title: A novel marginal periosteal pedicle graft as an autogenous guided tissue membrane for the treatment of intrabony periodontal defects.
abstract: OBJECTIVE
  The aim of the present study was to clinically examine the effects of a novel marginal periosteal pedicle graft (MPP) as a guided tissue membrane for treating proximal intrabony defects in comparison to a an open flap debridement.
  
  
  METHODS
  Fifteen patients with severe chronic periodontitis and no systemic diseases participated in this prospective, controlled clinical trial. Each subject contributed matched pairs of interproximal two- or three-walled intrabony defects. Baseline clinical examination included plaque index (PlI), gingival index (GI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) of selected sites and were performed two weeks following completion of cause-related therapy. Radiographic measurements were also recorded to ascertain the radiographic depth of the defect. Each pair of periodontal defects were randomly assigned into the experimental group G1, marginal periosteal pedicle graft (MPP) guided tissue membrane or the control open flap debridement group, G2. In the MMP, partial thickness flaps were elevated at the vestibular surface of the tooth adjacent to the interproximal defect to harvest a 4 mm marginal pedicle periosteal graft. Exposed root surfaces were root planed and the remaining bony walls of the selected defect were degranulated prior to the periosteal pedicle barrier membrane being rotated to cover the intrabony defect. Sites representing the control group were treated with only open flap debridement. Clinical and radiographic parameters were recorded at 3, 6 and 9 months after surgery for treatment outcome evaluation.
  
  
  RESULTS
  Baseline data showed no differences in any of the investigated parameters, suggesting parameters were balanced between the two groups. Both experimental and control groups showed significant improvements in all of the soft and hard tissue parameters when compared to baseline (p < 0.001). At nine months, the experimental MPP group showed significant improvement in PD reduction, CAL gain and intrabony defect reduction when compared to the control (p < 0.01). In the MPP group, the mean reduction in PD was 3.8 mm, mean CAL gain was 3.4 mm and mean reduction in intrabony defect was 2.2 mm. In sites treated with open flap DEBRIDEMENT, the mean PD reduction was 2.5 mm, CAL gain was 2.0 mm and mean reduction in intrabony defect was 0.6 mm.
  
  
  CONCLUSIONS
  Within the limits of this study, it can be concluded that the placement of a marginal periosteal pedicle graft as a barrier membrane significantly improved clinical and radiographic parameters of deep intrabony defects and proved superior to OPEN FLAP DEBRIDEMENT alone.
authors.affiliation: Faculty of Dental Medicine, El Azhar University, Cairo, Egypt.
authors.forename: Ahmed Y
authors.initials: AY
authors.lastname: Gamal
authors.forename: Jason M
authors.initials: JM
authors.lastname: Mailhot
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000601:surgery*; D000539:Alveolar Process / Q000000981:diagnostic imaging; D055113:Chronic Periodontitis / Q000601:surgery; D003646:Debridement; D003774:Dental Plaque Index; D005260:Female; D005500:Follow-Up Studies; D005884:Gingival Hemorrhage / Q000601:surgery; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000601:surgery; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000601:surgery; D010521:Periosteum / Q000637:transplantation*; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D016745:Root Planing; D013524:Surgical Flaps; D014092:Tooth Root / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome