Vascular survey of the maxillary vestibule and gingiva—clinical impact on incision and flap design in periodontal and implant surgeries

Arvin Shahbazi, Georg Feigl, Anton Sculean, András Grimm, Dániel Palkovics, Bálint Molnár, Péter Windisch
2020 Clinical Oral Investigations  
Currently, empirical clinical findings on the blood supply of the maxillary vestibule are not backed up with sufficient literature. The purpose of this study was to investigate the mucosal and periosteal vascular supply in the maxillary vestibule macroscopically and radiographically to improve surgical strategies and flap designs. Thirty head corpses were selected (9 dentate, 11 partially edentulous, 10 edentulous). Twenty-six corpses were injected by red latex milk and embalmed with Thiel
more » ... med with Thiel solution. Four cadavers were prepared for corrosion casting. Arterial path and anastomoses in the maxillary vestibule of dentate, partially edentulous and edentulous ridges, were analyzed macroscopically and by computed tomography (CT). Transverse periosteomucosal anastomoses were detected in the posterior and esthetic zones of the maxillary vestibule. The buccal branches penetrated the interdental septum toward the palate. In the esthetic zone, superior labial artery (SLA) supplied the mucosa and the infraorbital artery (IOA) supplied the periosteum. Corrosion casting showed anastomoses between IOA and nasal septal branches. CT analysis revealed ipsilateral and contralateral anastomoses between SLA and IOA. In dentate ridges, mucosal star-shaped terminal branches were detected. The macroscopic and radiographic vascular survey analysis revealed the anatomical background behind several clinically documented phenomena related to oral and periodontal surgeries. This study permits clinicians to design less invasive flaps when releasing incisions in the maxillary vestibule during periodontal and implant surgeries. Our observations strongly point to the significance of an undamaged periosteum to prevent compromised flap revascularization and wound healing disturbances.
doi:10.1007/s00784-020-03419-w pmid:32638127 fatcat:7usw6vhcavcxpcsidz3cp2ykda