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Mahajan A, Goyal L, Asi KS, Walhe MS, Chandel N. Clinical effectiveness of periosteal pedicle graft for the management of gingival recession defects-a systematic review and meta-analysis. Evid Based Dent 2023; 24:93-94. [PMID: 37286696 DOI: 10.1038/s41432-023-00898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE 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. MATERIAL AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Ajay Mahajan
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India.
| | - Lata Goyal
- All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Kanwarjit Singh Asi
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Monika Shekhar Walhe
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Nidhi Chandel
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
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Nisha S, Shashikumar P. 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. J Oral Biol Craniofac Res 2021; 11:99-106. [PMID: 33532194 DOI: 10.1016/j.jobcr.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/01/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022] Open
Abstract
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. Results There 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. Conclusion In 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.
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Affiliation(s)
- Swet Nisha
- Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - Pratibha Shashikumar
- Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
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Swathi S, Murthy KRV, Kishore DT, Kumar YSP, Kumar GNV. Novel Surgical Approach for Root Coverage Using Coronally Advanced Flap in Conjunction With Transposition of Periosteal Pedicle Graft. Clin Adv Periodontics 2020; 11:195-200. [PMID: 33210840 DOI: 10.1002/cap.10133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/03/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Gingival recession is a complex phenomenon with multifactorial etiology. It is defined as the apical migration of the soft tissue margin beyond the cemento-enamel junction, thereby exposing the root surface. It results in the destruction of both soft and hard tissues. CASE PRESENTATION Three patients with buccal gingival recession defects underwent surgical treatment consisting of transposition of a periosteal pedicle in conjunction with the coronally advanced flap (CAF) technique. As the cambium layer of the periosteum has greater osteoblastic potential than the fibrous layer, this study considered juxtaposing of the cambium layer directly onto the denuded root surface. A 9-month review demonstrated satisfactory: root coverage; gain in clinical attachment, reduction in probing depth; and increase in width of keratinized gingiva with a good color match and minimal scarring. CONCLUSION Within the limits of the study, this CAF technique, in conjunction with the cambium layer of periosteum, showed a significant amount of root coverage.
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Affiliation(s)
- Seepana Swathi
- Department of Periodontics and Oral Implantology, Gandhi Institute of Technology and Management (GITAM) Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - K Raja V Murthy
- Department of Periodontics and Oral Implantology, Gandhi Institute of Technology and Management (GITAM) Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - D Trinath Kishore
- Department of Periodontics and Oral Implantology, Gandhi Institute of Technology and Management (GITAM) Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Y Sandhya Pavan Kumar
- Department of Periodontics and Oral Implantology, Gandhi Institute of Technology and Management (GITAM) Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - G Naveen Vital Kumar
- Department of Periodontics and Oral Implantology, Gandhi Institute of Technology and Management (GITAM) Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
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Clagett R, Ogdon D, Kim M, Geisinger ML. Treatment of Recession Defects With Mucosal Access and Use of Soft Tissue Allograft: A Case Report of a Simplified Protocol. Clin Adv Periodontics 2019; 10:30-37. [PMID: 31524323 DOI: 10.1002/cap.10076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/29/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Esthetic and functional root coverage procedures using a variety of techniques and materials allow for predictable outcomes in Miller Class I and II defects, but may be accompanied by high levels of postoperative discomfort and lengthy intrasurgical time. Current techniques may also require a steep practitioner learning curve, cumbersome intrasurgical steps, and their use in challenging clinical situations, e.g. multiple adjacent recession defects, limited vestibular depth, and anatomical limitations can prove difficult. This report introduces the side access mucosal releasing incision (SAMRI) technique as an innovative and simplified method to perform mucosal-access root coverage procedures. CASE PRESENTATION A 42-year-old female presents with 3 to 4 mm of gingival recession at #9-11 and opts for treatment with a vestibular approach and acellular dermal matrix graft to avoid a secondary surgical site. CONCLUSION SAMRI procedure allows for optimal root coverage and esthetic results while limiting intrasurgical time and postoperative patient morbidity.
