTRM1/3 and BTRA1/3 were quantified and compared (preoperative vs postoperative, colored by red). BTRA1/3 = bone thickness of root apical 1/3, BTRC1/3 = bone thickness of root coronal 1/3, BTRM1/3 = bone thickness of root middle 1/3, PAOO = periodontally accelerated osteogenic orthodontics.

Figure 5.

Photographs after PAOO surgery. (A) Materia alba can be observed on sutures in the operation area at 2 weeks after PAOO surgery; (B) gingiva recovered at 3 months after PAOO surgery. PAOO = periodontally accelerated osteogenic orthodontics.

Figure 6.

Laser analysis on surface profile of the exposed and non-exposed area. (A) Methylene blue was used to stain the exposed suture (arrows) and then the suture was severed according to staining; (B) statistically there is significant difference between the length of the exposed sutyre and the total; (C–E) according to surface morphology analysis by laser microscope, normal sutures, as blank control, represent smooth surface and shows significantly low V_mp variation; there suggested no significant difference in surface roughness between hidden suture and blank control; exposed sutures showed irregularity and notable variation in surface morphology with substantial pore structures, and its V_mp suggested statistic difference compared with blank control (P < .05). PAOO = periodontally accelerated osteogenic orthodontics, SSS = subgingival sing suture. ** Significant difference, P < .05.

Figure 7.

Preoperative and postoperative CBCT images. (A) Image-based 3-dimensional reconstruction before surgery and at postoperative 3-month; area of bone augmentation was colored by red; (B) CBCT images of horizontal view shows significant alveolar bone augmentation in the same mandibular anterior area at postoperative 3-month; (C) images of buccal-lingual view shows significant alveolar bone augmentation in the buccal radicular surface after PAOO; red lines show BTRC1/3, BTRM1/3 and BTRA1/3. BTRA1/3 = bone thickness of root apical 1/3, BTRC1/3 = bone thickness of root coronal 1/3, BTRM1/3 = bone thickness of root middle 1/3, CBCT = cone-beam computerized tomography, PAOO = periodontally accelerated osteogenic orthodontics.