This connective tissue graft shows how exposed the tooths root was before and how effective we are at covering that exposure for relief of the symptoms. Depending on the volume of tissue required to correct the recession, multiple harvesting procedures may be required. Connective tissue graft to correct periimplant soft tissue margin. Straumann emdogaintm with a connective tissue graft to treat recession defects gingival recession is a common finding among patients and can lead to esthetic concerns and thermal sensitivity. A clinical report jamil awad shibli, dds, phd,a susana davila, dds, ms,b and elcio marcantonio jr, dds, phdc guarulhos university, guarulhos, sa. The graft was placed over the recipient site such that its coronal margin was located at the cej and its apical margin at least 3. The first surgery included a connective tissue graft to increase the width of the keratinized gingival tissue. Clinical evaluation of papilla reconstruction using. Palatal harvesting technique department of oral and. The graft used may either be an epithelialized graft or a. Your surgical stent is made of acrylic and is designed for your comfort after your grafting procedure. This article describes the use of the subepithelial connective tissue graft as a donor source for root coverage.
The maxillary tuberosity is reported to have thicker soft tissue than the hard palate and may therefore be a suitable donor source for connective tissue graft. Pdf a comparison of two techniques for obtaining a connective. Sep 17, 2010 the patient received three soft tissue grafting procedures to augment the gingival tissue. Marginal tissue recession is a displacement of the soft. Gingival recession, root coverage procedure, connective tissue graft. Pdf complications of harvesting a connective tissue. The objective of this study was to clinically evaluate and compare the efficacy of platelet concentrate graft pcg with that of subepithelial connective tissue graft sctg using a coronally. Subepithelial connective tissue canadian dental association. Palatal harvesting technique modification for better control of the connective tissue graft dimensions danilo maeda reino, arthur belem novaes jr. Controlled palatal harvest cph technique for harvesting. Free soft tissue grafts epithelialized free gingival grafts, subepithelial connective tissue grafts.
Journal club on subepithelial connective tissue graft. Jbr journal of interdisciplinary medicine and dental science. The subepithelial connective tissue graft sciencedirect. Acellular dermis, collagen, dental enamel proteins, platelet rich fibrin, gingival recession. Subepithelial connective tissue graft brunos technique a report of 3 cases article pdf available in journal of the indian dental association 57. Application of tunnel techniques and acellular dermal matrices.
Palatal harvesting technique modification for better control. Evaluation of using connective tissue graft as a biological. Treatment of recession and mucogingival defects using connective. Nabers introduced this surgical technique almost 50 years ago in 1966. Alloderm there are two types of autogenous or selfdonor gingival grafts. Stratul, subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of miller class i and ii gingival recessions. Pedicle flaps have provided consistent results, but adequate tissue must be present initially. Subepithelial connective tissue grafting can be performed to achieve root coverage,7 but an additional surgical site is needed to harvest the connective tissue. In this video, dr kuljeet mehtaperiodontist, demonstrates the periodontal surgery. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. It is a multifaceted problem for which several treatment options are available. I have seen decent results with alloderm, but my preference is a palatal graft.
In one group 15 sites, the surgery was carried out in a traditional fashion. Application of tunnel techniques and acellular dermal matrices douglas h. The full text of this article is available in pdf format. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks. Histologic healing and clinical root coverage periodontal plastic surgical techniques have evolved to meet the demands of todays dental patient. Significance of the epithelial collar on the subepithelial. Subepithelial connective tissue grafts sctgs have been extensively used to augment soft tissue volume on dental implants and natural teeth.
Mahn, dds adms have been highly successful in the treatment of gingival recession and allow for the treatment of multiple teeth in a single visit. Clinical comparison of the subepithelial connective tissue. Subepithelial connective tissue grafts have been shown to be effective in obtaining root coverage. Subepithelial connective tissue graft for root coverage.
Application of subepithelial connective tissue graft with or without enamel matrix derivative for root coverage. Subepithelial definition of subepithelial by the free. The subepithelial connective tissue graft with a cornonally advanced flap is gold standard grafting procedure. The success of these grafts has been attributed to the doubleblood supply at the recipient site from the underlying connective tissue base and the overlying recipient flap. This case series comprises three cases of multiple adjacent recessions which were treated using pouch and tunnel technique with connective tissue grafting from palate using lius class 1a incision. Keratinized tissue plays a major role around teeth and dental implants, helping to maintain and facilitate oral hygiene. Introduction for many reasons, patients may present loss of gingival tissue, which can negatively affect esthetics and function. Within the limits of this study, we conclude that both sctg and lprf proved to be reliable options for the treatment of. View of treated area 12 months after root coverage surgery.
