4. Discussion
postoperative pain, swelling, fibrous, tooth, ultra-conservative
SEQUELA, PERIOSTEUM, WOUND DEHISCENCE, HAND SWELLING, HYDROXYAPATITE, COMPLICATIONS
Most dental surgeries, such as guided bone regeneration and implant surgeries, require extensive soft and hard tissue manipulation, resulting in subsequent loss of the tissue volume. Over the years, surgical methods have been refined in order to take advantage of ultra-conservative approaches which cause the least possible sacrifice of the tissues, contributing to superior healing of the surgical sites.The rapid ridge resorption which follows tooth extraction is an inevitable sequela, making it more challenging to reclaim the lost alveolar bone. Increased complexity and lack of predictability are the main challenges for all ridge augmentation procedures.Block bone grafting—onlay grafting, ridge expansion, guided bone regeneration with titanium mesh, and distraction osteogenesis—are some of the invasive procedures presenting dubious outcomes, more often than not. The common complications encountered with such procedures are severe postoperative pain and swelling, membrane exposure, wound dehiscence, loss of graft material, and occurring most frequently, the need for additional membrane to secure the bone graft into position.Minimally invasive surgical procedures have been revolutionizing surgical periodontology. Its entry into ridge augmentation procedures is relatively recent, with the introduction of laparoscopic procedures [The mean ridge width (MRW) at the baseline in the test group was 5.05 ± 1.43 mm, and for the control group, it was 5.03 ± 0.82 mm. At 6 months, the MRW was 6.51 ± 1.57 mm and 7.17 ± 1.98 mm for the test and control groups, respectively. Thus, the gain in ridge width was 1.40 ± 0.95 mm and 2.14 ± 1.65 mm for the test and control groups, respectively, which showed the effectiveness of the MRA technique for ridge augmentation. The control group did show a marginally higher gain compared to the test group. However, this gain did not reach a statistically significant level. This could be explained by confounding factors, such as the age of the patients and individual healing characteristics.The horizontal ridge gain achieved in this study was similar to that obtained in a study by Kfir et al. in 2007 (Gain = 1.3–3.9 mm) and Block and Degan in 2004 [Unlike the results of the current study, a study by Lee et al. [Mean bone density is an important parameter for assessing the quality of regenerated bone. The test site showed an MBD of 1040 ± 490 HU at baseline, which reduced to 904 ± 402.55 HU at 6 months. At the control site, it was 1138.20 ± 342.50 HU, which reduced to 1093.9 ± 380.36 HU from baseline to 6 months. The change in bone density (CBD) was −136.40 HU in the test and −44.30 HU in the control group.The reduction in bone density (BD) at both sites could be attributed to the ongoing bone remodeling process. There were no comparative studies for the assessment of bone density in minimally invasive surgical procedures; however, in a study by Lorenz et al. [The bone substitute employed in the study was G Graft (combination of HA and collagen). G graft showed better results when used for socket preservation in molar extraction sockets compared with G Bone (a combination of BTCP and HA) in a study by Panday V et al. in 2015 [HA has been used as a graft substitute in regenerative periodontics for decades. A study by Lindgren et al. in 2010 [Comparison between the test and the control groups concerning the gain in ridge width, as well as bone density, did not reveal any statistically significant difference (The intragroup comparison of bone density (BD) did not show a significant change in the test or control groups. The control group’s mean bone density (MBD) decreased from 1138.20 342.50 HU to 1093.90 380.36 HU, while the test group’s MBD decreased from 1040.70 490.74 HU to 904.30 402.35 HU at baseline and six months. There seems to be no peripheral effect of biostimulation on bone healing in terms of regeneration. There have been a handful of studies regarding the impact of laser biostimulation on bone regeneration in human subjects. A study by Garcia et al. in 2015 [On the other hand, a study by Mandic in 2015 [The variations in the results observed for LLLT could be explained by the role of individual laser parameters, namely the active medium, wavelength, energy, exposure time, and frequency of exposure.The mean surgical time required for the test group was 0.45 ± 0.35 h, and for the control group, it was 0.61 ± 0.37 h. (We found the present technique to be simple, with reduced patient morbidity and a relatively reduced risk of loss of augmentation volume. Patient-reported outcomes are an integral part of the quality of treatment. In both the test and control groups, specific outcomes regarding any discomfort or swelling intraoperatively and postoperatively were recorded. A total of 70% of the subjects in the test group and 80% of the subjects in the control group reported no discomfort or swelling during the procedure and postoperative time period, while 10% of the subjects reported moderate discomfort, and the remaining fraction of the patients reported only mild discomfort. The difference in patient outcomes between the two groups was not statistically significant (Early in the1980s, Kent et al. proposed minimally invasive horizontal ridge augmentation (MIHRA) utilizing a subperiosteal tunneling technique in which a small vertical incision was made in the alveolar ridge, and hydroxyapatite particles were administered underneath the periosteum. Initially, the graft was successful, but studies conducted in the late 1980s revealed that injected hydroxyapatite particles were unstable, and fibrous encapsulation was observed, resulting in partial bone formation [Our study effectively employed a similar technique for maxilla and mandible ridge reconstruction. Based on the literature, this is the first study to investigate the bone quality (in Hounsfield units) regenerated by CBCT for minimally invasive ridge augmentation. The technique not only yielded significant ridge gain, but also showed better patient acceptance and simplicity of execution. This clinical study is unique in that it also explores the adjunctive utilization of LLLT for bone regeneration in human subjects.This study has several limitations. First, the sample size was small; thus, a larger sample size and a longer follow-up duration after implant placement could shed more light on the overall outcome of the study. Secondly, laser irradiation could have been performed for more than one day, which may have improved the outcomes in the test group. Additionally, other growth-promoting materials, in combination with bone grafts, could have been employed that may have altered the outcomes.