Periosteum: a highly underrated tool in dentistry

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.

Figure 1

Highly vascular periosteum covering the alveolar bone.

Figure 2

The three different Zones of periosteum; Zone 1 has an average thickness of 10–20 um consisting predominantly of osteoblasts; the majority of cells in Zone 2 are fibroblasts, with endothelial cells being most of the remainder. Zone 3 has the highest volume of collagen fibrils among all the three zones. The bottom of the figure shows regenerative capacity of the periosteum to form different cell types.

Figure 3

The use of periosteum for the treatment of gingival recession defect. (a) Clinical photograph showing gingival recession defect in relation to the maxillary first right premolar. (b) A partial thickness flap lifted to expose the underlying periosteum covering the alveolar bone. (c) The periosteum which is separated from the underlying bone. (d) The periosteum is used as a pedicle graft for covering the recession defect. (e) The periosteal graft is covered with the overlying coronally advanced flap which is sutured using 4–0 silk suture. (f) Satisfactory treatment outcome.