Each procedure has clear advantages and disadvantages that need to be evaluated according to the patients needs. Surgical treatment of gingival recession is used when there is need to cover exposed roots, as well as to gain softtissue volume. Subepithelial connective tissue graft brunos technique. A periosteal elevator was used to separate the graft periosteum from the bone. Connective tissue gum graft postoperative instructions. Pdf harmony between hard and soft tissue morphologies is essential for form, function, and a good esthetic outlook. Kotsilkov department of periodontology faculty of dental medicine, medical university sofia, bulgaria journal of imab annual proceeding scientific papers 2008, book 2 summary. The second surgery included the use of autografting connective tissue graft to coronally position the soft tissue and achieve implant coverage. The most predictable technique used for gingival augmentation is the subepithelial connective tissue graft sctg. Soft tissue volume gain around dental implants using.
Connective tissue and bone grafting for anterior immediate implant placement. The axiomatic goal of reconstructive therapy is the restoration of health, function, and esthetics, which often requires correcting gingival recession defects within the esthetic zone. Pdf the versatile subepithelial connective tissue graft. Listing a study does not mean it has been evaluated by the u. You want to be gentle with the surgery site, but you also want to keep it clean. Treatment of gingival recession with subepithelial. An alternative technique to the harvesting of a connective tissue graft from a thin palate. The most widelyused plastic surgery procedure today is the subepithelial connective tissue graft because its high predictability in achieving root coverage. When minimal bone width is present, implant placement becomes a challenge and often resulting in. The donor connective tissue is placed between the elevated splitthickness flap and the alveolar ridge with its periosteum and connective tissue covering. An increase in soft tissue volume is achieved at the receptor site, which is. Treatment of multiple areas of gingival recession using a simple harvesting technique for autogenous connective tissue graft.
The versatile subepithelial connective tissue graft. The palatal subepithelial connective tissue flap method. You can reduce stomach upset by taking it with food andor plenty of liquid. Subepithelial connective tissue grafts in the treatment of.
Treatment of gingival recession with subepithelial connective. General suggestions following connective tissue grafting. Treat receding gums w gum grafting poway frenectomy. Advanced papillary flap with interposed sub epithelial connective tissue graft can offer predictable results for the reconstruction of interdental papilla. The sctge followed the same procedure as the sctgn, except that the second horizontal incision wasmade2 mmapicaltothe initial incisionline toinclude a 2mm epithelial collar on the graft. This dental procedure code refers to the type of grafting that takes tissue from within the mouth to cover teeth with receding gums. Pdf application of subepithelial connective tissue graft. Surgical management of gingival recession using autogenous. You will be able to go home following the procedure. However, if your dentist gives you a sedative to help you relax, you will need to make arrangements. Careful case selection and surgical management are critical if a successful outcome is to be achieved. Two groups of volunteers will randomly assigned to one of the two study groups. Step by step palatal subepithelial connective graft technique.
A thin piece of tissue is taken from the roof of the mouth or gently moved over from adjacent areas to provide a stable band of attached gingiva around the tooth. T hirty 30 c lass i and c lass ii recessions in 30 subjects were treated with a subepithelial connective tissue graft procedure. Recession of the gingival tissue from the root surface of the teeth has. Nov 19, 2015 alloderm is an alternative, but studies have shown that donor tissue from the palate has a somewhat better long term durability, and develops a thicker graft. Pedicle soft tissue graft with the use of a membrane guided tissue regeneration. Stabilizing sutures were given at the apical portion of the graft fig 5. The free gingival graft fgg is a surgical procedure frequently used in periodontics to increase the amount of keratinized tissue surrounding a tooth or a dental implant. Over the last few years, connective tissue graft ctg has become a reliable treatment modality for increasing the width of keratinized gingiva,1 root coverage,2,3. The aim of this study was to evaluate and compare, clinically, the efficiency of the subepithelial connective tissue graft sctg and plateletrich fibrin lprf using the tunnel technique to cover the multiple gingival recessions on anterior teeth, in the same patient.
