The influence of palatal harvesting technique on the donor site vascular injury: A split-mouth comparative cadaver study

Lorenzo Tavelli, Shayan Barootchi, Sharon S Namazi, Hsun-Liang Chan, David Brzezinski, Theodora Danciu, Hom-Lay Wang, Lorenzo Tavelli, Shayan Barootchi, Sharon S Namazi, Hsun-Liang Chan, David Brzezinski, Theodora Danciu, Hom-Lay Wang

Abstract

Background: The aim of this study was to evaluate the influence of two harvesting approaches on the donor site vascular injury.

Methods: A split-mouth cadaver study was designed on 21 fresh donor heads. Every hemi-palate was assigned to receive the trap-door harvesting technique (TDT) or the epithelialized free gingival graft harvesting technique (FGGT). A soft tissue graft was harvested from each side for histology analyses. Betadine solution was used to inject the external carotid artery and a collagen sponge was positioned over the harvested area to compare the amount of "leakage."

Results: The mean leakage observed was 16.56 ± 3.01 µL in the FGGT-harvested sites, and 69.21 ± 7.08 µL for the TDT group, a ratio of 4.18 (P < 0.01). Regression analyses demonstrated a trend for more leakage at thinner palatal sites for the FGGT group (P = 0.09), and a statistically significant correlation for the TDT-harvest sites (P = 0.02). Additionally, a shallow palatal vault height (PVH) was associated with a higher leakage in both harvesting groups (P = 0.02). The histomorphometric analyses revealed that grafts harvested with TDT exhibited a significantly higher mean number of medium (ø = 0.1 to 0.5 mm, P = 0.03), and large vessels (ø ≥ 0.5 mm, P = 0.02).

Conclusions: Within the limitations of the present research, the TDT resulted in a significantly higher leakage than the FGGT, which was also correlated with the histology analyses where a greater number of medium and large vessels were observed in the harvested grafts.

Keywords: bleeding; blood loss; cadaver; hemorrhage; histology; surgical flaps.

© 2019 American Academy of Periodontology.

References

REFERENCES

    1. Giannobile WV, Jung RE, Schwarz F, Groups of the 2nd Osteology Foundation Consensus Meeting. Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: Osteology Foundation Consensus Report Part 1-effects of soft tissue augmentation procedures on the maintenance of peri-implant soft tissue health. Clin Oral Implants Res. 2018;29(suppl 15):7-10.
    1. Cairo F. Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontol 2000. 2017;75:296-316.
    1. Chambrone L, Pini Prato GP. Clinical insights about the evolution of root coverage procedures: the flap, the graft, and the surgery. J Periodontol. 2018;9:9-15
    1. Atieh MA, Alsabeeha N, Tawse-Smith A, Payne AG. Xenogeneic collagen matrix for periodontal plastic surgery procedures: a systematic review and meta-analysis. J Periodontal Res. 2016;51:438-452.
    1. Bertl K, Melchard M, Pandis N, Muller-Kern M, Stavropoulos A. Soft tissue substitutes in non-root coverage procedures: a systematic review and meta-analysis. Clin Oral Investig. 2017;21:505-518.
    1. Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol. 2014;41(suppl 15):S44-S62.
    1. Thoma DS, Buranawat B, Hammerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol. 2014;41(suppl 15):S77-S91.
    1. Yu SH, Tseng SC, Wang HL. Classification of soft tissue grafting materials based on biologic principles. Int J Periodontics Restorative Dent. 2018;38:849-854.
    1. de Resende DRB, Greghi SLA, Siqueira AF, Benfatti CAM, Damante CA, Ragghianti Zangrando MS. Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial. Clin Oral Investig. 2018;23(2):539-550
    1. Cairo F, Cortellini P, Pilloni A, et al. Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol. 2016;43:849-856.
    1. Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol. 2013;84:1755-1767.
    1. Brasher WJ, Rees TD, Boyce WA. Complications of free grafts of masticatory mucosa. J Periodontol. 1975;46:133-138.
    1. Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative complications following gingival augmentation procedures. J Periodontol. 2006;77:2070-2079.
    1. Rossmann JA, Rees TD. A comparative evaluation of hemostatic agents in the management of soft tissue graft donor site bleeding. J Periodontol. 1999;70:1369-1375.
    1. Zucchelli G, Mele M, Stefanini M, et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol. 2010;37:728-738.
    1. Tavelli L, Ravida A, Saleh MHA, et al. Pain perception following epithelialized gingival graft harvesting: a randomized clinical trial. Clin Oral Investig. 2018;23(1):459-468
    1. Nabers JM. Free gingival grafts. Periodontics. 1966;4:243-245.
    1. Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. J Clin Periodontol. 1974;1:185-196.
    1. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol. 1985;56:715-720.
    1. Harris RJ. A comparison of two techniques for obtaining a connective tissue graft from the palate. Int J Periodontics Restorative Dent. 1997;17:260-271.
    1. Bruno JF. Connective tissue graft technique assuring wide root coverage. Int J Periodontics Restorative Dent. 1994;14:126-137.
    1. Hurzeler MB, Weng D. A single-incision technique to harvest subepithelial connective tissue grafts from the palate. Int J Periodontics Restorative Dent. 1999;19:279-287.
    1. Lorenzana ER, Allen EP. The single-incision palatal harvest technique: a strategy for esthetics and patient comfort. Int J Periodontics Restorative Dent. 2000;20:297-305.
    1. Maino GNE, Valles C, Santos A, Pascual A, Esquinas C, Nart J. Influence of suturing technique on wound healing and patient morbidity after connective tissue harvesting. A randomized clinical trial. J Clin Periodontol. 2018;45:977-985.
    1. Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000. 2015;68:333-368.
    1. Bertl K, Pifl M, Hirtler L, et al. 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. J Periodontol. 2015;86:1331-1339.
    1. Romano F, Perotto S, Cricenti L, Gotti S, Aimetti M. Epithelial inclusions following a bilaminar root coverage procedure with a subepithelial connective tissue graft: a histologic and clinical study. Int J Periodontics Restorative Dent. 2017;37:e245-e252.
    1. Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R. The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site. A preliminary study. J Clin Periodontol. 2002;29:848-854.
    1. Keskiner I, Aydogdu A, Balli U, Kaleli AE. Quantitative changes in palatal donor site thickness after free gingival graft harvesting: a pilot study. J Clin Periodontol. 2016;43:976-984.
    1. Fu JH, Hasso DG, Yeh CY, Leong DJ, Chan HL, Wang HL. The accuracy of identifying the greater palatine neurovascular bundle: a cadaver study. J Periodontol. 2011;82:1000-1006.
    1. Tavelli L, Barootchi S, Ravida A, Oh TJ, Wang HL. What is the safety zone for palatal soft tissue graft harvesting based on the locations of the greater palatine artery and foramen? A systematic review. J Oral Maxillofac Surg. 2018;77(2):271
    1. Klosek SK, Rungruang T. Anatomical study of the greater palatine artery and related structures of the palatal vault: considerations for palate as the subepithelial connective tissue graft donor site. Surg Radiol Anat. 2009;31:245-250.
    1. Caraballo J, Galvez A, Manzanares-Cespedes MC, Valdivia-Gandur I, Figueiredo R, Valmaseda-Castellon E. Vascular structures of the lateral wall of the maxillary sinus: a vascular labeling technique. Implant Dent. 2017;26:153-157.
    1. Schneider CA, Rasband WS, Eliceiri KW. NIH image to ImageJ: 25 years of image analysis. Nat Methods. 2012;9:671-675.
    1. Wessel JR, Tatakis DN. Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol. 2008;79:425-430.
    1. Burkhardt R, Hammerle CH, Lang NP, Research Group on Oral Soft Tissue Biology & Wound Healing. Self-reported pain perception of patients after mucosal graft harvesting in the palatal area. J Clin Periodontol. 2015;42:281-287.
    1. Tavelli L, Asa'ad F, Acunzo R, Pagni G, Consonni D, Rasperini G. Minimizing patient morbidity following palatal gingival harvesting: a randomized controlled clinical study. Int J Periodontics Restorative Dent. 2018;38:e127-e134.
    1. Yildirim S, Ozener HO, Dogan B, Kuru B. Effect of topically-applied hyaluronic-acid on pain and palatal epithelial wound healing: an examiner-blind, randomized, controlled clinical trial. J Periodontol. 2017:1-14.
    1. Keceli HG, Aylikci BU, Koseoglu S, Dolgun A. Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery. J Clin Periodontol. 2015;42:582-589.
    1. Zuhr O, Baumer D, Hurzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014;41(suppl 15):S123-S142.
    1. Chan HL, Wang HL, Fowlkes JB, Giannobile WV, Kripfgans OD. Non-ionizing real-time ultrasonography in implant and oral surgery: a feasibility study. Clin Oral Implants Res. 2017;28:341-347.
    1. Tavelli L, Barootchi S, Ravida A, Suarez-Lopez Del Amo F, Rasperini G, Wang HL. Influence of suturing technique on marginal flap stability following coronally advanced flap: a cadaver study. Clin Oral Investig. 2018;23(4):1641-1651
    1. Reiser GM, Bruno JF, Mahan PE, Larkin LH. The subepithelial connective tissue graft palatal donor site: anatomic considerations for surgeons. Int J Periodontics Restorative Dent. 1996;16:130-137.
    1. Baab DA, Ammons WF, Jr., Selipsky H. Blood loss during periodontal flap surgery. J Periodontol. 1977;48:693-698.
    1. Moore PA, Doll B, Delie RA, et al. Hemostatic and anesthetic efficacy of 4% articaine HCl with 1:200,000 epinephrine and 4% articaine HCl with 1:100,000 epinephrine when administered intraorally for periodontal surgery. J Periodontol. 2007;78:247-253.
    1. Zigdon H, Levin L, Filatov M, Oettinger-Barak O, Machtei EE. Intraoperative bleeding during open flap debridement and regenerative periodontal surgery. J Periodontol. 2012;83:55-60.
    1. Berdon JK. Blood loss during gingival surgery. J Periodontol. 1965;36:102-107.
    1. Braganza A, Bissada N, Hatch C, Ficara A. The effect of non-steroidal anti-inflammatory drugs on bleeding during periodontal surgery. J Periodontol. 2005;76:1154-1160.
    1. Vassilopoulos P, Palcanis K. Bleeding disorders and periodontology. Periodontol 2000. 2007;44:211-223.
    1. Fickl S, Fischer KR, Jockel-Schneider Y, Stappert CF, Schlagenhauf U, Kebschull M. Early wound healing and patient morbidity after single-incision vs. trap-door graft harvesting from the palate-a clinical study. Clin Oral Investig. 2014;18:2213-2219.

Source: PubMed

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