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Affiliation(s)
- Ryan Clagett
- Private Practice Limited to Periodontics, Elizabethtown, KY
| | - Dorothy Ogdon
- Lister Hill Library, University of Alabama at Birmingham, Birmingham, AL
| | - Miyoung Kim
- Department of Prosthodontics, University of Alabama at Birmingham, Birmingham, AL
| | - Maria L Geisinger
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, AL
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Terenzi M, Pigossi SC, Pires LC, Cirelli JA, Sampaio JE. Modified approach for keratinized tissue augmentation in multiple teeth. J Indian Soc Periodontol 2018; 21:512-516. [PMID: 29551874 PMCID: PMC5846252 DOI: 10.4103/jisp.jisp_332_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case report demonstrated a modified technique of free gingival graft (FGG) aiming to increase keratinized attached tissue in large recipient areas. A FGG to increase the amount of attached gingival tissue, facilitate oral hygiene, and prevent further clinical attachment loss was realized in two patients. Because the extensive recipient area, a modified technique was performed to obtain a smaller graft of the donor area. A template of the graft was made about 25%–30% smaller than the total recipient area. After graft removal, interspersed incisions were made in the upper and lower edges of it. After 9–24 months of follow-up, the final width of the keratinized tissue was 4.0–4.4 times larger in comparison to initial clinical condition. In conclusion, this FGG technique can be considered an alternative to gain sufficient amount of keratinized gingival tissue using a smaller graft.
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Affiliation(s)
- Mayara Terenzi
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
| | - Suzane Cristina Pigossi
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
| | - Luana Carla Pires
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
| | - Joni Augusto Cirelli
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
| | - José Eduardo Sampaio
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
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Kumar A, Kaushal S, Verma N, Chandra D. Periosteum as a lateral pedicle graft for the treatment of single tooth root recession: A novel approach. J Oral Biol Craniofac Res 2016; 6:246-249. [PMID: 27761392 DOI: 10.1016/j.jobcr.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/04/2015] [Indexed: 11/16/2022] Open
Abstract
The treatment of gingival recession defects is indicated for esthetic and functional reasons to reduce root sensitivity, to remove muscle pull, to create or augment keratinized tissue, and to prevent disease progression. The presence of sufficient amount of periosteum adjacent to gingival recession defects makes it a suitable graft. The adult human periosteum is a highly vascular connective tissue with immense regenerative potential. It contains fibroblasts, osteogenic progenitor cells, and stem cells as a result of which it has the ability to differentiate into fibroblast, osteoblast, chondrocytes, adipocytes, and skeletal myocytes. The tissue provided by these cells includes cementum with periodontal ligament fibers and bone. Therefore, in the present case, periosteum has been used as a lateral pedicle graft for the coverage of the single tooth gingival recession (mandibular central incisor). The procedure is justified by the evidence that periosteum is capable of proliferation and osteogenesis after injury.
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Affiliation(s)
- Avadhesh Kumar
- Reader, Department of Periodontology, Career Post Graduate Institute of Dental Sciences & Hospital, Lucknow, U.P., India
| | - Shalini Kaushal
- Associate Professor, Department of Periodontology, Faculty of Dental Sciences, K.G. Medical University, Lucknow, U.P., India
| | - Neelu Verma
- Senior Lecturer, Department of Periodontology, Career Post Graduate Institute of Dental Sciences & Hospital, Lucknow, U.P., India
| | - Deepti Chandra
- PG Student, Department of Periodontology, Career Post Graduate Institute of Dental Sciences & Hospital, Lucknow, U.P., India
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Mahajan A, Asi KS. Periosteal pedicle graft for the treatment of gingival recession defects current status and future prospects: What the evidence suggests? J Indian Soc Periodontol 2016; 20:220-1. [PMID: 27143840 PMCID: PMC4847474 DOI: 10.4103/0972-124x.170850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Ajay Mahajan
- Department of Periodontics, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Kanwarjit Singh Asi
- Department of Periodontics, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
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8
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Periosteal Pedicle Flap Harvested during Vestibular Extension for Root Coverage. Case Rep Dent 2016; 2015:124039. [PMID: 26788377 PMCID: PMC4695641 DOI: 10.1155/2015/124039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/25/2015] [Indexed: 11/24/2022] Open
Abstract
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.
