Bissada, N, Sears, S. Quantitative assessment of free gingival grafts with and without periosteum and osseous perforation. J. Perio. 49:15, 1978

40 free gingival grafts were performed on 5 adult rhesus monkeys. Graft distribution was as follows.

• 10 grafts on recipient sites with periosteum.
• 10 grafts on recipient sites with perforated periosteum and perforated cortical bone.
• 10 grafts on recipient sites without periosteum.
• 10 grafts on recipient sites without periosteum and perforated bone.

The perforation of the cortical plate, three holes, each 1 diameter using a 2 round bur with a high speed and coolant. Perforation was into cancellous bone. Standard graft procedures. Evaluations at 1,2,4,8,16, 20, 24 weeks post-op.

Measurement of Graft Attachment by a Hiatt tensionmeter at 24 weeks post-op. Histologic samples at 24 weeks post-op of 2 randomly of each group.

• 37 of 40 survived, 3 non-survivors were placed on cortical bone w/o periosteum and 4 were placed on periosteum. Thus equal survival w/ or w/o periosteum.
• 7 of 20 with perforation (w/ and w/o periosteum) showed acute infection or fistula. Delayed healing was found these perforations grafts.
• Evaluation of graft attachment showed a greater force is necessary for grafts placed on PCB than grafts placed on recipient sites w/o perforations. There was no difference between grafts placed on sites w/ or w/o periosteum. (This may be due to the different type of analysis)
• Histologic, there was no difference between grafts w/ or w/o periosteum at 6 mos., or grafts with perforation, w/ or w/o periosteal retention.

Conclusion

• There was no difference in the survival or healing pattern of grafts placed on periosteum and grafts placed on bare bone.
• There was no significant difference in the degree of graft attachment placed on recipient sites w/ or w/o retention of the periosteum. (disagreement w/ Dordick)
• Grafts with perforation of the cortical plate of bone had significant stronger attachment compared to those w/o perforation.

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