Periosteal pedicle graft for the treatment of gingival recession defects current status and future prospects: What the evidence suggests?

BACKGROUND: Gingival Recession defects are one of the most common defects for which patients seek periodontal treatment. Many treatment options are available for the management of gingival recession. Most of the treatments offered aim to treat the cause, cover the denuded root surface and produce a long term aesthetic result. The use of periosteal pedicle graft (PPG) is a recent innovation for the treatment of gingival recession defects and has gained much attention in a short span of time. Although studies have been done utilizing PPG successfully for the treatment of gingival recession defects (GRD) but it is still not clear, whether PPG technique should be included in the established list of techniques used to treat GRD? An effort has been made to arrive at a decision on the current utility of PPG in the treatment of GRD based on the scientific evidence available in literature.
MATERIALS AND METHODS: A review of current literature was done to critically evaluate the evidence related to the Periosteal pedicle graft technique. RESULTS AND
CONCLUSION: Periosteal Pedicle Graft has come up as a viable treatment option for the treatment of GRD although it's still too early to predict the long-term results associated with PPG.

INTRODUCTION

It has been almost 6 years when the periosteal pedicle graft (PPG) was first introduced for the treatment of gingival recession defects (GRD).[1] In a small time frame, PPG has drawn a great deal of attention from the dental fraternity, especially from the periodontal surgeons. Although the use of periosteum in surgical fields is not new and, researchers have proven the ability of periosteum to regenerate the lost tissues especially the bone, the use of periosteum in dentistry is still limited. In the past, few studies have been done to utilize periosteum as a barrier membrane in bone regenerative procedures but recently the immense regenerative potential of the periosteum was underscored, and emphasis was made to utilize the same.[2] The use of periosteum for the treatment of GRD was suggested based on the following facts:[2]

Periosteum has a wide variety of cells which when stimulated retain their ability to regenerate into different cell types

Periosteum is a rich source of pluripotent stem cells

Periosteum is highly vascular

Periosteum has an ability to promote neovascularization due to the release of vascular endothelial growth factors.

Studies have been done utilizing PPG for the treatment of GRD and have shown encouraging results,[13456] in fact when the results were compared to subepithelial connective tissue graft (SCTG), and it was found that PPG was better in terms of root coverage and patient satisfaction as compared to SCTG.[7] The current evidence suggests that PPG has certain definite advantages over SCTG when used for the treatment of GRD, i.e.,

PPG can be harvested adjacent to the GRD eliminating the use of second surgical/donor site thus minimizing intraoperative trauma, time and postoperative complications

There is no limitation on the amount of the graft that can be harvested in case of PPG hence PPG can be used to great advantage to treat multiple adjacent gingival recession defects

Being a pedicle graft periosteal graft is highly vascular and is ideal for placement over avascular root surfaces during root coverage procedures

Since periosteum is a rich source of stem cells, there is an actual possibility of new attachment during the healing period

Patients always prefer procedures which require minimum intervention and trauma hence PPG scores better in terms of patient satisfaction over SCTG.

In the current scenario of evidence-based dentistry, the PPG has come up as a viable treatment option for the treatment of GRD although it's still too early to predict the long-term results associated with PPG. Future studies with long-term follow-ups and histological evidence regarding the healing of PPG are suggested to make PPG an established procedure for the treatment of GRD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest