Modified single incision technique to harvest subepithelial connective tissue graft

Ashish Kumar, Vishal Sood, Sujata Surendra Masamatti, M G Triveni, D S Mehta, Manish Khatri, Vipin Agarwal, Ashish Kumar, Vishal Sood, Sujata Surendra Masamatti, M G Triveni, D S Mehta, Manish Khatri, Vipin Agarwal

Abstract

Dental therapy in general and periodontal therapy in particular is directed increasingly at the esthetic outcome for patients. Gingival recession is one of the most common esthetic concerns associated with periodontal tissues. Although various treatment modalities have been developed, subepithelial connective tissue grafting remains the most successful and predictable technique for treatment of gingival recession. Harvesting a connective tissue graft from the palate is many times not only traumatic, but also very painful for the patient. Use of single incision to harvest the subepithelial connective tissue graft is one of the least traumatic, but relatively difficult technique to accomplish. This article presents a modified single incision technique, which is not only less traumatic and painful, but comparatively simple to employ and master. Two new instruments have been introduced to make harvesting of the connective tissue graft easier.

Keywords: Cementoenamel junction; connective tissue; gingival recession; grafts; subepithelial.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Single incisions marked on the palate, 2 mm below the gingival margin, extending from the canine to the first molar
Figure 2
Figure 2
(a) Diagrammatic representation of the angulation of the blade to raise a partial thickness flap through the first incision and (b) clinical photograph depicting the positioning of the blade approximately parallel to the long axis of the palate to raise a partial thickness flap
Figure 3
Figure 3
Photographs after raising the partial thickness flaps to the required depth
Figure 4
Figure 4
(a) Diagrammatic representation of the incision by placing the blade perpendicular to the bone surface through the single incision. The black line indicates the thickness of the connective tissue that would be harvested and (b) the clinical photograph depicting the angulation of the blade
Figure 5
Figure 5
(a) Diagrammatic representation of the connective tissue graft elevation and (b-d) The connective tissue grafts held between two instruments can be appreciated in all the three cases
Figure 6
Figure 6
(a) Diagrammatic representation of the mesial and distal vertical incisions and (b) Diagrammatic representation of horizontal medial incision under partial thickness flap to separate graft from surrounding tissue. (c) The new instruments used to make mesial and distal vertical incisions (Barraquer cataract knife) and (d) Horizontal medial incision under partial thickness flap (AVS blade)
Figure 7
Figure 7
Clinical photographs depicting use of the new instruments, to make (a) Mesial and distal vertical incisions and (b) a horizontal medial incision under partial thickness flap
Figure 8
Figure 8
Connective tissue graft being harvested through the single incision and the amount of tissue harvested
Figure 9
Figure 9
Donor sites sutured
Figure 10
Figure 10
The palatal wounds had healed and were completely closed by the twelfth day for all the three patients

References

    1. Informational paper: Oral reconstructive and corrective considerations in periodontal therapy. J Periodontol. 2005;76:1588–600.
    1. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol. 1985;56:715–20.
    1. Miller PD., Jr A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5:8–13.
    1. Harris RJ. Connective tissue grafts combined with either double pedicle grafts or coronally positioned pedicle grafts: Results of 266 consecutively treated defects in 200 patients. Int J Periodontics Restorative Dent. 2002;22:463–71.
    1. Rosetti EP, Marcantonio RA, Rossa C, Jr, Chaves ES, Goissis G, Marcantonio E., Jr Treatment of gingival recession: Comparative study between subepithelial connective tissue graft and guided tissue regeneration. J Periodontol. 2000;71:1441–7.
    1. Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinized gingiva. J Clin Periodontol. 1974;1:185–96.
    1. Harris RJ. The connective tissue and partial thickness double pedicle graft: A predictable method of obtaining root coverage. J Periodontol. 1992;63:477–86.
    1. Raetzke PB. Covering localized areas of root exposure employing the “Envelope” technique. J Periodontol. 1985;56:397–402.
    1. Bruno JF. Connective tissue graft technique assuring wide coverage. Int J Periodontics Restorative Dent. 1994;14:127–37.
    1. Hurzeler MB, Weng D. A single incision technique to harvest subepithelial connective tissue grafts from palate. Int J Periodontics Restorative Dent. 1999;19:279–87.
    1. Liu CL, Weisgold AS. Connective tissue graft: A classification for incision design from the palatal site and clinical case reports. Int J Periodontics Restorative Dent. 2002;22:373–9.
    1. Kumar A, Masamatti SS. A new classification system for gingival and palatal recession. J Indian Soc Periodontol. 2013;17:175–81.
    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.

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