Periosteal Envelope Flap as a Technique for Horizontal Bone Augmentation: A Case Series Study

Sepideh Arab1, Hamid Reza Arab2, Maryam Aghaloo3, Farid Shiezadeh4, Shamim Tajik4, Amir Moeintaghavi5, *
1 Private Practice, Mashhad, Iran
2 Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3 Dental Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Periodontics, Mashhad University of Medical Sciences, Mashhad, Iran
5 Oral & Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

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© 2018 Arab et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Oral & Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Vakilabad Blvd., Mashhad, Iran; Tel: 0098 511 6012189; Fax: 0098 511 8829500; E-mail:



Following tooth extraction, the alveolar bone is typically subject to irrevocable and progressive changes that are collectively referred to as natural bone resorption. This process eventually results in a deficiency of the vertical and horizontal dimensions of the bone. Conventionally, various methods are used to repair alveolar defects resulting from tooth extraction, and to achieve vertical or horizontal bone regeneration. The aim of this study was to evaluate the influence of periosteal pocket flap on the enhancement of horizontal length in alveolar bone regeneration.


Twenty-two patients (7 men, 15 women) aged 45–60 years were enrolled in this study. Periosteal envelope flaps and Cerabone were used to increase alveolar bone thickness. Ridge width was measured preoperatively and 4-6 months postoperatively using cone-beam computed tomography. The pre- and postoperative results were compared using the paired t-test.


An average of 2.53 mm (P < 0.001) horizontal enhancement of the alveolar ridge was achieved.


The results of this study suggest that the use of a periosteal pocket flap with xenograft material is an excellent method which increase more than 2 mm alveolar bone width. As the study sample was small, further clinical investigations with larger samples are recommended.

Keywords: Horizontal augmentation, GBR, Bone graft, Periosteal pocket, Osteogenic cells, Periosteal pocket flap.