Clinical, Tomographic, and Histological Assessment of Periosteal Guided Bone Regeneration with Cortical Perforations in Advanced Human Critical Size Defects
Bibliographic record
Abstract
BACKGROUND: Large osseous defects that fail to heal spontaneously require ridge augmentation prior to implant placement. The periosteum can act as an effective barrier membrane. Little is known about the influence of bone decortication in enhancing guided bone regeneration outcomes. PURPOSE: The aim of the present study was a clinical, tomographic, and histological evaluation of bone healing in large defect sites treated with cortical perforations without the use of other membranes but the periosteum. MATERIAL AND METHODS: Ten consecutive patients undergoing ridge augmentation on the pre-maxilla due to severe bone loss were followed for an average of 35 months. Recipient sites were cortico-perforated and augmented using a combination of autogenous particulate and block grafts. The periosteal membrane was preserved and it fully covered the autografts. Histological analysis was performed in four sites from a trephine core taken at the time of implant osteotomy preparation. Tomographic assessment (computed tomography [CT] scan) at baseline and post-augmentation evaluated graft volume maintenance. RESULTS: Recipient sites were re-entered for implant placement showing good incorporation of the grafts with minimal volume loss. Biopsy specimens showed viable bone rich in osteoblast-like cells with little or no inflammatory cells. Clinical exam revealed absence of implant transparency, mucosal recession, mobility, bleeding on probing, or suppuration at follow-up. CT scan evaluation showed an average increased bucco-lingual width at the recipient site of 8.1 mm ± 0.9 (2.5 fold) versus a 3.2 ± 0.9 at baseline (p < .0001; CI 95%: 4.04-5.71 mm), maintaining on average 98% of the augmented width at 2.9 years. CONCLUSIONS: Periosteal preservation seems to be sufficient as a barrier membrane to protect particulate or block osseous grafts provided that good primary closure is achieved. Bone decortication may enhance clinical and histological outcomes. Graft viability (biopsy specimens) and volume maintenance (CT evaluation) remained stable 35 months post-augmentation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".