Learning the Inverted Periosteal Graft
The suture is tied drawing the periosteum completely over the graft, resulting in the buccal and lingual periosteum to connect interproximally. Note that in this case the periosteum was sutured both mesial and distal before closing over the graft. When the periosteum is closed, the flaps are sutured.
6 week post op. Probings within normal limits, gingiva healthy. In time, the papilla will continue to regenerate but all cases respond differently. The inverted periosteal graft places regenerative cells over the area to be regenerated. In addition, the periosteum is an ideal barrier to unwanted cells. The attached gingiva and the periosteum will not tolerate contact with each other and therefore the periosteum is an ideal biological barrier. In the posterior, the papilla will not lay over the periosteum. In the anterior, the papilla will lay over the periosteum. A minimum of 6 weeks is required before the tissues can reorganize and the periodontal ligament can be probed. Over a few months, the tissue will fully reorganize into normal anatomy. The radiographic appearance of the bone will continue to increase in radiodensity over the following months and a periodontal ligament will appear radiographically.
This surgery is very technique sensitive. The methods and materials have been developed over a 10-year period and any alteration in technique or materials will likely lead to failure of this surgery. It is advised that the surgeon follow instructions precisely until experience is gained.
American Society for Bone and Mineral Research (ASBMR) Tissue Engineering and Regenerative Medicine International Society (TERMIS)