The gingival graft may be placed in such a way as to cover the exposed portion of the root. Advanced papillary flap with interposed sub epithelial connective tissue graft can offer predictable results for the reconstruction of interdental papilla. The functional and aesthetic indications for soft tissue. One of the impediments to patients accepting softtissue procedures to correct gingival loss is the trauma from harvesting palatal donor tissue. Acellular dermis, collagen, dental enamel proteins, platelet rich fibrin, gingival recession. 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. There are several techniques available to harvest a suitable. Subepithelial connective tissue grafts have been shown to be effective in obtaining root coverage. Pdf the versatile subepithelial connective tissue graft.
A free gingival graft will work nicely as described. Subepithelial connective tissue grafts in the treatment of. The most widelyused plastic surgery procedure today is the subepithelial connective tissue graft because its high predictability in achieving root coverage. However, little is known about the longterm results. Marginal tissue recession is a displacement of the soft. In this technique, the epithelialized grafts are placed to cover the exposed root surfaces.
You just had your soft tissue graft surgery done, now what. Stabilizing sutures were given at the apical portion of the graft fig 5. Subepithelial connective tissue sect graft procedure. 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. Stratul, subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of miller class i and ii gingival recessions. View the article pdf and any associated supplements and figures for. Dental implants are becoming the treatment of choice to replace missing teeth, especially if the adjacent teeth are free of restorations. The full text of this article is available in pdf format. Treatment of recession and mucogingival defects using connective.
Harvesting of autogenous grafts for gingival recession. A periosteal elevator was used to separate the graft periosteum from the bone. The effect of subepithelial connective tissue graft. 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. Pdf complications of harvesting a connective tissue. Soft tissue grafting to improve implant esthetics ccide. An evaluation of short and longterm results randall j.
Connective tissue and bone grafting for anterior immediate. 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. The second surgery included the use of autografting connective tissue graft to coronally position the soft tissue and achieve implant coverage. 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. Types of grafts include bone, skin, vascular and ligament. 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. The most predictable technique used for gingival augmentation is the subepithelial connective tissue graft sctg. Free gingival and subepithelial grafts can be harvested from the palate or edentulous ridge sites. Replacement grafts for correction of soft tissue defects around the teeth have become important to periodontal plastic and implant surgical procedures. Treatment of gingival recession with subepithelial. This paper reports a case in which a new double papillary connective tissue graft technique has been used in the treatment of gingival recession.
Subepithelial synonyms, subepithelial pronunciation, subepithelial translation, english dictionary definition of subepithelial. 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. Within the limits of this study, we conclude that both sctg and lprf proved to be reliable options for the treatment of. Clinical evaluation of papilla reconstruction using. Connective tissue graft to correct periimplant soft. Pedicle soft tissue graft with the use of a membrane guided tissue regeneration. 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. Alternatives to connective tissue graft in the treatment of localized. A gingival graft is designed to solve these problems. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks. Gingival recession as a clinical entity has been described and documented since the last century. 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. The versatile subepithelial connective tissue graft. 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.
A clinical report jamil awad shibli, dds, phd,a susana davila, dds, ms,b and elcio marcantonio jr, dds, phdc guarulhos university, guarulhos, sa. Pdf harmony between hard and soft tissue morphologies is essential for form, function, and a good esthetic outlook. 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. 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. You will be able to go home following the procedure. Histologic healing and clinical root coverage periodontal plastic surgical techniques have evolved to meet the demands of todays dental patient. General suggestions following connective tissue grafting.
Gingival recession, root coverage procedure, connective tissue graft. The advent of subepithelial connective tissue graft sctg technique has improved the predictability of soft tissue grafts to treat marginal, tissue recession, as this. Comparison of cyanoacrylate adhesives to sutures in the. The goal of this study was to evaluate and compare the shortterm. When minimal bone width is present, implant placement becomes a challenge and often resulting in. Subepithelial connective tissue graft brunos technique a report of 3 cases article pdf available in journal of the indian dental association 57. Palatal harvesting technique modification for better control of the connective tissue graft dimensions danilo maeda reino, arthur belem novaes jr. 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. Emd or subepithelial connective tissue graft for the.
Mar 19, 2015 in this video, dr kuljeet mehtaperiodontist, demonstrates the periodontal surgery. Significance of the epithelial collar on the subepithelial. 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. Listing a study does not mean it has been evaluated by the u. View of treated area 12 months after root coverage surgery.
Alloderm there are two types of autogenous or selfdonor gingival grafts. Application of tunnel techniques and acellular dermal matrices. Subepithelial connective tissue grafting can be performed to achieve root coverage,7 but an additional surgical site is needed to harvest the connective tissue. The purpose of this clinical trial is to compare cyanoacrylate tissue adhesives to polytetrafluoroethylene ptfe sutures in the donor site of connective tissue grafts. In this video, dr kuljeet mehtaperiodontist, demonstrates the periodontal surgery.
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. 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. Lateral pedicle and connective tissue graft a combined approach for management of isolated gingival recession. Nabers introduced this surgical technique almost 50 years ago in 1966. The palatal subepithelial connective tissue flap method. Connective tissue gum graft postoperative instructions. Clinical comparison of the subepithelial connective tissue. Connective tissue graft in the treatment of multiple adjacent gingival recessions christina popova, k. Straumann emdogain with a connective tissue graft to treat. Treatment of recession and mucogingival defects using. 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 tissue margin. 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. It is a multifaceted problem for which several treatment options are available. Subepithelial connective tissue grafts sctgs have been extensively used to augment soft tissue volume on dental implants and natural teeth. Three of the commonly used proceduresthe free gingival graft, the subepithelial connective tissue graft, and acellular dermal connective tissue allograft procedureswere described. 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. Free gingival grafts fggs, pedicle flaps, subepithelial connective tissue grafts sctgs, acellular dermal matrix. An alternative technique to the harvesting of a connective tissue graft from a thin palate. The presence of gingival recession associated with an insufficient amount of keratinized tissue may indicate gingival augmentation procedure. Root coverage using subepithelial connective tissue graft. The first surgery included a connective tissue graft to increase the width of the keratinized gingival tissue. Your surgical stent is made of acrylic and is designed for your comfort after your grafting procedure. 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. Prognosis amount of root coverage achieved will depend on the severity size of recession. 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. Kotsilkov department of periodontology faculty of dental medicine, medical university sofia, bulgaria journal of imab annual proceeding scientific papers 2008, book 2 summary. The type of graft taken depends on the type of gum defect present as well as the purpose of the graft. If papilla loss occurs solely due to softtissue damage, reconstructive techniques can completely restore it.
Depending on the volume of tissue required to correct the recession, multiple harvesting procedures may be required. Soft tissue grafting to improve implant esthetics moawia m kassabdivision of periodontics, marquette university, school of dentistry, milwaukee, wi, usaabstract. T hirty 30 c lass i and c lass ii recessions in 30 subjects were treated with a subepithelial connective tissue graft procedure. Easy harvesting and grafting connective tissue from the palate. 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.
Jbr journal of interdisciplinary medicine and dental science. 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. An increase in soft tissue volume is achieved at the receptor site, which is. Esthetic root coverage with double papillary subepithelial. Pdf application of subepithelial connective tissue graft. You want to be gentle with the surgery site, but you also want to keep it clean. Acellular dermal matrix grafts for root coverage procedures.
Sep 17, 2010 the patient received three soft tissue grafting procedures to augment the gingival tissue. This technique success has been mainly attributed to the double blood supply for grafts nutrition, originating from the connective tissue of both the periosteum and flap. 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. This technique resulted in excellent root coverage and complete healing of. 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. The application of soft tissue autografts has characterized the last 50 years of clinical periodontology, and till. Introduction for many reasons, patients may present loss of gingival tissue, which can negatively affect esthetics and function. May 16, 2017 step by step palatal subepithelial connective graft technique.
