The osteogenic activity of bone removed from healing extraction sockets in humans.

Cores of bone from healing extraction sites were studied at time intervals of 4, 6, 8, 10, 12 and 16 weeks. The results revealed that between 4 and 8 weeks proliferation of cellular and connective tissue elements occur within the healing socket. Islands of new bone with an osteoid seam surrounded by osteoblasts are present within the connective tissue. From 8 to 12 weeks the bone undergoes maturation and forms a trabecular pattern. Although less pronounced, and osteoid seam is still present and osteoblasts occur in fewer numbers. By 12 to 16 weeks the bony trabeculae are mature with very little osteoid and few osteoblasts. This bone resembles alveolar trabecular bone. Two phases of bony regeneration are apparent from the present study. From 4 to 8 weeks there is a progressive osteogenic phase with proliferation of osteogenic cells and immature bone formation. From 8 to 12 weeks the osteogenesis slows down and the trabeculae mature and increase in volume. From 12 to 16 weeks the bone appears to stabilize with an established alveolar trabecular bone being present. Very little osteogenesis occurs as evidenced by minimal or no osteoid seam with only occasional osteoblasts. It is apparent that in the period between 8 and 12 weeks a substantial quantity of relatively mature well formed bone is present which contains osteoblasts and an osteoid seam. This appears to be an optimal time period to secure bone from a healing extraction site for grafting purposes.

The free autogenous gingival graft.

The free autogenous gingival graft is an excellent surgical procedure for treating gingival extension. It is a procedure that can be performed rapidly with little postoperative trauma to the patient. Its greatest feature is the high degree of predictability of success in producing a specific dimension of masticatory mucosa. However, we have a moral and ethical obligation to our patients to be more selective in its use in treating gingival recession. Too many patients have been subjected to unnecessary surgery, especially in cases in which the recession has been of long duration and is stable. In the maintenance of such cases, surgical intervention should be elective to solve problems of maintenance of the dentoginginval junction as they arise. As a result of the innovations from the 1970s, the gingival graft procedure appears to be extremely versatile. It will probably undergo further innovative developments in the future as a procedure to be extremely helpful to the restorative dentist. We have already seen its use in new attachment procedures, for improving the edentulous ridge for denture prosthesis, and in other restorative procedures.

Clinical evaluation of free autogenous gengival grafts placed on alveolar bone. Part I. Clinical predictability.

1. Thirty free autogenous gingival grafts were placed on bone and 30 were placed on a periosteal bed. The distribution into the groups was random. All 60 grafts survived, showing that both procedures were predictable. 2. Over one-half (17 of 30) of those on periosteum demonstrated mobility by 6 months postoperatively. No mobility was observed in the group placed directly on bone. 3. Osseous placed grafts demonstrated less swelling and better hemostasis than did the periosteally placed grafts. 4. A healing lag was observed in the grafts placed on bone which lasted only for the first two postoperative visits, approximately 2 weeks. 5. No infections or sequestrations were noted in any case.