Clinical, Tomographic, and Histological Assessment of Periosteal Guided Bone Regeneration with Cortical Perforations in Advanced Human Critical Size Defects

Abstract

Periosteal preservation seems to be sufficient as a barrier membrane to protect particulate or block osseous grafts provided that good primary closure is achieved. Bone decortication may enhance clinical and histological outcomes. Graft viability (biopsy specimens) and volume maintenance (CT evaluation) remained stable 35 months post-augmentation.

Human Bone Repair After Mandibular Symphysis Block Harvesting: A Clinical and Tomographic Study

“…1A) may affect the healing potential of large defects. The intact periosteum may act as a barrier, allowing guided bone regeneration of the defect 11 . Moreover, this native membrane provides a source of blood supply and nutrients that artificial membranes lack 8,9,11 .…”

“…The intact periosteum may act as a barrier, allowing guided bone regeneration of the defect 11 . Moreover, this native membrane provides a source of blood supply and nutrients that artificial membranes lack 8,9,11 . Lemperle et al 19 studied the healing of large calvarial and mandibular defects in mongrel dogs evaluating bone regeneration with and without periosteal preservation.…”

“…Recent human research has suggested that periosteal preservation and cortical perforations may be important factors to favor osseous repair and wound healing in large human CSDs 11 . In a recent animal model study, Huh et al 12 created bilateral continuity mandibular defects ranging from 5 to 60 mm.…”

Effects of oestrogen deficiency and 17β-estradiol therapy on bone healing in calvarial critical size defects treated with bovine bone graft

“…1 A variety of bone grafting or substitutes [2][3][4][5] have been placed in these defects in order to facilitate and/or promote bone healing. However, the problems associated with bone healing followed bone reconstruction may be associated more with systemic skeletal disorders.…”

Periosteum

“…By this approach, they gain soft-tissue expansion as well as expansion of the periosteum, with obvious advantages to the subsequent surgical bone augmentation procedures. Verdugo et al (2012) showed that a successful GBR of large bone defects can be achieved by means of cortical perforation and no use of membranes but the periosteum alone. The protocol includes the elevation of a full-thickness mucoperiosteal flap by means of a crestal incision and two vertical releasing incisions, followed by decortication and fixation of autologous bone block grafts.…”