Topography of the greater palatine artery and the palatal vault for various types of periodontal plastic surgery

Abstract

The purpose of the present study is to provide useful data that could be applied to various types of periodontal plastic surgery by detailing the topography of the greater palatine artery (GPA), looking in particular at its depth from the palatal masticatory mucosa (PMM) and conducting a morphometric analysis of the palatal vault. Forty-three hemisectioned hard palates from embalmed Korean adult cadavers were used in this study. The morphometry of the palatal vault was analyzed, and then the specimens were decalcified and sectioned. Six parameters were measured using an image-analysis system after performing a standard calibration. In one specimen, the PMM was separated from the hard palate and subjected to a partial Sihler's staining technique, allowing the branching pattern of the GPA to be observed in a new method. The distances between the GPA and the gingival margin, and between the GPA and the cementoenamel junction were greatest at the maxillary second premolar. The shortest vertical distance between the GPA and the PMM decreased gradually as it proceeded anteriorly. The GPA was located deeper in the high-vault group than in the low-vault group. The premolar region should be recommended as the optimal donor site for tissue grafting, and in particular the second premolar region. The maximum size and thickness of tissue that can be harvested from the region were 9.3 mm and 4.0 mm, respectively.

Relative Composition of Fibrous Connective and Fatty/Glandular Tissue in Connective Tissue Grafts Depends on the Harvesting Technique but not the Donor Site of the Hard Palate

“…When bone sounding was performed with a sharp needle puncturing the palate, higher mean values were reported (4.4 to 5.8 mm), 27 similar to those observed in the present histologic assessment (3.7 to 4.5 mm). Further, male sex, older age, and higher body mass index have been associated with thicker palatal mucosa 8‐11,13,25 . Nevertheless, in the present study, increased palatal mucosal thickness was not associated with increased thickness of the lamina propria, irrespective of whether the cutoff value regarding presence of FGT was set to ≤25% or ≤50%, i.e., the increased thickness was mainly due to increased thickness of the submucosa.…”

“…Palatal mucosal thickness has been previously assessed with various techniques. By means of bone sounding with a periodontal probe, 9‐11,13,25 ultrasonic measuring device, 26 or CT measurements, 8 palatal mucosal thickness was found to be 1.8 to 3.9 mm, on average. When bone sounding was performed with a sharp needle puncturing the palate, higher mean values were reported (4.4 to 5.8 mm), 27 similar to those observed in the present histologic assessment (3.7 to 4.5 mm).…”

“…The thickness of the palatal mucosa varies strongly within the various areas of the palate and among individuals; the mucosa is generally thicker at the premolar area and thinner at the first molar 8–11 . The greater palatine artery (GPA) runs anterior from the second molar to the canine 7 to 17 mm distant from the cemento‐enamel junction, and the greater palatine nerve regularly lies more medially 12–15 . To reduce the risk of GPA violation, harvesting of CTG by split‐flap (SF) preparation should be restricted to the region anterior to the first molar 1,16‐18 .…”

Randomized controlled clinical study evaluating effectiveness and safety of a volume‐stable collagen matrix compared to autogenous connective tissue grafts for soft tissue augmentation at implant sites

“…, Kim et al. , Yu et al. ), (iii) patients often complain about pain and numbness, especially in the donor site for several weeks after the surgery (Griffin et al.…”

Anatomical preconditions for the palatal sinus floor augmentation—A three-dimensional feasibility study

“…In the palatal approach the nerveevessel bundle, containing the greater palatine artery and the palatine nerve, is always close to the bony window. The greater palatine artery emerges from the great palatine foramen, most frequently at the height of the second molar, and runs in a bony sulcus about 2 mm medially from the alveolar process (Klosek and Rungruang, 2009;Seemann et al, 2013;Kim et al, 2014). If the palatal mucoperiosteal flap is elevated carefully, the artery is elevated together with the flap and does not represent a risk at all.…”