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9
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Vincent-Bugnas S, Charbit Y, Lamure J, Mahler P, Dard MM. Modified Tunnel Technique Combined with Enamel Matrix Derivative: A Minimally Invasive Treatment for Single or Multiple Class I Recession Defects. J ESTHET RESTOR DENT 2015; 27:145-54. [DOI: 10.1111/jerd.12170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Séverine Vincent-Bugnas
- Pole of Odontology; Department of Periodontology; Nice University Hospital; Nice France
- Nice-Sophia Antipolis University; MICORALIS EA7534 Nice France
| | - Yves Charbit
- Pole of Odontology; Department of Periodontology; Nice University Hospital; Nice France
| | - Julie Lamure
- Pole of Odontology; Department of Periodontology; Nice University Hospital; Nice France
- Nice-Sophia Antipolis University; MICORALIS EA7534 Nice France
| | - Patrick Mahler
- Pole of Odontology; Department of Periodontology; Nice University Hospital; Nice France
| | - Michel M. Dard
- Department of Periodontology and Implant Dentistry, College of Dentistry; New York University; NY 10010 USA
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Mahajan A. Periosteal pedicle graft for the treatment of gingival recession: A viable alternative to sub-epithelial connective tissue graft. World J Stomatol 2015; 4:37-38. [DOI: 10.5321/wjs.v4.i2.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/20/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023] Open
Abstract
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.
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Shah MP, Patel AP, Shah KM. Periosteal pedicle graft: A novel root coverage approach. J Indian Soc Periodontol 2015; 19:99-102. [PMID: 25810603 PMCID: PMC4365168 DOI: 10.4103/0972-124x.145828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/12/2014] [Indexed: 12/11/2022] Open
Abstract
Gingival recession along with reduced width of attached gingiva and inadequate vestibular depth is a very common finding. Many techniques have been adopted in order to treat such defects and obtain predictable root coverage. Several graft procedures are used to obtain the coverage, but they have not been able to deliver predictable and satisfactory results (except connective tissue graft). Some of them also resulted in the secondary surgical site that was very uncomfortable for the patients. There was an intense need for a technique that provides not only good and predictable root coverage, but also reduces the need for secondary surgical site. Hence, this paper describes a single stage technique for increasing the width of attached gingiva and root coverage by using the periosteal pedicle graft.
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Affiliation(s)
- Mishal Piyush Shah
- Department of Periodontology, Narsinhbhai Patel Dental College, Visnagar, Gujarat, India
| | - Akash Prahlad Patel
- Department of Periodontology, Narsinhbhai Patel Dental College, Visnagar, Gujarat, India
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12
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Saimbi CS, Gautam A, Khan MA, Nandlal. Periosteum as a barrier membrane in the treatment of intrabony defect: A new technique. J Indian Soc Periodontol 2014; 18:331-5. [PMID: 25024547 PMCID: PMC4095626 DOI: 10.4103/0972-124x.134571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 11/21/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The purpose of the study was to evaluate the clinical effectiveness of periosteum as a barrier membrane for the treatment of intrabony defects. MATERIALS AND METHODS The study was conducted in patients having bilateral intrabony defects. A total of 20 intrabony defects in 10 patients were treated, out of which 10 defects received periosteal barrier and the other 10 defects received conventional open flap debridement procedure. The efficacy of the treatment was assessed using clinical parameters and dentascan. RESULTS Statistically significant gain in clinical attachment level (CAL) was found in the test group (2.00 ± 0.26 mm) as compared to the control group (0.60 ± 0.22 mm). In both the treatment modalities (test and control groups), a significant decrease in probing pocket depth of 3.90 ± 0.35 mm and 2.90 ± 0.31 mm was observed, respectively. The difference between the two groups was not statistically significant. Bone defect fill was 1.40 ± 0.16 mm for the test group and 0.90 ± 0.18 mm for the control group, but the difference observed was not statistically significant. CONCLUSION The results of this study show that periosteal barrier membrane can be a better alternative of barrier membranes for the treatment of intrabony defects.
