Periosteal Pedicle Graft Research Articles

Clinical effectiveness of periosteal pedicle graft for the management of gingival recession defects-a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of periosteal pedicle graft (PPG) in terms of root coverage and patient related outcomes. To the best of our knowledge this is the first systematic review with meta-analysis on PPG. A comprehensive search was performed using electronic and hand searches upto January 2023. Primary outcomes were Recession depth Reduction (Rec Red), mean root coverage (mRC) and complete root coverage (CRC). Secondary outcomes were gain in width of keratinized gingiva (WKG) and patient reported outcome measures (PROMs). Meta-analysis was performed when possible. The risk bias assessment was done using RevMan5.4.1 and Joanna Briggs institute scale for the included RCTs and case series respectively. A total of 8 RCTs and 2 case series (538 recession sites) were included based upon the predefined inclusion and exclusion criteria. The follow up period ranged from 6 months to 18 months. Results demonstrated that mRC of PPG + Coronally advanced flap (CAF) was 87.7% for localized gingival recession defects (GRDs) and 84.83% for multiple GRDs. An overall gain in WKG (Weighted Mean =1.49 ± 0.27 mm) was observed among all the included studies in the PPG + CAF group with mean difference (-0.10 (95% CI [-0.52, 0.33], p = 0.66)). Sub-group meta-analysis comparing PPG + CAF with sub-epithelial connective tissue graft (SCTG) + CAF resulted in similar outcomes in terms of Rec Red (0.10 (95% CI [-0.56 to 0.77], p = 0.76)) and gain in WKG (-0.03 (95% CI [-0.25 to 0.18], p = 0.76)). In terms of PROMs systematic review revealed better patient satisfaction with PPG + CAF than SCTG + CAF. PPG + CAF is a viable treatment modality for management of GRDs. The primary and secondary outcomes achieved utilizing PPG + CAF were found to be comparable to other conventional techniques including the gold standard i.e., SCTG.

Clinical evaluation of periosteal pedicle flap in the treatment of gingival recessions for esthetic root coverage: A randomized controlled clinical trial.

Root coverage using subepithelial connective tissue graft (SCTG) is gold standard with few drawbacks such as requirement of second surgical site, reduced donor tissue availability, and increased surgical complications and pain. Periosteal pedicle graft (PPG) due to its rich source of pluripotent stem cells and nonrequirement of second surgical site could be a successful alternative for invasive SCTG. Therefore, current research aims to compare the amount of root coverage obtained with PPG to SCTG. Fifty-two single gingival recessions were included in the sample, with 26 patients allocated to the SCTG (control) and PPG (test) groups at random. At baseline, 3, and 6 months after surgery, clinical measurements of probing depth, clinical attachment level (CAL), recession depth (RD), recession width (RW), and width of keratinized tissue were taken. Both procedures, i.e., SCTG and PPG, resulted in root coverage to a variable extent and a significant decrease in RD (1.69, 1.38 mm in SCTG and PPG groups, respectively) and RW, CAL gain is found in both the groups without any intergroup statistical variance. Complete root coverage (CRC) was obtained in 14 out of 26, i.e., 53.8% defects in both SCTG and PPG groups. A better comfort level is found in the group treated with PPG. Gingival recessions can be successfully treated with PPG, which has predictability comparable to SCTG and does not require a second surgical site.

Periosteal Pedicle Graft

Gingival recession is a very common periodontal defect where gingiva moves apically and results in the exposure of root surface causing hypersensitivity, root caries that further leads to shallow vestibule and narrowing the amount of attached gingiva. Various surgical techniques are performed multiple times to get predictable results. In order to avoid patients' discomfort and number of invasive procedures, an intense need for an autograft is required, which has an adequate vascular supply and can be obtained from the same surgical site. Hence, we presented a case series where periosteal pedicle graft is used in treating Miller's class I and II single and multiple recession defects and its effectiveness over a 6-month period.

Periosteal pedicle graft with coronally advanced flap and its comparison with modified coronally advanced flap in the treatment of multiple adjacent gingival recessions-a randomized clinical trial

The present study aimed at evaluating clinical utility of periosteal pedicle graft with coronally advanced flap (PPG ​+ ​CAF) vs modified coronally advanced flap (M-CAF) in cases of multiple adjacent gingival recessions involving maxillary and mandibular anteriors labially. Random allocation of 40 patients with 269 gingival recessions was done into two groups. In Test group (20 patients) periosteal pedicle graft followed by coronally advanced flap (PPG ​+ ​CAF) technique was performed and in control group (20 patients) modified coronally advanced flap (M-CAF) was attempted. Primary outcome measures included percentage root coverage (PRC), gingival thickness (GT), probing depth (PD), clinical attachment level (CAL), recession depth (RD) and width of keratinized gingiva (WKG). Secondary outcomes measures were patient centred outcomes, plaque index (PI) and gingival index (GI). Patients were recalled at baseline, 3,6 and 18 months postoperatively. ResultsThere was a significant decrease in the mean recession depth from 3.58 ​± ​0.53 ​mm (baseline) to 0.22 ​± ​0.01 ​mm (18 months) in PPG ​+ ​CAF test group and 3.7 ​± ​0.56 ​mm (baseline) to 0.21 ​± ​0.01 mm (18 months) in M-CAF control group. With 85% root coverage in test group and 78% root coverage in control group, the difference was statistically significant at 18 months. The test group showed significant higher clinical attachment level gain and increase in width of keratinized gingiva as compared to control group. ConclusionIn both the study groups PPG ​+ ​CAF and M-CAF, significant root coverage was achieved. However, in terms of increase in width of keratinized gingiva, gingival thickness and percentage root coverage, PPG ​+ ​CAF group presented significantly better results than M-CAF group at 18 months follow up. Thus, periosteum can be used as a pedicle graft along with coronally advanced flap as an alternative method in achieving better results with minimal cost.

COMPARISON OF AUTOGENOUS PERIOSTEAL PEDICAL GRAFT AS A BARRIER AND BIORESORBABLE COLLAGEN MEMBRANE IN MANAGEMENT OF PERIODONTAL INTRABONY DEFECTS: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Introduction: The autogenous periosteal pedicle graft (PPG) has been viewed as having regenerative potential and provides adequate blood supply rich in growth factors. It also provides a rigid barrier maintaining the patency of the periodontal intrabony defect space for regenerative cell repopulation. Thus, PPG might be an alternative to currently available barrier membranes used for guided tissue regeneration (GTR). So, the aim of this study was to evaluate the clinical and radiographic outcomes of autogenous PPG as a barrier compared to bioresorbable collagen membrane (CM) for treating periodontal intra-bony defects.Materials and methods: Twenty chronic periodontitis patients having matched contralateral periodontal intrabony defects participated in this randomized controlled clinical trial. Using split-mouth design, defects were randomly treated with either autogenous PPG or bioresorbable CM (Bioteck®, Arcugnano VI, Italy). Clinical outcomes included; plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment level (CAL). Digital periapical radiographs and linear measurements were used to calculate the radiographic outcomes; bone defect area (BDA). Measurements were taken at the time of surgery (baseline) and 6-months postoperatively. Statistical analysis was conducted using Wilcoxon’s-Signed-Rank test.Results: At 6 months both treatments resulted in statistically significant improvement in all clinical and radiographic outcomes compared with baseline (P 0.05). Conclusion: Within the limitations of this study, it can be concluded that both the autogenous PPG and the bioresorbable CM improved clinical and radiographic outcomes and were effective GTR membranes in management of intra-bony defects.

Clinical efficacy of periosteal pedicle graft with subepithelial connective tissue graft in gingival recession coverage.

Introduction:Correction of gingival recession (GR) involves eliminating the cause of recession and it often requires surgical correction. Subepithelial connective tissue graft (SCTG) technique by Langer and Langer provides excellent esthetics and is considered most predictable in obtaining marginal tissue recession coverage. However, the requirement of a second surgical procedure for harvesting CTG remote from planned site of recession coverage increases the chances of postoperative infection. There is also a limitation in the amount of graft that can be harvested and an increased operative time contributing to patient discomfort.Materials and Methods:Overcoming these difficulties has become possible with the introduction of “periosteal pedicle graft” (PPG). The study is a split-mouth design where patients with bilateral, isolated GR defects were treated using two different surgical techniques, i.e., PPG versus the SCTG in obtaining GR coverage. The objective was to analyze the comparative amount of root coverage and the gain in width of attached gingiva achieved by both the techniques.Results:All the clinical parameters evaluated were comparable between SCTG and PPG when recorded at 6 and 9 months posttreatment.Conclusion:Both techniques produced satisfactory and predictable results. PPG eliminated the need for the 2nd operative site, lesser intraoperative time, and hence, patient comfort was enhanced.