Application of tunnel techniques and acellular dermal matrices douglas h. The authors reported a clinical case in which a millers class i recession. Careful case selection and surgical management are critical if a successful outcome is to be achieved. Surgical video for connective tissue graft from palate. Soft tissue grafting postop instructions esthetic tissue grafting, connective tissue grafts, alloderm, perioderm, etc. Abstract immediate implant placement in a onestage approach, with or without provisionalization, has proven to be advantageous in preserving gingival anatomy around dental implants. Pedicle flaps have provided consistent results, but adequate tissue must be present initially. Root coverage using subepithelial connective tissue graft with. Is it time to retire the free gingival graft procedure in. The subepithelial connective tissue graft, traditionally harvested from the patients palate, is commonly used for root coverage in periodontal recession defects. Connective tissue and bone grafting for anterior immediate implant placement.
Free soft tissue grafts epithelialized free gingival grafts, subepithelial connective tissue grafts. Two groups of volunteers will randomly assigned to one of the two study groups. There is a direct correlation between flap tension and reduced root coverage, and between tissue thickness and the percentage of cover connective tissue. 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. Connective tissue grafts have become an important part of periodontal reconstructive surgery. 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. 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.
Treat receding gums w gum grafting poway frenectomy. Treatment of multiple areas of gingival recession using a simple harvesting technique for autogenous connective tissue graft. 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. 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. This study evaluates the safety and effectiveness of a living human. Controlled palatal harvest cph technique for harvesting a palatal subepithelial connective tissue graft. Recession of the gingival tissue from the root surface of the teeth has. In one group 15 sites, the surgery was carried out in a traditional fashion. You can reduce stomach upset by taking it with food andor plenty of liquid. Surgical management of gingival recession using autogenous. 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. Palatal harvesting technique department of oral and. Controlled palatal harvest cph technique for harvesting.
Surgical treatment of gingival recession is used when there is need to cover exposed roots, as well as to gain softtissue volume. 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. Autogenous soft tissue grafting for the treatment of gingival recession. Journal club on subepithelial connective tissue graft. Subepithelial connective tissue graft brunos technique. Step by step palatal subepithelial connective graft technique. This free online tool allows to combine multiple pdf or image files into a single pdf document.
Subepithelial definition of subepithelial by the free. Epithelialized subepithelial connective tissue graft esctg combined with an envelope type flap is a treatment alternative combining the advantages of fggs and sctgs. In such situations anthem periodontics and dental implants in las vegas and henderson can assist you to regenerate that lost tissue, with the help of a process called connective tissue grafting. Treatment of gingival recession with subepithelial connective. Each procedure has clear advantages and disadvantages that need to be evaluated according to the patients needs. Because the connective tissue for the graft is transplanted without the superficial epithelium from the donor site, it is termed subepithelial. Palatal harvesting technique modification for better control. Application of subepithelial connective tissue graft with or without enamel matrix derivative for root coverage. The subepithelial connective tissue graft sciencedirect. The connective tissue graft was sutured to the underlying connective tissue at t he level of cej usin g 50 vicryl suture.
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. I have seen decent results with alloderm, but my preference is a palatal graft. Background connective tissue graft ctg is considered as the gold standard for the treatment of gingival recessions gr. The donor connective tissue is placed between the elevated splitthickness flap and the alveolar ridge with its periosteum and connective tissue covering. 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. Subepithelial connective tissue graft technique for root. The subepithelial connective tissue graft with a cornonally advanced flap is gold standard grafting procedure. The graft used may either be an epithelialized graft or a. Evaluation of using connective tissue graft as a biological.
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. Oct 17, 2016 cyanoacrylate tissue adhesives have been successfully used for wound closure. Subepithelial connective tissue graft for root coverage. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. 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. The amount of keratinized tissue was 5 mm and there was no difference in the probing depth before and after surgery table 1. Soft tissue volume gain around dental implants using. However, if your dentist gives you a sedative to help you relax, you will need to make arrangements. Keratinized tissue plays a major role around teeth and dental implants, helping to maintain and facilitate oral hygiene. Subepithelial connective tissue canadian dental association. A subepithelial meaning below the skin connective tissue graft ct graft is one of four tissue grafts performed to correct hum tissue loss. This dental procedure code refers to the type of grafting that takes tissue from within the mouth to cover teeth with receding gums.
The effect of subepithelial connective tissue graft placement on esthetic outcomes after immediate implant placement. This article describes the use of the subepithelial connective tissue graft as a donor source for root coverage. 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. There are 2 types of palatal harvests, a free gingival graft or a connective tissue graft.