title: Island osteoperiosteal flaps with interpositional bone grafting in rabbit tibia: preliminary study for development of new bone augmentation technique.
abstract: OBJECTIVE
  Loss of alveolar vertical height is one of the most challenging conditions in the field of implantology. A few augmentation techniques have been proposed to address this challenge, including guided bone regeneration, alveolar distraction osteogenesis, sandwich osteotomies and autogenous block grafting. This is a pre-clinical study of lengthening the alveolar bone height using a thin osteoperiosteal bone flap, the "island bone flap" or i-flap, to establish vitality, stability and incorporation of the augmentation material after healing.
  
  
  METHODS
  A rabbit tibia model was designed for this study and included 8 rabbits. An osteoperiosteal osteotomy was performed through the periosteum cutting 1 mm of the outer cortex of the bone in order to elevate a bone flap. The bone flap was detached, and remained attached to the periosteum as a free floating osteoperiosteal flap, and the resultant defect was filled with xenograft.
  
  
  RESULTS
  The histological analysis demonstrates formation of maturing trabeculae in the site of the i-flap. In cases of trauma to the bone marrow during the surgical procedure, a centripetal gradient of bone remodeling from the surgical site toward the periphery was evident, while the bony component of the i-flap maintained vital.
  
  
  CONCLUSIONS
  Creating a free floating osteoperiosteal flap, used here with interpositional grafting in a rabbit tibia, appears to heal by both appositional modeling and creeping substitution remodeling. Volumetric augmentation persisted despite exuberant bone turnover in this animal model. This technique holds promise as a possible augmentation bone grafting approach for use in alveolar reconstruction.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel. nard@cc.huji.ac.il
authors.forename: Nardy
authors.initials: N
authors.lastname: Casap
authors.forename: Maya
authors.initials: M
authors.lastname: Brand
authors.forename: Robert
authors.initials: R
authors.lastname: Mogyros
authors.forename: Michael
authors.initials: M
authors.lastname: Alterman
authors.forename: Ole T
authors.initials: OT
authors.lastname: Jensen
mesh_terms: D000540:Alveolar Ridge Augmentation / Q000379:methods*; D000818:Animals; D001861:Bone Regeneration; D016025:Bone Transplantation / Q000379:methods* / Q000502:physiology; D005260:Female; D023421:Models, Animal; D010521:Periosteum / Q000098:blood supply / Q000601:surgery*; D011817:Rabbits; D013524:Surgical Flaps / Q000098:blood supply*; D013977:Tibia / Q000601:surgery