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Affiliation(s)
- Charanjeet Singh Saimbi
- Department of Periodontics, Carrier Postgraduate Institute of Dental Sciences and Hospital, Ghaila, Sitapur-Hardoi Bypass, IIM Road, Lucknow, Uttar Pradesh, India
| | - Anju Gautam
- Department of Periodontics, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mohd. Akhlak Khan
- Department of Periodontics, Faculty of Dental Sciences, C. S. M. Medical University, Lucknow, Uttar Pradesh, India
| | - Nandlal
- Department of Periodontics, Faculty of Dental Sciences, C. S. M. Medical University, Lucknow, Uttar Pradesh, India
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Gupta GK, Kulkarni MR, Thomas BS. Post-operative morbidity following the use of the inverted periosteal graft: A case series. J Indian Soc Periodontol 2014; 18:82-4. [PMID: 24744551 PMCID: PMC3988651 DOI: 10.4103/0972-124x.128197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 07/11/2013] [Indexed: 11/11/2022] Open
Abstract
Post-operative complications following flap surgeries or mucogingival procedures are important factors influencing patient's perception of periodontal procedures. Hence, it is important to foresee such complications and take adequate measures pre- and post-operatively. We treated five consecutive cases of gingival recession in the maxillary canine-premolar area using the inverted periosteal graft with a coronally positioned flap technique. Following each of these surgeries, the patients complained of post-operative swelling the next day involving the canine space or buccal space area. The swelling persisted for at least 5 days, however, it was painless. This paper highlights the post-operative complications associated with the said procedure and makes a case for detail enquiry in the form of controlled studies.
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Affiliation(s)
- Gazal Kaushelendra Gupta
- Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Mihir Raghavendra Kulkarni
- Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Betsy Sara Thomas
- Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
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Rajpal J, Gupta KK, Srivastava R, Arora A. Vestibular deepening by periosteal fenestration and its use as a periosteal pedicle flap for root coverage. J Indian Soc Periodontol 2013; 17:265-70. [PMID: 23869140 PMCID: PMC3713765 DOI: 10.4103/0972-124x.113095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 03/14/2013] [Indexed: 01/07/2023] Open
Abstract
Gingival recession along with reduced width of attached gingiva and inadequate vestibular depth is a very common finding. Multiple techniques have been developed to obtain predictable root coverage and to increase the width of attached gingiva. Usually, the width of gingiva is first increased and then the second surgery is caried out for root coverage. The newer methods of root coverage are needed, not only to reconstruct the lost periodontal tissues but also to increase predictability, reduce the number of surgical sites, reduce the number of surgeries and improve patient comfort. Hence, this paper describes a single stage technique for increasing the width of attached gingiva and root coverage by using the periosteal pedicle flap.
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Affiliation(s)
- Jaisika Rajpal
- Department of Periodontology, Subharti Dental College, Meerut, India
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15
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A novel approach for treatment of an unusual presentation of radicular cysts using autologous periosteum and platelet-rich fibrin in combination with demineralized freeze-dried bone allograft. Case Rep Dent 2013; 2013:893791. [PMID: 23984115 PMCID: PMC3747416 DOI: 10.1155/2013/893791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 07/08/2013] [Indexed: 11/17/2022] Open
Abstract
Radicular cysts are the most common cystic lesions affecting the jaws. They are most commonly found at the apices of the involved teeth. This condition is usually asymptomatic but can result in a slow-growth tumefaction in the affected region. The following case report presents the successful treatment of radicular cysts using autologous periosteum and platelet-rich fibrin with demineralized freeze-dried bone allograft.
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Mahajan A, Bharadwaj A, Mahajan P. Comparison of periosteal pedicle graft and subepithelial connective tissue graft for the treatment of gingival recession defects. Aust Dent J 2012; 57:51-7. [PMID: 22369558 DOI: 10.1111/j.1834-7819.2011.01648.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- A Mahajan
- Department of Periodontics, Himachal Pradesh Government Dental College and Hospital, Shimla, India.
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Periosteum: a highly underrated tool in dentistry. Int J Dent 2011; 2012:717816. [PMID: 21961003 PMCID: PMC3179889 DOI: 10.1155/2012/717816] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/26/2011] [Indexed: 02/07/2023] Open
Abstract
The ultimate goal of any dental treatment is the regeneration of lost tissues and alveolar bone. Under the appropriate culture conditions, periosteal cells secrete extracellular matrix and form a membranous structure. The periosteum can be easily harvested from the patient's own oral cavity, where the resulting donor site wound is invisible. Owing to the above reasons, the periosteum offers a rich cell source for bone tissue engineering; hence, the regenerative potential of periosteum is immense. Although the use of periosteum as a regenerative tool has been extensive in general medical field, the regenerative potential of periosteum is highly underestimated in dentistry; therefore, the present paper reviews the current literature related to the regenerative potential of periosteum and gives an insight to the future use of periosteum in dentistry.
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