Bone Defect Reconstruction in Horizontal Mandibular Atrophy Using Periosteal Flap and Guided Bone Regeneration Technique: A Case Report

Horizontal atrophy of the alveolar ridge represents a significant challenge in contemporary dental practice, substantially limiting the possibilities for successful osseointegration of dental implants and requiring the application of various bone grafting methods. Traditional approaches to guided bone regeneration often require the use of additional barrier membranes and fixation elements, and may be associated with increased surgical trauma. This paper presents a clinical case of a modified guided bone regeneration technique using a periosteal flap as a natural barrier membrane, which allows for maximum utilization of the regenerative potential of the patient's own tissues with minimal procedural invasiveness.

A 28-year-old patient presented with complaints of missing teeth 3.5 and 3.6 in the left mandibular region. Cone-beam computed tomography revealed significant horizontal bone deficiency with an alveolar ridge width of 2.72 mm in the area of tooth 3.5 and 4.66 mm in the area of tooth 3.6. A guided bone regeneration procedure was performed with periosteal flap formation through split-thickness mucoperiosteal flap technique, creation of multiple cortical perforations, and filling of the subperiosteal space with allogenic material Lioplast. Three months post-intervention, follow-up computed tomography demonstrated an increase in alveolar ridge width of 1.50 mm (55%) in the area of tooth 3.5 and 0.54 mm (12%) in the area of tooth 3.6. Histological examination confirmed the formation of mature bone tissue with active vascularization, presence of lamellar structure in the cortical plate, and cancellous bone with high cellular density of reticular tissue.

The presented clinical case demonstrates the high effectiveness of using a periosteal flap as a natural barrier membrane in guided bone regeneration, providing sufficient bone tissue augmentation for subsequent dental implantation with minimal trauma and without the need for additional fixation elements. This approach can be considered as a promising alternative to traditional bone grafting techniques for horizontal atrophy of the mandibular alveolar ridge.