Comparison of Effectiveness of the Novel Periosteal Pedicle Graft Technique with Coronally Advanced Flap for the Treatment of Long‐Span Unesthetic Multiple Gingival Recession Defects

IntroductionMultiple gingival recession defects (MGRD) are considered a complex clinical scenario; therefore, recent scientific evidence suggests the need for further clinical research for treating MGRD. While coronally advanced flap (CAF) is an established procedure for the effective management of MGRD, its success is limited in terms of long‐term stability. The periosteal pedicle graft (PPG) has been drawing considerable attention as a treatment modality for managing gingival recession defects (GRD) owing to its immense regenerative potential and has shown promising results.Case SeriesThirty‐five patients, with maxillary MGRD in the age group of 25 to 40 years were randomly divided into PPG (test) and CAF (control) groups. The percentage of root coverage along with mean change in probing depth (PD), gingival thickness (GT), width of keratinized gingiva (WKG) and width of attached gingiva (WAG) were recorded, at baseline and after 1 year. Patient satisfaction criteria were also compared, and the results were analyzed statistically.ConclusionAfter 1 year, the test group had 91.3% defect coverage while the control group had 76.3% defect coverage. PPG was more predictable than CAF in terms of percent root coverage with superior esthetic outcomes for the treatment of MGRD.

Comparison of Marginal Periosteal Pedicle Graft and Bioactive Glass with Platelet-rich Fibrin and Bioactive Glass in the Treatment of Intrabony Defects - A Clinicoradiographic Study.

Introduction and Objectives:The objective of the study was to compare clinically and radiographically the regenerative potential of marginal periosteal pedicle graft (MPPG) or platelet-rich fibrin (PRF) with a bioactive glass in the treatment of two- and three-wall intrabony defects.Methods:A total of 28 sites (bilateral or contralateral infrabony defects) from 14 patient were treated with MPPG (Experimental site A) and the other site was treated with PRF (Experimental site B). The clinical parameters, such as full-mouth plaque index (PI) and site PI, were recorded at baseline, 3, 6, and 9 months’ postsurgery while sulcus bleeding index (SBI), probing pocket depth (PD), clinical attachment level (CAL), and gingival recession were recorded at baseline, 6, and 9 months. Radiographic evaluation was carried out to evaluate the defect fill, change in alveolar crest height, and percent defect fill at 6 and 9 months.Results:Results showed that both the experimental groups showed clinically and statistically significant reduction in mean PI, SBI, PD, radiographic defect depth, and gain in CAL. The percentage of defect fill at 6 months (70.55 ± 15.99 vs. 55.30 ± 11.87) and 9 months (84.55 ± 11.74 vs. 72.2 ± 9.91) was significantly greater in Site A compared to Site B.Conclusions:Within the limitations of this study, it can be concluded that both the treatment modalities showed the potential of enhancing bone regeneration. However, the use of marginal periosteal pedicle flap showed better improvement in clinical and radiographic parameters.

Multiple Gingival Recession Defects Treated with Coronally Advanced Flap and Either the VISTA Technique Enhanced with GEM 21S or Periosteal Pedicle Graft: A 9-Month Clinical Study.

