THE DEVELOPMENT and utilization of a flap in surgery is at least four thousand years old as indicated by attempts of the early Hindus to repair facial deformities with flap surgery. Tagliacozzi is given credit for the revival of flap procedures in plastic surgery during the 16th century. These methods were later refined and employed as the mucoperiosteal flap which is widely used today in oral surgical procedures.

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This retrospective study based on histologic evaluations of 100 human block sections and extracted teeth taken from sites treated via bone and marrow autograft, allograft and nongraft regenerative procedures revealed the following findings: 1. Graft procedures yielded new cementum formation in 66 of 79 sites evaluated while nongraft approaches yielded new cementum formation in only 7 of 21 sites. Two of the grafted sites not yielding new cementum were only 14 days duration. 2. Block section evaluation revealed new bone formation in 33 of 39 graft sites and in 7 of 21 nongraft sites. 3. When regeneration did occur, as seen in the block sections, the nature of the new attachment was similar in all graft approaches and was comparable to healthy functioning periodontium. 4. The potential for regeneration of a functional attachment apparatus including new cementum, bone and functionally oriented periodontal ligament has been demonstrated in autograft and allograft approaches. 5. Adverse immune response to bone and marrow allografts could not be detected at a clinical, histologic or chemical level. 6. No ankylosis or root resorption was noted with fresh intra-oral donor material and with frozen iliac autografts or allografts. Root resorption was noted in two cases treated with nongraft methods and in 16 of 275 sites treated with fresh iliac autograft material.

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