Tension- Relief for Primary Closure

When performing extensive GBR, we want to insure the primary closure of the flap margins over the graft and membrane. In this example, following the placement of the DALI bone graft and OsseoSeal membrane, the buccal flap was released from the periosteum for passive mobilization (Pictures 1,2,3,4). Prior to suturing the flap margins together at the crest, a periosteal-relief suture is placed in order to prevent any tension from pulling back the flaps (Picture 5). This allows the flaps to stay relaxed without needing to be pulled together. Afterwards, sutures are used to approximate the buccal and palatal flap margins to achieve primary closure that will endure throughout the initial healing period (Picture 6). We see that following 2 weeks of healing, proper primary closure allowed the grafted site to remain covered (Picture 7).

Hope this helps. Please let me know if you have any questions by visiting the forum (link below).

Dr. Daniel Gober