Effect of Removal of Periosteum on Postoperative Result of Mucogingival Surgery

Abstract

V ARIOUS surgical techniques have been advocated in the last decade attempting to create attached gingiva when this is missing or greatly reduced. 1 " 4 The reasons for the need of a wide band of attached gingiva, according to Friedman 5 are to eliminate the tension and pull on the marginal gingiva and to provide sufficient vestibular depth and freedom from frena for efficient tooth brushing and reflection of food in mastication. Some authors claim that the periosteum must be removed because attached gingiva will form only to cover areas where bone is denuded during the operation. 1 ' 6 Others believe that the periosteum should not be disturbed. 7 In a histologic study in dogs, Wilderman et al 8 have found that the denudation of bone during mucogingival surgery produces a loss of marginal bone. The present investigation was undertaken to study quantitatively the periodontal response to bone denudation in mucogingival surgery. MATERIAL AND METHODSThe study was made on four healthy adult mongrel dogs. The animals were anesthetized with Nembutal by intraperitoneal injection and the following procedure was performed:(1) A small cavity was drilled with a No½ round bur in the buccal aspect of the lower incisors and cuspids so as to have a fixed point from which to make the measurements.(2) The distances from the fixed point to the gingival margin and the mucogingival line were measured by means of a compass and millimetered ruler (Fig. 1).(3) The mucogingival fold was deepened by sharp dissection with a Bard-Parker knife to a depth of about 20 mm. and extending laterally beyond the distal aspect of both cuspids (Fig. 2, B).'^Faculty of Dentistry University of Buenos Aires.(4) A vertical incision was made between the two central incisors and to the bottom of the deepened fold.(5) The bone corresponding to the incisors and cuspid of the left side was denuded of periosteum by the use of curettes and scalers (Fig. 2, C).(6) The remaining unattached gingiva on the left side was also completely removed and the periosteum eliminated as thoroughly as possible.(7) The remaining attached gingiva on the right side was eliminated with scissors and periodontal knives, but the periosteum was allowed to remain in place (Fig. 2, D).(8) The area was covered with surgical periodontal pack maintained in place by an acrylic stent wired to the teeth (Fig. 2, E).One month after the operation the animals were anesthetized, the periodontal pack removed and the distances from the fixed point to the gingival margin and the mucogingival line again measured. At this time one animal was sacrificed and the operated area prepared for histologic study. The remaining three animals were left unpacked and again anesthetized and measured two and three months postoperatively. RESULTSThe findings to be presented consist only of the statistical study of the measurements done in three animals. Table I shows the differences between the preoperative measurements obtained on each tooth and the one, two and three months measurements.For the statistical analysis...

Culture of Human Gingival Fibroblasts on a Biodegradable Scaffold and Evaluation of Its Effect on Attached Gingiva: A Randomized, Controlled Pilot Study

“…In the present study, the mean increased keratinized tissue at the control sites was 1.9 mm, which was approximately similar to the results of the aforementioned studies. The histologic findings at the control sites in the present study (a parakeratinized epithelium with a dense connective tissue) were similar to those in the study by Carranza and Carraro 30 . Tissue‐engineered gingival grafts have several advantages: a very small donor site, sufficient amounts of keratinized tissue obtained, and minimal discomfort for the patient.…”

“…Similar histologic results were reported in that study and the present study, despite the use of different fibroblasts (gingival and skin fibroblasts). Carranza and Carraro 30 evaluated the effect of periosteal fenestration in a gingival extension operation. They reported an increase of 2.3 ± 0.38 mm in the width of keratinized tissue with that technique.…”

Histologic Study of Cellular Mobilization and Repair Following a Periosteal Retention Operation Via Split Thickness Mucogingival Flap Surgery

“…(2) The effect of the retention of periosteum on the reparative process of bone, connective tissue and epithelium. (2) The effect of the retention of periosteum on the reparative process of bone, connective tissue and epithelium.…”

The Origin of Granulation Tissue and Its Impact on Postoperative Results of Mucogingival Surgery

“…[15][16][17][18][19] It appears that the denudation technique tends to yield more consistent results than the periosteal retention. 3,20 Other mucogingival procedures such as "the apically repositioned flap" 21 and the "periosteal retention proce dure with fenestration" 12 are, in principle, modifications of the denudation and periosteal retention techniques.…”