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The video of this week is going to demonstrate, step-by-step, how to harvest connective tissue graft from the palate. (for more info: Treatment of gingival recessions)

For many reasons, patients may present loss of gingival tissue, which can negatively affect esthetics and function. 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 and edentulous alveolar ridge depressions (2) and to remove amalgam tattoos (3). SCTG is predictably used to treat gingival recessions and to manage root sensitivity (4,5). Recently, SCTG was also used with immediate implants, to obtain esthetics in anterior areas (6).


Several techniques have been proposed to obtain autogenous SCTG. Some surgeons use a method that consists in creating a partial-thickness trapezoidal palatal flap followed by SCTG harvesting (7,8). The use of this technique has been abandoned because it may compromise the vascularization of the flap, resulting in delayed healing (7,8).

Another technique proposed to harvest a SCTG is to remove a free gingival graft and then bisect it into one part with connective tissue and another piece with epithelium and a thin connective tissue (9). McLeod et al. (10) considered it a challenging technique because it is often difficult to bisect the free gingival graft removed and proposed a modification: a back-action periodontal surgical chisel was previously used to deepithelialize the donor site, and a gingivectomy was made to harvest the graft. These techniques present greater morbidity and produce more discomfort to patients because the connective donor site remains uncovered and the healing occurs by second intention.


Some other techniques were developed in an attempt to generate less connective donor site exposure, and to obtain better healing. An incision design was described to harvest the SCTG with a band of epithelium (11), and a single incision technique was created to harvest a full thickness SCTG (12). These two techniques reduce patient morbidity, but may result in a small void at the donor site, often requiring long periods to repair for second intention (13).

Recently, the single incision technique was modified to avoid causing the void at the donor site, with the objective of reducing patient morbidity and to accelerate the donor site healing (13). This modification is the less invasive technique for SCTG harvesting, but it also removes a full thickness SCTG, which may jeopardize the healing of the donor site. Additionally, more fat tissue can be harvested with the graft, which is not desirable. Furthermore, with this technique it is difficult to control the thickness of the harvested graft.


Each technique to harvest autogenous SCTG has benefits and disadvantages. The purpose of this report is to describe a modification of the single incision technique without removing the periosteum from the donor site, in an attempt to control the thickness of the harvested SCTG without increasing patient discomfort or morbidity.

Source: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-64402013000600565


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