Epiperiosteal dissection

Structure of the bone

Under a epiperiostalen preparation is meant in medicine , dentistry and veterinary medicine a bone close surgical procedure, wherein the exposure in the surgical area periosteum (periosteum) is not from the bone will be replaced.

Basics

Bone is surrounded by the periosteum and soft tissue. If the defect is covered, the epiperiosteal approach can be used, i.e. the periosteum can be left on the bone and only the soft tissue is mobilized or subperiosteally, for example a mucoperiosteal flap, can be prepared. Branches of the vessels of the periosteum enter the Volkmann canals (canales perforantes), larger ones enter the bone through the macroscopically perceptible foramina nutricia and form a rich vascular network in the marrow, osteons and cancellous bone , so that the periosteum is essential for nutrition and preservation of the bone.

Juvenile mammals, and thus also humans, have a thick periosteum with rich capillary vascular networks that supply the entire bone, apart from the joint surfaces. In the course of the maturation process, these vessels atrophy, which means that only the outer third of the bone is supplied from the periosteum. It follows that at least 33% of the blood supply to the bone in adults comes from the periosteum.

The epiperiosteal preparation is used with a view to maintaining the blood supply to the bone, with the idea that it is indicated especially for previously damaged bone ( IORN ). Further investigations could show that a separation between the periosteum and the surrounding soft tissue, i.e. a reduction in the vascularization of the periosteum, delayed the healing of a bone defect. Consequently, the supplying function of the bone through the periosteum is dependent on the blood supply to the periosteum itself through the supraperiosteal vascularization.

Epiperiosteal preparation in dentistry

Other studies have shown that the epiperiosteal preparation does not expose the alveolar bones and prevents resorption of the alveolar bones. In the case of subperiosteal preparation of a mucoperiosteal flap to cover the defect, a segment of periosteal-free bone and thus resorption processes would be present temporarily.

Some studies have shown the influence of the epiperiosteal defect coverage dissection on midface growth by causing midface hyperplasia. The reason for the development of such hyperplasts are microcirculation disorders. In rabbit experiments it could be shown after the creation of anterior palatal defects that the periosteal blood flow was significantly worse after epiperiosteal compared to subperiosteal preparations. Both techniques showed a significant reduction in capillary blood flow, but the number of blood flowed capillaries per tissue area was significantly lower in epiperiosteal preparations.

Individual evidence

1. ↑ CP Adler: Bone Diseases: Diagnosis of macroscopic, histological and radiological structural changes in the skeleton. 3. Edition. 2004, ISBN 3-540-21962-5 .
2. ↑ I. Steinbrück, D. Baumhoer, P. Helle: Intensive anatomy. Urban & Fischer Verlag / Elsevier, 2008, ISBN 978-3-437-43670-3 .
3. ^ A. Remedios: Bone and bone healing. In: The Veterinary clinics of North America. Small animal practice. Volume 29, Number 5, September 1999, pp. 1029-1044. PMID 10503283 (Review).
4. ↑ G. Iglhaut, H. Schliephake: Soft tissue management and augmentation in implant surgery. In: German Dental Journal. 65 (6) (2010)
5. ^ I. Macnab, WG De Haas: The role of periosteal blood supply in the healing of fractures of the tibia. In: Clinical orthopedics and related research. Number 105, 1974 Nov-Dec, pp. 27-33. PMID 4430170 .
6. ↑ SF Ramfjord, ER Costich: Healing after exposure of periosteum on the alveolar process. In: Journal of periodontology. Volume 39, Number 4, July 1968, pp. 199-207. PMID 5242103 .
7. ↑ M. Rücker, T. Binger et al. a .: Reduction of midfacial periosteal perfusion failure by subperiosteal versus supraperiosteal dissection. In: Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons. Volume 63, Number 1, January 2005, pp. 87-92. PMID 15635562 .

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