The objective of this study was to clinically evaluate and compare the efficacy of the vestibular incision subperiosteal tunnel access (VISTA) technique using Bio-Gide (Geistlich) membrane enhanced with GEM 21S (Osteohealth) with periosteal pedicle graft (PPG) using a coronally advanced flap. Multiple gingival recession sites in 15 individuals were randomly assigned either to experimental site A (VISTA) or experimental site B (PPG) in a split-mouth design. The clinical parameters were recorded at baseline and 9 months postoperatively. Repeated measures analysis of variance with post hoc Bonferroni correction and paired t test were used to assess statistical significance (P < .05). Mean recession depth significantly decreased from 4.21 ± 1.08 mm (presurgery) to 0.61 ± 0.92 mm (9 months) with VISTA (87.37 ± 17.78% root coverage) and from 4.17 ± 1.18 mm (presurgery) to 1.16 ± 0.92 mm (9 months) with PPG (71.84 ± 19.25% root coverage). Width of keratinized tissue and clinical attachment gain were significantly higher in the VISTA group compared with the PPG group. Within the limits of the study both VISTA and PPG groups resulted in a significant amount of root coverage. The VISTA technique was less invasive and required minimal time and clinical maneuvering. It also resulted in a superior esthetic outcome.

Platelet-rich fibrin-reinforced periosteal pedicle graft with vestibular incision subperiosteal tunnel access technique for the coverage of exposed root surface

Platelet-rich fibrin (PRF) has been shown to promote soft tissue healing because it contains growth factors. Periosteal pedicle graft (PPG) provides not only good and predictable root coverage, but also reduces the need for the second surgical site. Access to the surgical site is obtained by minimally invasive technique known as vestibular incision subperiosteal tunnel access (VISTA) technique. Therefore, the purpose of this case report was to evaluate the PRF-reinforced PPG with VISTA technique for the coverage of exposed root surface. A patient with Miller Class II gingival recession of 6.5 mm was treated by PRF-reinforced PPG with VISTA technique. PRF was prepared from whole blood and applied to the root surface. After 6 months, 5.5 mm, that is, 84.6% of the root coverage was obtained. PRF-reinforced PPG with VISTA technique can be predictably used for the achievement of successful root coverage. The long-term follow-up with histologic studies will be required to obtained more information about PRF-reinforced PPG with VISTA technique for the coverage of exposed root surface. Clinical Relevance to Interdisciplinary Dentistry PRF is a fibrin matrix network in which platelets are trapped. Platelets in PRF release high amount of growth factors which take part in soft tissue and hard tissue repair and regeneration. As PRF-reinforced PPG and VISTA technique for coverage of exposed root surface showing good promising results, PRF can be used in various aspects/disciplines of the dentistry as well as in interdisciplinary dentistry to reinforced natural tissue regeneration (NTR) and natural bone regeneration (NBR).

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

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

Role of Space Provision in Regeneration of Localized Two‐Wall Intrabony Defects Using Periosteal Pedicle Graft as an Autogenous Guided Tissue Membrane

Marginal pedicle periosteum (MPP) has been used as a rigid membrane in guided tissue regeneration (GTR) for osseous defects. The present study aims to study the effect of space provision by an alloplastic graft material in bone defect area (BDA) reduction of 2-wall defects. Twenty interproximal intrabony 2-wall defects in healthy non-smoking patients with chronic periodontitis were randomly divided in control (group 1, periosteum alone) and experimental (group 2, periosteum with alloplastic graft material) groups. Measurements of probing depth (PD), clinical attachment level (CAL), and radiographic BDA were done at the baseline and 6-month postoperative evaluations. The 6-month postoperative assessment showed clinical and radiographic improvements with PD reduction, CAL gain, and changes in BDA in both groups, which was statistically significant compared with baseline (P <0.05). However, BDA reduction was statistically greater in group 2 (48.88% ± 18.61%) compared with group 1 (14.08% ± 12.97%) at the 6-month follow-up (P = 0.009). Within the limitations of this study, it can be concluded that space provision by an alloplastic graft material increases the regenerative potential of MPP as a GTR membrane and results in increased defect fill.

PERIOSTEAL PEDICLE GRAFT: A PROMISING TECHNIQUE FOR THE TREATMENT OF GINGIVAL RECESSION DEFECTS

The periosteum is a rich vascular connective tissue with great regenerative potentiality. The qualities of periosteum make it an ideal autogenous graft. The present case report describes the utilisation of periosteal pedicle graft for the treatment of gingival recession defect successfully.

