Notas Breves

Periosteoplasty for Soft Tissue Closure and Augmentation in Preprosthetic Surgery: A Surgical Report (*)

Soft tissue closure is a critical factor in preprosthetic surgery and implant placement. In large transverse or vertical bone augmentations, there is often insufficient or very thin mucosa available.
Soft tissue dehiscences and bone or implant exposure may result. Based on the application of a periosteal flap, the presented method solves this problem.
The flap is prepared in the neighboring area and folded into the corresponding surgical area. It not only provides good soft coverage but also results in soft tissue augmentation.
Periosteoplasty has been successfully applied in over 60 patients over the last 2 years.


Replacement of maxillary incisors with 2 implants. Because of labial exposure, bone augmentation with the membrane technique was planned.	The buccal area around the implants is augmented with a nonresorbable membrane.

The periosteal flap side is prepared from the elevated soft tissues on the vestibular side.	The flap is reflected to cover the whole grafted area. It is inserted and sutured into a palatal pocket, with care taken to fixate the flap tightly around the adyacent teeth.

At the end of the procedure, the soft tissues are closed with a multilayer technique.	At second-stage surgery (membrane removal and abutment connection), the soft tissues appear very favorable, with a nice margin around the neighboring teeth.

Augmentation of a completely edentulous atrophic area. Onlay grafts from the iliac crest are placed buccallu to restore a correct maxillomandibular relationship. The grafts are fixed with bone screws and protected with a titanium mesh.

The periosteal flap is prepared in 2 parts, on both sides of the midline.

The single parts of the flap are then reflected over the grafts and inserted into a palatal pocket, where they are sutured.	Before final closure of the soft tissues, the augmentated areas are completely covered by the periosteal flap.

The soft tissues are closed with a multilayer technique.	Application to an orthodontic / periodontal problem. Because of a slight skeletal Class II situation, the mandibular incisors were orthodontically protruded too far, such that the roots were partially exposed and the attached gingiva became very thin. The plan was to augment the soft tissues and advance an anterior bone block including the teeth in a distraction, thus later enabling retrusion of the teethinto the bone.

Illustration of the anterior block distraction on a model. Note the osteotomy, the hinge-joint bone plate in the midline, and the orthodontic appliance containing the distraction screw.	Initially, marginal incisions bring the required vertical release of the soft tissues.

Soft tissue preparation was done prior to the osteotomy.	After the osteotomy and placement of the hinge-joint plate (note its upper part in the midline), the periosteal flap was prepared from the lower border of the elevated soft tissues.

The periosteal flap was fixed around the teeth, augmenting the soft tissues at the height of the roots.	Closure of the soft tissues. Tight adaptation around the teeth is important.

Key words: periosteum, preprosthetic oral surgical procedure, soft tissue augmentation, surgical flap.

Albino Triaca, Dr Med, Dr Med Dent
Roger Minoretti, Dr Med, Dr Med Dent
Mauro Merli, DMD
Beat Merz, Dr Sc Techn, MBA

(*) Extraido de la revista "The International Journal of ORAL & MAXILLOFACIAL IMPLANTS" - 2001;16:851-856

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Notas Anteriores

Clinical Evaluation of a Bilayered Collagen Membrane (Bio-Gide) Supported by Autografts in the Treatment of Bone Defects Around Implants (*)

The aim of this study was to determine the efficacy of a bioresorbable collagen membrane (Bio-Gide) in combination with autogenous bone grafts in the treatment of peri-implant dehiscences, fenestrations, or limited vertical defects.
Eighteen titanium dental implants with exposed threads placed in 17 patients were studied. Autogenous bone was used in all cases to fill the defect and maintain the space undermeath the barrier.
The collagen membrane was trimmed and adapted to cover the defect in a saddle configuration. The membrane absorbed the blood and easily covered and adhered to the underlying bone. It was not stabilized by any retentive means.
Sixteen to 32 months postoperatively, the sites were reentered and the amount of bone regenerated was measured. The results showed significant bone gain (average 87.6%) in the treatment of peri-implant defects with Bio-Gide and autogenous bone.


Implant placed to replace the maxillary left central incisor. The dehiscence measured 4 mm on the labial side. A 1-mm wall vertical defect was present on the mesial and distal slides.	Autogenous bone was gently packed into defect.

The membrane was placed in a saddle configuration, covering the defect.	Healing at 6 months. The defect is filled with bone that has regenerated; bone has also regenerated over the cover screw.

A 9-mm labial dehiscence on the implant placed in the mandibular left canine site.	Reentry at 4 months showing bone regeneration.

Key words: autologous transplantation, bioresorbable membrane, guided bone regeneration, peri-implant defect.

Georges Tawil, DDS, DSc, OD
Georgina El-Ghoule, DDS
Muhieddine Mawla, DCD, DES

(*) Extraido de la revista "The International Journal of ORAL & MAXILLOFACIAL IMPLANTS" - 2001;16:857-863

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Notas Anteriores