The Effect of Periosteal Vertical Mattress Suture on Postoperative Graft Stability Following Guided Bone Regeneration in the Maxillary Esthetic Zone: A Retrospective Study

Background The periosteal vertical mattress suture (PVMS) technique can stabilize grafts through soft-tissue tension during guided bone regeneration (GBR), but its influence on level-specific postoperative graft behaviour remains uncertain. This study evaluated whether PVMS was associated with level-specific graft stability. Methods This study retrospectively reviewed 49 patients (77 implant sites) treated with GBR in the maxillary anterior esthetic zone. The Suture Group received GBR with PVMS ( n = 23), whereas the Non-Suture Group received GBR without membrane fixation ( n = 26). Cone-beam computed tomography images were assessed preoperatively (T0), immediately postoperatively (T1), and at postoperative follow-up (T2; 4.5–8.0 months). Linear mixed-effects models examined dimensional changes at 1, 3, 5, and 7 mm, accounting for measurements nested within sites and patients; restricted cubic splines explored the nonlinear relationship between immediate horizontal augmentation and its retention rate. Results Overall augmentation was similar between groups, but the model identified a significant level-dependent pattern ( P = .008). The Suture Group showed greater mean retained horizontal augmentation in the apical region, whereas the Non-Suture Group showed greater mean retention at the coronal 1-mm level. After baseline-width adjustment, the group-by-level interaction remained significant ( P = .003), but direct between-group contrasts at individual levels were not significant. Immediate graft volume gain correlated with postoperative graft volume reduction in the Non-Suture Group ( P < .001), but not significantly in the Suture Group ( P = .097); the between-group correlation comparison was nonsignificant (P = .055). Conclusion PVMS was associated with a level-dependent pattern of postoperative graft stability during early healing, rather than a demonstrated overall volumetric benefit. Lower coronal and higher apical mean retention should both be considered when interpreting the postoperative alveolar contour. Clinical relevance: These findings can inform level-specific augmentation planning with PVMS, emphasizing coronal contour preservation to support implant esthetics in the maxillary anterior region.