Subepithelial Connective Tissue Graft Technique for Root Coverage

Abstract

This article describes the use of the subepithelial connective tissue graft as a donor source for root coverage. The success of these grafts has been attributed to the double-blood supply at the recipient site from the underlying connective tissue base and the overlying recipient flap. Four cases have been illustrated to demonstrate the versatility of this procedure for areas of single or multiple root coverage especially in the maxillary arch, coverage of existing crown margins and areas requiring a combination of ridge augmentation and root coverage. An increase of 2 to 6 mm of root coverage has been achieved in 56 cases over 4 years with minimal sulcus depth and no recurrence of recession. The donor site is a closed wound which produces less postoperative discomfort.

Gingival recession: part 3. Surgical management using free grafts and guided tissue regeneration

“…Langer and Langer 10 described an alternative technique which involved placing the subepithelial connective tissue graft with a coronally positioned pedicle flap for covering exposed root surfaces. Figures 2a-c show a clinical case treated using this technique.…”

“…A cuff of epithelial tissue is removed from around the recession site. Crevicular incision with relieving incisions can be made to raise a three sided split thickness flap around the recession defect, 10 alternatively an envelope flap can be raised by extending the crevicular incision around adjacent teeth and then undermining the tissue to create a pouch. 9,11 Avoiding relieving incisions ensures better blood supply to the flap and therefore more predictable outcome.…”

Treatment of gingival recession

“…30 A partial-thickness flap with two vertical incisions was elevated on the recipient site, followed by placement of the graft (which is collected from the palate by a double parallel incision technique). The flap is coronally positioned to attempt to cover the graft and benefit from a double blood supply.…”

Pouch and Tunnel Technique for Root Coverage using Palatal Connective Tissue Graft

“…The tunnel technique followed in this case report is the one described by Langer et al [3],with a modification that includes placement of a vertical incision on one aspect of the tunnel to facilitate placement of the connective tissue graft.…”