This free online tool allows to combine multiple pdf or image files into a single pdf document. The subepithelial connective tissue graft sctg technique has been used to increase the height and thickness of keratinized mucosa 1, to correct uneven gingival margins. Replacement grafts for correction of soft tissue defects around the teeth have become important to periodontal plastic and implant surgical procedures. Lateral pedicle and connective tissue graft a combined approach for management of isolated gingival recession. If papilla loss occurs solely due to softtissue damage, reconstructive techniques can completely restore it. The goal of this study was to evaluate and compare the shortterm. Periodontics additions two 2 cdt codes d4283 autogenous connective tissue graft procedure including donor and recipient surgical sites each additional contiguous tooth, implant or edentulous tooth position in same graft site used in conjunction with d4273. Root coverage using subepithelial connective tissue graft. A pedicle subepithelial connective tissue flap is prepared from the palatal mucosa near the area to be treated and is displaced into the receptor site. The connective tissue is generally taken from the hard palate, although it may be taken from other sites as well, such as the maxillary tuberosity area. An evaluation of short and longterm results randall j. Periosteum and connective tissue are allowed to remain over the alveolar ridge which will become a source of blood supply to help nourish the autogenous connective tissue graft fig.
Surgical video for connective tissue graft from palate. It has been shown that the use of a subepithelial connective tissue graft to cover treated carious root surfaces and noncarious cervical lesions is highly effective and predictable. Free gingival and subepithelial grafts can be harvested from the palate or edentulous ridge sites. However, little is known about the longterm results. Subepithelial synonyms, subepithelial pronunciation, subepithelial translation, english dictionary definition of subepithelial. Alloderm is an alternative, but studies have shown that donor tissue from the palate has a somewhat better long term durability, and develops a thicker graft. Connective tissue graft in the treatment of multiple adjacent gingival recessions christina popova, k. The amount of keratinized tissue was 5 mm and there was no difference in the probing depth before and after surgery table 1. Treatment of recession and mucogingival defects using. Among a multitude of surgical techniques and graft materials reported in the literature, the subepithelial connective tissue graft sctg has gained wide popularity and acceptance. Dental implants are becoming the treatment of choice to replace missing teeth, especially if the adjacent teeth are free of restorations. Soft tissue grafting to improve implant esthetics moawia m kassabdivision of periodontics, marquette university, school of dentistry, milwaukee, wi, usaabstract. Subepithelial connective tissue graft technique for root. It s not d4271 anymore for a gingival graft now d4277d4278 includes the donor site for tooth and ridge d4273 subepithelial connective tissue graft procedure d4276 connective tissue graft with double papilla flap d4275 soft tissue allograft augment gingiva with or without root coverage.
This paper reports a case in which a new double papillary connective tissue graft technique has been used in the treatment of gingival recession. A gingival graft is designed to solve these problems. Is it time to retire the free gingival graft procedure in. Comparison of cyanoacrylate adhesives to sutures in the. Soft tissue grafting to improve implant esthetics ccide. Feb 03, 2016 journal club on subepithelial connective tissue graft associated with apicoectomy and rootend fillings in the treatment of deep localized gingival recession w slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Easy harvesting and grafting connective tissue from the palate. Because the connective tissue for the graft is transplanted without the superficial epithelium from the donor site, it is termed subepithelial. Types of grafts include bone, skin, vascular and ligament. There are currently different techniques for root coverage which include pedicle grafts, free gingival grafts, connective tissue grafts, and guided tissue regeneration gtr. Connective tissue graft to correct periimplant soft. The authors reported a clinical case in which a millers class i recession. Connective tissue and bone grafting for anterior immediate.
Root coverage using subepithelial connective tissue graft with. The effect of subepithelial connective tissue graft placement on esthetic outcomes after immediate implant placement. Alternatives to connective tissue graft in the treatment of localized. The purpose of this study was to evaluate the effect of using connective tissue graft as a biological barrier to cover immediately placed dental implants in maxillary anterior. In this technique, the epithelialized grafts are placed to cover the exposed root surfaces. Treatment of recession and mucogingival defects using connective tissue grafts on teeth and implants 39 ply to the graft increases its success rate 10, 55, 56. Straumann emdogain with a connective tissue graft to treat. Controlled palatal harvest cph technique for harvesting a palatal subepithelial connective tissue graft. Autogenous soft tissue grafting for the treatment of gingival recession.