Comparison of periosteal pedicle graft and subepithelial connective tissue graft for the treatment of gingival recession defects

The use of periosteum as a pedicle graft in the treatment of gingival recession defects is a recent advancement. The subepithelial connective tissue graft (SCTG) is considered the gold standard for the treatment of gingival recession defects. The present randomized controlled trial was done to compare periosteal pedicle graft (PPG) with SCTG for the treatment of gingival recession defects. 10 males and 10 females between the ages of 16 and 40 years (mean age 25.2 years) with Miller's Class I and II recessions ≥3 mm participated in this one-year clinical study. They were assigned randomly to test group (PPG) and control group (SCTG). Results were evaluated based on parameters measuring patient satisfaction and clinical outcomes associated with two treatment procedures. Significance was set at p < 0.05. At the end of the study, the defect coverage was 3.1 ± 0.13 mm or 92.6% in the test group compared to the control group in which the defect coverage was 2.70 ± 0.11 mm or 88.5%. The difference between the two groups was statistically significant (p < 0.0001). The average residual defect was comparable between the two groups, i.e. 0.3 ± 0.67 and 0.5 ± 0.84 in the PPG and SCTG group respectively. The test group was rated higher in terms of overall patient satisfaction (p < 0.02) and comfort during and after the procedure (p < 0.001). PPG and SCTG have comparable clinical effectiveness, but PPG is superior to SCTG in terms of patient-centred outcomes, reflecting improved patient comfort and overall patient satisfaction.

Role of Periosteal Pedicle Graft as an Autogenous Guided Tissue Membrane in Periodontal Regeneration: An Ethical Perspective

Role of Periosteal Pedicle Graft as an Autogenous Guided Tissue Membrane in Periodontal Regeneration: An Ethical Perspective

Platelet‐Derived Growth Factor‐BB Release Profile in Gingival Crevicular Fluid After Use of Marginal Periosteal Pedicle Graft as an Autogenous Guided Tissue Membrane to Treat Localized Intrabony Defects

The aim of this study is to evaluate levels of platelet-derived growth factor-BB (PDGF-BB) in gingival crevicular fluid (GCF) during the early stages of healing for sites treated by marginal periosteal pedicle (MPP) graft as an autogenous guided tissue membrane compared to that of the control open flap debridement (OFD). Fifteen non-smoking patients (13 males and 2 females) with severe chronic periodontitis participated in this prospective, controlled, masked trial. Each subject contributed matched pairs of 2- or 3-walled intrabony interproximal defects in premolar or molar teeth. Interproximal contralateral defects were randomly assigned to either the MPP group 1 or control OFD group 2. GCF samples were collected at 1, 3, 7, 14, and 30 days after surgery. PDGF-BB in the GCF samples was measured using a human PDGF-BB enzyme-linked immunosorbent assay kit. In both MPP and OFD, PDGF-BB concentrations peaked in the samples obtained during the early postoperative days (days 2 and 3) and decreased sharply in the samples obtained 7, 14, and 30 days post-surgery. Periosteal coverage of periodontal defects is not associated with a significant increase in PDGF-BB levels.

Treatment of Multiple Gingival Recession Defects Using Periosteal Pedicle Graft: A Case Series

The periosteum is a highly vascular connective tissue with immense regenerative potential. These qualities make it a suitable autogenous graft. A technique is described for using an autogenous periosteal pedicle graft (PPG) for the treatment of multiple gingival recession defects. Twenty teeth in six subjects with Miller Class I and II recessions ≥ 2 mm were treated using PPGs. In addition to the depth of the gingival recession defect, the probing depth and widths of keratinized and attached gingiva were recorded. The mean +/- SD was calculated for each of the clinical parameters. The paired t test was used to test the significance of the change. At the end of 1 year, 90.95% of root coverage was attained with a significant increase in the widths of keratinized and attached gingiva (P = 0.0001); no change was observed in probing depths (P = 0.36). The PPG technique can be successfully used for the treatment of multiple gingival recession defects.

Periosteal pedicle graft for the treatment of gingival recession defects: a novel technique

The periosteum is a highly cellular connective tissue with rich vascularity and regenerative potential. These qualities make it a suitable autogenous graft. A technique utilizing autogenous periosteal pedicle graft (PPG) for the treatment of gingival recession defects is described. Four patients with Miller Class I and II recessions > or = 3 mm were treated utilizing PPG. At the end of one year, all defects were completely covered. The PPG technique can be used for the treatment of gingival recession defects successfully.