The role of the periosteum on osteointegration of Bio-Oss®(Geistlich, Wolhusen/Switzerland) was studied in rabbit calvarial defect. 12 New Zealand white male rabbits between 2.8 and 4 kg were included in this randomized, blinded, prospective study. Each rabbit was anesthetized with Ketamine HCl(5 mg/kg) and Xylazine HCl(1.5 ml/kg). An incision was made to the bony cranium and the periosteum was reflected. Using a 6-mm trephine bur(3i. USA), four 8-mm defects were created with copious irrigation. The defects were classified into barrier membrane(Tefgen®, Lifecore Biomedical, Inc, U.S.A.) only group as a control, Bio-Oss® with barrier membrane group, Bio-Oss® with periosteum covering group, and Bio-Oss® without periosteum covering group. There were 2 rabbits in each group. The wound was closed with resorbable suture materials. Rabbits were sacrificed using phentobarbital(100 mg/kg) intravenously at 1, 2, and 4 weeks after surgery. The samples were fixed in 4% paraformaldehyde, and decalcified in hydrochloric acid decalcifying solution(Fisher Scientific, Tustin, CA) at 4℃ for 2-4 weeks. It was embedded in paraffin and cut into 6 µm thickness. The sections were stained with H & E and observed by optical microscope.

The results were as follows; 1. The periosteum played an important role in osteointegration of Bio-Oss® in bone defects. 2. When the periosteum remained intact and Bio-Oss® was placed on the defect, Bio-Oss® with periosteum covering has been incorporated into the newly formed bone from 2-week postoperatively. 3. When the periosteum was removed at the surgical procedure, invasion of connective tissue took place among the granules, and new bone formation was delayed compared to periosteum covering group.

Therefore, when the bone grafting was performed with periosteal incision procedure to achieve tension-free suture, the integrity of the overlying periosteum should be maintained to avoid fibrous tissue ingrowth.