Soft Tissue Grafting

 

Today there are many reasons for soft tissue grafting to be performed.  The most prevalent reason for these grafts is the lack of keratinized attached tissue. This zone of tissue provides stability to the gums surrounding the teeth or implants and helps prevent recession, inflammation, and infection. 

The two most common types of grafts to address the lack of keratinized attached tissue are the free gingival graft (FGG) and the connective tissue graft (CTG).  The purpose of the FGG is to increase the amount of keratinized attached tissue where an insufficient zone is present. This can be on one tooth or multiple teeth.  A thin graft is harvested from the palate and secured in the area of insufficiency. The donor site heals within a couple days and the recipient site heals within a few weeks.  The patient is requested to be on a soft food diet for the first week and to not brush the recipient site of the graft.  An antimicrobial solution is given to the patient to gently clean around the base of the teeth adjacent to the graft for the first two weeks. No vigorous rinsing is allowed.

The second type of graft is the Connective Tissue graft.  This graft can be an autologous graft, meaning that the graft is harvested from the patient typically from the palate or tuberosity area.  The graft can also be an allograft, meaning that the graft is from a cadaver of the same species.  The purpose of the CTG graft is to either support covering of the recession on the roots of teeth or aid in the thickening of the existing attached tissue.

Many techniques are available for the harvesting and placement of the CTG in the recipient site.  I favor the papilla sparing tunneling technique.  This technique requires the utilization of microsurgical instrumentation and insures an abundant blood supply to the graft which maximizes the success rate. Additional biomodifiers such as Platlet Rich Fibrin obtained from the centrifuged blood of the patient can be used in addition to assist vascularization and healing.  The post operative healing protocol is similar to the FGG recommendations.

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