Palatal Harvesting Technique Modification for Better Control of the Connective Tissue Graft Dimensions

Abstract

Subepithelial connective tissue graft (SCTG) has been extensively used for a variety of clinical applications. However, the surgical procedure may not allow control of graft thickness. The purpose of this case series is to illustrate a modification to the single incision palatal harvesting technique in order to control the SCTG thickness without increasing patient discomfort. Fifty cases from thirty systemically and periodontally healthy patients with at least one multiple gingival recession were treated with coronally advanced flaps combined with a SCTG. The palatal area served as the donor site, from where a single perpendicular incision was made to obtain a full thickness flap. Next, 1-2 mm of the flap was elevated and dissected to obtain a partial thickness flap. The graft remained attached to the full-partial thickness flap. After determining the desired SCTG thickness, the graft was harvested from the palatal flap. The patients healed uneventfully at 7 days postoperatively and primary closure was obtained for all palatal donor sites. The SCTG length and width varied depending on the needs of each case, but the SCTG thickness was well controlled with only 0.24 mm standard deviation. The suggested modification granted control of the SCTG dimensions and achieved complete wound closure within a week.

Miller Class III root coverage with coronary tissue repositioning associate with conjunctive graft

“…In addition, palatal healing is obtained by first intention, which consequently causes a lower rate of morbidity to the patient, since the donor area is sutured soon after the acquisition of a mucosal flap from a mucoperiosteal flap of total thickness. Therefore, it presents a better clinical prognosis to the detriment of the application of graft collection techniques that leave the donor site uncovered or without epithelium, with the presence of bloody tissue, which closure will occur in a secondary way, causing greater discomfort to the patient [16][17][18][19][20] .…”

Prospective longitudinal comparison study of surgical therapies for peri‐implantitis: 3‐year follow‐up

“…Group 2 (n = 9) – chemical decontamination with citric acid and subsequent subepithelial connective tissue graft (SCTG) harvested from the palate and sutured over the exposed implant surface . Briefly, after local anaesthesia, a single incision approximately 3 mm apical to the gingival margin of the maxillary premolars was performed and a partial thickness flap was raised.…”

44-year journey of palatal connective tissue graft harvest: A narrative review

“…Few researchers harvested graft from the inner surface of freely mobile reflected flap and reported adequate control because of good visibility, good predictability in ensuring sufficient uniform graft and flap thickness, and less chances of leaving behind a thin flap (which might slough or necrose) for closure at the donor site and hence improved graft success. [13236]…”

“…Furthermore, modifications were attempted to leave a layer of periosteum on the donor bone surface as removal may retard healing, whereas if left may provide nourishment and act as a recipient bed for the flap. [3236]…”