This study evaluates the safety and effectiveness of a living human. There is a direct correlation between flap tension and reduced root coverage, and between tissue thickness and the percentage of cover connective tissue. Connective tissue grafts have become an important part of periodontal reconstructive surgery. Subepithelial connective tissue sect graft procedure. View the article pdf and any associated supplements and figures for. One of the impediments to patients accepting softtissue procedures to correct gingival loss is the trauma from harvesting palatal donor tissue. Acellular dermal matrix grafts for root coverage procedures. Abstract immediate implant placement in a onestage approach, with or without provisionalization, has proven to be advantageous in preserving gingival anatomy around dental implants. Background connective tissue graft ctg is considered as the gold standard for the treatment of gingival recessions gr. A subepithelial meaning below the skin connective tissue graft ct graft is one of four tissue grafts performed to correct hum tissue loss.
Treatment of gingival recession with subepithelial connective tissue harvested from the maxillary tuberosity by distal wedge procedure junbeom park, dds, msd, phd clinical showcase is a series of pictorial essays that focus on the technical art of clinical dentistry. Journal club on subepithelial connective tissue graft associated with apicoectomy and rootend fillings in the treatment of deep localized gingival recession w slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Esthetic root coverage with double papillary subepithelial. May 16, 2017 step by step palatal subepithelial connective graft technique.
Harvesting of autogenous grafts for gingival recession. The connective tissue graft was sutured to the underlying connective tissue at t he level of cej usin g 50 vicryl suture. Three of the commonly used proceduresthe free gingival graft, the subepithelial connective tissue graft, and acellular dermal connective tissue allograft procedureswere described. Free gingival grafts fggs, pedicle flaps, subepithelial connective tissue grafts sctgs, acellular dermal matrix.
You just had your soft tissue graft surgery done, now what. The subepithelial connective tissue graft, traditionally harvested from the patients palate, is commonly used for root coverage in periodontal recession defects. The type of graft taken depends on the type of gum defect present as well as the purpose of the graft. This technique resulted in excellent root coverage and complete healing of. Mar 19, 2015 in this video, dr kuljeet mehtaperiodontist, demonstrates the periodontal surgery. The effect of subepithelial connective tissue graft. There are 2 types of palatal harvests, a free gingival graft or a connective tissue graft. The application of soft tissue autografts has characterized the last 50 years of clinical periodontology, and till. There are few studies assessing the complications that can arise in the donor site when harvesting a connective tissue graft ctg and how the harvesting technique can influence those complications.
A free gingival graft will work nicely as described. Jan 15, 2018 abstract aim to compare the soft tissue volume gain vg around single tooth implants with subepithelial connective tissue graft sctg from either the lateral palate lp or from the tuberosity ar. The presence of gingival recession associated with an insufficient amount of keratinized tissue may indicate gingival augmentation procedure. General suggestions following connective tissue grafting surgery general suggestions following connective tissue grafting surgery the following advice is offered to minimize the discomfort and optimize healing following periodontal surgery. The gingival graft may be placed in such a way as to cover the exposed portion of the root. Connective tissue gum graft postoperative instructions antibiotic if an antibiotic has been prescribed, start taking it the first day unless directed otherwise and use to completion. In dentistry, the subepithelial connective tissue graft sect graft, and sometimes referred to simply as a connective tissue ct graft is an oral and maxillofacial surgical procedure first described by alan edel in 1974. Oct 17, 2016 cyanoacrylate tissue adhesives have been successfully used for wound closure. The advent of subepithelial connective tissue graft sctg technique has improved the predictability of soft tissue grafts to treat marginal, tissue recession, as this. Emd or subepithelial connective tissue graft for the. If the patient is very cosmetically oriented and you think may object to a graft of a different color, the connective tissue graft is the best choice then. The purpose of this clinical trial is to compare cyanoacrylate tissue adhesives to polytetrafluoroethylene ptfe sutures in the donor site of connective tissue grafts. If the clinical goal of the periodontal plastic surgery is the complete root coverage, then the microscopically goal standard is to obtain a true periodontal regeneration.
Epithelialized subepithelial connective tissue graft esctg combined with an envelope type flap is a treatment alternative combining the advantages of fggs and sctgs. The functional and aesthetic indications for soft tissue. Gingival recession as a clinical entity has been described and documented since the last century. Soft tissue grafting postop instructions esthetic tissue grafting, connective tissue grafts, alloderm, perioderm, etc.