Skip to main content

Advertisement

Log in

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

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Greenstein G, Greenstein B, Cavallaro J, Elian N, Tarnow D (2009) Flap advancement: practical techniques to attain tension-free primary closure. J Periodontol 80:4–15

    Article  Google Scholar 

  2. Henry BM, Tomaszewski KA, Ramakrishnan PK, Roy J, Vikse J, Loukas M, Tubbs RS, Walocha JA (2017) Development of the anatomical quality assessment (AQUA) tool for the quality assessment of anatomical studies included in meta-analyses and systematic reviews. Clin Anat 30:6–13

    Article  Google Scholar 

  3. Inoko M, Rubin S, Ono Y, Saito A (2018) Releasing incisions using upward-motion scissors technique for flap mobilization for guided bone regeneration or periodontal surgery: technical introduction and a case report. Int J Periodontics Restor Dent 38:503–507

    Article  Google Scholar 

  4. Iwanaga J, Watanabe K, Saga T, Tabira Y, Kitashima S, Kusukawa J, Yamaki KI (2016) Accessory mental foramina and nerves: application to periodontal, periapical, and implant surgery. Clin Anat 29:493–501

    Article  Google Scholar 

  5. Iwanaga J, Simonds E, Oskouian RJ, Tubbs RS (2017) Cadaveric study for intraoral needle access to the infratemporal fossa: application to posterior superior alveolar nerve block technique. Cureus 9:e1761

    PubMed  PubMed Central  Google Scholar 

  6. Iwanaga J, Kamura Y, Tanaka T, Watanabe K, Kusukawa J, Oskouian RJ, Tubbs RS (2017) A new space of the face: the bucco-mandibular space. Clin Anat 30:958–962

    Article  Google Scholar 

  7. Koymen R, Karacayli U, Gocmen-Mas N, Ertugrul-Koymen C, Ortakoglu K, Gunaydin Y, Magden O (2009) Flap and incision design in implant surgery: clinical and anatomical study. Surg Radiol Anat 31:301–306

    Article  Google Scholar 

  8. Lee HJ, Won SY, Jehoon O, Hu KS, Mun SY, Yang HM, Kim HJ (2018) The facial artery: a comprehensive anatomical review. Clin Anat 31:99–108

    Article  Google Scholar 

  9. Moslemi N, Khorsand A, Torabi S, Shahnaz A, Soleimani Shayesteh Y, Fekrazad R (2016) Periosteal releasing incision with diode laser in guided bone regeneration procedure: a case series. J Lasers Med Sci 7:259–264

    Article  Google Scholar 

  10. Mörmann W, Ciancio SG (1997) Blood supply of human gingiva following periodontal surgery: a fluorescein angiographic study. J Clin Periodontol 48:681–692

    Article  Google Scholar 

  11. Ogata Y, Griffin TJ, Ko AC, Hur Y (2013) Comparison of double-flap incision to periosteal releasing incision for flap advancement: a prospective clinical trial. Int J Oral Maxillofacc Implants 28:597–604

    Article  Google Scholar 

  12. Park JC, Kim CS, Choi SH, Cho KS, Chai JK, Jung UW (2012) Flap extension attained by vertical and periosteal-releasing incisions: a prospective cohort study. Clin Oral Implants Res 23:993–998

    Article  Google Scholar 

  13. Romanos GE (2010) Periosteal releasing incision for successful coverage of augmented sites. A technical note. J Oral Implantol 36:25–30

    Article  Google Scholar 

  14. Standring S (2015) Gray’s anatomy: the anatomical basis of clinical practice, 42nd edn. Elsevier Health Sciences, London

    Google Scholar 

  15. Tomaszewski KA, Henry BM, Kumar Ramakrishnan P, Roy J, Vikse J, Loukas M, Tubbs RS, Walocha JA (2017) Development of the Anatomical Quality Assurance (AQUA) checklist: guidelines for reporting original anatomical studies. Clin Anat 30:14–20

    Article  Google Scholar 

  16. Zitzmann NU, Scharer P, Marinello CP (2001) Long-term results of implants treated with guided bone regeneration: a 5-year prospective study. Int J Oral Maxillofac Implants 16:355–366

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank those who donated their bodies for the advancement of medical research and education.

Funding

The authors received no funding or grants for this work from any organization or foundation.

Author information

Authors and Affiliations

Authors

Contributions

JI: protocol/project development, data collection, data analysis, manuscript writing. KS: protocol/project development, data analysis, manuscript writing. RST: protocol/project development, data collection, manuscript editing.

Corresponding author

Correspondence to Joe Iwanaga.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iwanaga, J., Shiromoto, K. & Tubbs, R.S. Releasing incisions of the buccal periosteum adjacent to the lower molar teeth can injure the facial artery: an anatomical study. Surg Radiol Anat 42, 31–34 (2020). https://doi.org/10.1007/s00276-019-02319-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-019-02319-3

Keywords

Navigation