Periosteal pedicle graft: A novel root coverage approach

Healing of periosteal pedicle graft in the treatment of gingival recession defects: A histological study in rabbits

Purpose

Various surgical techniques are described in the literature to manage gingival recession defects but the histopathologic evidence to support the current available techniques, is scarce. Recently periosteal pedicle graft (PPG) has proven to be an effective treatment option to treat gingival recession defects (GRD) with results comparable to subepithelial connective tissue graft (SCTG).

Objective

The present histopathological study was done to evaluate the healing pattern of periosteal pedicle autogenous graft along with coronally advanced flap in the treatment of gingival recession defects.

Materials and Methods

The present study was performed on 10 sites in 5 rabbits. Two sites were selected in each animal and gingival recession defects were surgically created and then treated using periosteal pedicle pedicle graft along with coronally advanced flap procedure. Healing pattern was assessed histopathologically at pre-defined intervals till 6 months.

Results

On the 7th day of healing, dilated blood vessels with inflammatory cells were seen, while rudimentary rete-pegs appeared on 14th day. Between 3 months to 6 months, advanced histological repair with connective tissue organization with initiation of junctional epithelium, cementum and bone formation were observed.

Conclusion

Gingival recession defects treated with PPG had evidences of regeneration of cementum, bone and periodontal ligament fibers with new connective tissue attachment.

A New Approach for Root Surface Biomodification Using Injectable Platelet-Rich Fibrin (I-PRF)

Background

This study investigated the potential effects of Injectable Platelet-Rich Fibrin (I-PRF) on root coverage of free gingival graft surgery.

Material/Method

A total of 40 patients with Miller class I or II gingival recession were included. The patients who participated in this study were randomly divided into 2 groups, including the control and experiment groups. The patients in the control group were treated only with free gingival graft (FGG). The patients in the experiment group were treated with free gingival graft and injected with I-PRF as a root surface biomodification agent (FGG+I-PRF). The patients were called back after 3 months, and the amount of exposed root surface was determined and compared to the preoperative findings.

Results

The mean initial exposed root surface was 4.7±1.49 mm for the FGG+I-PRF group, 4.1±1.07 mm for the FGG group, and 4.4±1.31 mm for all subjects. Three months after the operation, the mean root surface coverage values of the 2 groups were 3.5±1.05 and 3.9±0.78 mm in the control and experiment groups, respectively.

Conclusions

The findings showed that the injection of Injectable Platelet-Rich Fibrin (I-PRF) had a positive effect on root coverage in free gingival graft surgery.

Periosteal pedicle graft for the treatment of gingival recession defects current status and future prospects: What the evidence suggests?

BACKGROUND

Gingival Recession defects are one of the most common defects for which patients seek periodontal treatment. Many treatment options are available for the management of gingival recession. Most of the treatments offered aim to treat the cause, cover the denuded root surface and produce a long term aesthetic result. The use of periosteal pedicle graft (PPG) is a recent innovation for the treatment of gingival recession defects and has gained much attention in a short span of time. Although studies have been done utilizing PPG successfully for the treatment of gingival recession defects (GRD) but it is still not clear, whether PPG technique should be included in the established list of techniques used to treat GRD? An effort has been made to arrive at a decision on the current utility of PPG in the treatment of GRD based on the scientific evidence available in literature.

MATERIALS AND METHODS

A review of current literature was done to critically evaluate the evidence related to the Periosteal pedicle graft technique.

RESULTS AND CONCLUSION

Periosteal Pedicle Graft has come up as a viable treatment option for the treatment of GRD although it's still too early to predict the long-term results associated with PPG.

Periosteal Pedicle Flap Harvested during Vestibular Extension for Root Coverage

Root exposure along with inadequate vestibular depth is a common clinical finding. Treatment option includes many techniques to treat such defects for obtaining predictable root coverage. Normally, the vestibular depth is increased first followed by a second surgery for root coverage. The present case report describes a single-stage technique for vestibular extension and root coverage in a single tooth by using the Periosteal Pedicle Flap (PPF). This technique involves no donor site morbidity and allows for reflection of sufficient amount of periosteal flap tissue with its own blood supply at the surgical site, thus increasing the chances of success of root coverage with simultaneous increase in vestibular depth.

Periosteal pedicle graft for the treatment of gingival recession: A viable alternative to sub-epithelial connective tissue graft

Treating gingival recessions is important to satisfy the functional and aesthetic needs of the patients. Among various available techniques to treat gingival recessions, the subepithelial connective tissue graft technique is still considered to be the best despite its inherent disadvantages. The recent innovation utilising periosteum as a pedicle graft to treat gingival recession defects has drawn considerable attention and may provide a viable alternative to subepithelial connective tissue graft.