Bone loss after ridge expansion with or without reflection of the periosteum.

Stricker, Andres; Fleiner, Jonathan; Stübinger, Stefan; Schmelzeisen, Rainer; Dard, Michel; Bosshardt, Dieter (2015). Bone loss after ridge expansion with or without reflection of the periosteum. Clinical oral implants research, 26(5), pp. 529-536. Wiley-Blackwell 10.1111/clr.12437

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To evaluate the role of the periosteum in preserving the buccal bone after ridge splitting and expansion with simultaneous implant placement.


In 12 miniature pigs, the mandibular premolars and first molars were removed together with the interdental bone septa and the buccal bone. Three months later, ridge splitting and expansion of the buccal plate was performed with simultaneous placement of two titanium implants per quadrant. Access by a mucosal flap (MF) was prepared on test sides, while a mucoperiosteal flap (MPF) with complete denudation of the buccal bone was increased on control sides. After healing periods of six and 12 weeks, the animals were sacrificed for histologic and histometric evaluation.


In the MF group, all 16 implants were osseointegrated, while in the MPF group, four of 16 implants were lost. Noticeable differences of bone levels on the implant surface and of the bone crest (BC) were found between the MF and the MPF group. Buccally after 6 weeks, the median distance between the implant shoulder (IS) and the coronal-most bone on the implant (cBIC) was for the MF group -1.42 ± 0.42 mm and for the MPF group -4.80 ± 2.72 mm (P = 0.15). The median distance between the IS and the buccal BC was -1.24 ± 0.51 mm and -2.78 ± 1.98 mm (P = 0.12) for the MF and MPF group, respectively. After 12 weeks, median IS-cBIC was -2.12 ± 0.84 mm for MF and -7.19 mm for MPF, while IS-BC was -2.08 ± 0.79 mm for MF and -5.96 mm for MPF. After 6 weeks, the median buccal bone thickness for MF and MPF was 0.01 and 0 mm (P < 0.001) at IS, 1.48 ± 0.97 mm and 0 ± 0.77 mm (P = 0.07) at 2 mm apical to IS, and 2.12 ± 1.19 mm and 1.72 ± 01.50 mm (P = 0.86) at 4 mm apical to IS, respectively. After 12 weeks, buccal bone thickness in the MF group was 0 mm at IS, 0.21 mm at 2 mm apical to IS, and 2.56 mm at 4 mm apical to IS, whereas complete loss of buccal bone was measured from IS to 4 mm apical to IS for the MPF group.


In this ridge expansion model in miniature pigs, buccal bone volume was significantly better preserved when the periosteum remained attached to the bone.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > School of Dental Medicine > School of Dental Medicine, Periodontics Research
04 Faculty of Medicine > School of Dental Medicine > School of Dental Medicine, Oral Surgery Research

UniBE Contributor:

Bosshardt, Dieter


600 Technology > 610 Medicine & health








Eveline Carmen Schuler

Date Deposited:

28 Oct 2015 15:15

Last Modified:

25 Jan 2017 12:15

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

bone regeneration, bone splitting/ridge expansion, miniature pig, osseointegration, periosteum




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