A resident colleague mentioned that when he was on a periodontal clinical course, they practiced periosteal releases on porcine ribs. Well, I was just watching another method of periosteal release (in the OR) and figured I'd revisit the release - with a porcine rib. It also helps that I do the grocery shopping! I tried using a bovine (cow) rib, however, the periosteum is about 1.5 mm thick. The porcine rib better mimics human periosteum which is several cells to 0.375mm thick (see article below).
The periosteal release technique appears to be a well protected secret. I have no idea why it is a secret, but, it is rarely described by any author (other than the article referenced below), and yet, it is one of the many critical steps to successful ridge augmentation. Tension free flaps during augmentation procedures allow primary closure of the wound and prevention of flap dehiscence. Additionally, it is usually is performed before wound closure - meaning - that the clinician is tired by this point, and often, visual access is impaired (especially inferior to the anterior nasal spine).
The amount of release required dictates the type of release/periosteal scoring that you need. However, in my humble experience, you can never have enough easily moveable mucosa, ready to be sutured over your augmentation (or cashew in this case).
This was a one shot video, and there are a few errors that I'd like to point out - the largest being that I mean coronally positioned flap vs apically (around the 1-2min mark). A great article to review regarding tension free flaps is:
Flap advancement: practical techniques to attain tension-free primary closure ( http://www.ncbi.nlm.nih.gov/pubmed/19...)
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Please watch: ""
https://www.youtube.com/watch?v=MaA_K...
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teething rash Bone Graft - Periosteal Release - Porcine Rib | |
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| Science & Technology | Upload TimePublished on 19 Dec 2011 |
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