Healing of periosteal pedicle graft in the treatment of gingival recession defects: A histological study in rabbits

Abstract

Purpose: Various surgical techniques are described in the literature to manage gingival recession defects but the histopathologic evidence to support the current available techniques, is scarce. Recently periosteal pedicle graft (PPG) has proven to be an effective treatment option to treat gingival recession defects (GRD) with results comparable to subepithelial connective tissue graft (SCTG).

Objective: The present histopathological study was done to evaluate the healing pattern of periosteal pedicle autogenous graft along with coronally advanced flap in the treatment of gingival recession defects.

Materials and methods: The present study was performed on 10 sites in 5 rabbits. Two sites were selected in each animal and gingival recession defects were surgically created and then treated using periosteal pedicle pedicle graft along with coronally advanced flap procedure. Healing pattern was assessed histopathologically at pre-defined intervals till 6 months.

Results: On the 7th day of healing, dilated blood vessels with inflammatory cells were seen, while rudimentary rete-pegs appeared on 14th day. Between 3 months to 6 months, advanced histological repair with connective tissue organization with initiation of junctional epithelium, cementum and bone formation were observed.

Conclusion: Gingival recession defects treated with PPG had evidences of regeneration of cementum, bone and periodontal ligament fibers with new connective tissue attachment.

Keywords: Histology; periosteal pedicle graft; recession; wound healing.

Figure 1

External bevel incision given for the defect creation (a), notch at CEJ (b and c), harvested periosteal pedicle graft (d), periosteal pedicle graft placed over the gingival recession defect (e), and periosteal pedicle covered with coronally advanced flap (f)

Figure 2

(a and b) 7^th-day histopathological analysis of the biopsy specimen showing engorged blood vessels (magnification 10x)

Figure 3

1-month histopathological analysis of the biopsy specimen showing demarcation zone between graft and periosteum (a), well-organized bundles of collagen fibers (b), increased thickness of surface epithelium (c), and collagen fibers penetrating the graft (d)

Flow Chart 1

Time line for sacrifice and sample collection

Figure 4

3-month histopathological analysis of the biopsy specimen showing epithelium, which has regained its normal shape, thickness, and appearance

Figure 5

6-month histopathological analysis of the biopsy specimen showing well-stabilized gingival epithelium (a), osteoblast (b), fibroblast (c), the junctional epithelium (d), and new bone tissue, cementum, and the thick layer of collagen fibers (e and f)