Investigation of effect of various agents on periosteal bone formation.
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Most periodontal surgery has been performed on the basis of the regenerating capacity of the periosteum. Recently it has been pointed out that the blood supply is important to the osteogenic and fibrogenic activity of the periosteum. The purpose of the present study was three-dimensional observation of blood vessels distributed within the gingival periosteum and the periosteum beneath the alveolar mucosa of adult mongrel dogs. Corrosion cast specimens of vessels were observed from three directions: mucosal side, bone side, and horizontal cut surface. It was revealed that the plexus distributed in the periosteum of the gingiva formed a coarse network structure, which consisted mainly of arterioles and venules. In contrast, in the periosteum of the alveolar mucosa, a dense network structure consisting of arterioles, capillaries, and venules formed a vascular bed. Thus, the mucogingival junction was easily located even in the plexus of periosteum which was distributed beneath the gingiva and the alveolar mucosa, suggesting that the difference in tissue specificity was reflected in the plexus of the periosteum.
This study clinically analyzed the efficacy of a connective tissue graft including the periosteum used as a barrier to enhance new attachment and osseous regeneration. Fifteen patients, with no systemic diseases, and adult periodontitis including 2 Class II furcation involvements in lower molars comprised the study group. After completion of the initial phase of therapy, all patients were treated with full-thickness periodontal flaps, using sulcular incisions, and thorough scaling and root planing. One furca, selected at random, had a connective tissue graft, obtained from the palate and including the periosteum, placed over the furca with the flap sutured over the top of this graft. Control furcas received no graft and the flap was sutured in its original position. Both molars were treated in the same session. The following presurgical measurements were made: probing pocket depth, attachment level, gingival recession, sulcular bleeding index, and plaque index. The horizontal and vertical dimensions of the osseous defects were recorded after flap elevation and debridement. Six months later all clinical parameters were again measured and reentry flaps were performed to measure the bony defects. No statistically significant differences were found preoperatively between control and experimental molars with respect to soft tissue and osseous measurements. Six months after surgery, the experimental molars showed, in comparison to the controls, significant reduction in pocket depth and gain in attachment level as well as in vertical and horizontal measurements of the inter-radicular osseous defect.
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