Subepithelial connective tissue graft in the management of. The functional and aesthetic indications for soft tissue. This graft was placed at the site with a p20 periosteal elevator, carefully passing it through the tunnel so as to preserve interdental papilla insertion intact figure 1d. D4273 autogenous connective tissue graft, per tooth d4275 nonautogenous connective tissue graft including recipient site and donor material first tooth, implant, or edentulous tooth position in graft d4276 combined connective tissue and double pedicle graft, per tooth d4277. Supepithelial connective tissue graft sctg and deepithelialized gingival graft. The palatal portion opposite to the molars is selected for harvesting the graft. Langer and langer reported increase of 2 to 6mm of root coverage by placement of subepithelial connective tissue graft. Your surgical stent is made of acrylic and is designed for your comfort after your grafting procedure. World heritage encyclopedia, the aggregation of the largest. During the procedure, a flap of skin is cut at the roof of your mouth palate.
The harvested connective tissue graft was sutured over the defect using a 50 vicryl suture to cover the graft, both papillae were first sutured midbuccally. Currently, it is generally used to obtain root coverage following gingival recession, which was a later development by burt langer in the early 1980s. The use of subepithelial connective tissue graft for. Recession of the gingival tissue from the root surface of the teeth has. Surgeons must become completely familiar with the anatomy of the palatal donor site to feel confident in providing the subepithelial connective tissue graft procedure. The use of a subepithelial connective tissue graft sctg has been successful in achieving root coverage and augmenting tissue thickness. Subepithelial connective tissue graft and gtr journal section. This article classifies palatal vaults according to. Microsurgical approach to subepithelial connective tissue.
Pedicle soft tissue graft with the use of a membrane guided tissue regeneration. Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of multiple class iiiiv recessions in lower anterior teeth. The donor connective tissue is placed between the elevated splitthickness flap and the alveolar ridge with its periosteum and connective tissue covering. Connective tissue was sourced from the palate and sutured in the recipient site with a 4. Tissue from under the flap, called subepithelial connective tissue, is removed and then stitched to the gum tissue surrounding the exposed root. A technique has been described which can augment concavities and irregularities in edentulous ridges where cosmetics are important. Surgical reconstruction of interdental papilla using. Department of periodontology, school of dentistry, nile college, sudan. The sub epithelial connective tissue grafts reported by langer and calagna in 1980 and gaber and rosenberg in 1981 have greatly helped to completely reconstruct class b defects 6. Connective tissue graft as a biological barrier for guided. The use of subepithelial connective tissue graft technique. A 3year randomized clinical trial faustino mercado1,2 stephen hamlet1,3 saso ivanovski2 1school of dentistry and oral health, griffith university, gold coast, queensland, australia. Tunnel techniques enable root coverage with results that. Threewalled intrabony defects were created surgically in the mesial aspect of the right and left.
The harvested graft consisted of subepithelial connective tissue from the posterior palatal region. The aim of this study was to evaluate the histometric findings of the subepithelial connective tissue graft as barrier in intrabony defects compared to a bioabsorbable membrane. Immediate implantation, despite many advantages, carries a risk of gingival recession. Periodontal plastic surgical techniques have evolved to meet the demands of todays dental patient. This randomized clinical trial compared the coronally positioned flap cpf alone or in conjunction with a subepithelial connective tissue graft sctg the treatment of gingival recession. The effect of subepithelial connective tissue graft. Subepithelial connective tissue graft the international literature has thoroughly documented that gingival recession can be successfully treated using several surgical procedures, irrespective of the tech. Masa dental center for paedodontics specialty, khartoum, sudan. 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.
Emd or subepithelial connective tissue graft for the. During the procedure, a flap of skin is cut at the roof of your mouth palate and tissue from under the flap, called subepithelial connective tissue, is removed and then stitched to the gum. You want to be gentle with the surgery site, but you also want to keep it clean. The graft used may either be an epithelialized graft or a subepithelial connective tissue graft of palatal masticatory mucosa. The pedicle can be a coronally positioned pedicle, as suggested by langer and langer. Subepithelial connective tissue graft with and without the. Significance of the epithelial collar on the subepithelial connective. Treatment of multiple miller class i and iii gingival. Techniques for harvesting a subepithelial connective tissue graft sctg from the palate. A subepithelial connective tissue graft was harvested from the hard palate using an ophthalmic blade and the trapdoor technique. Research clinical evaluation of subepithelial connective tissue graft and guided tissue regeneration for treatment of millers class 1 gingival recession comparative, split mouth, six months study. Coronally positioned flap with subepithelial connective tissue graft for root coverage. You just had your soft tissue graft surgery done, now what. Combined connective tissue and double pedicle graft must meet same criteria as other soft tissue grafts.
Also avoid salt water rinses as this can cause dehydration of the grafted tissues. In health teeth are surrounded by two types of tissue. This will cause a disturbance to the blood vessels that are required to nourish the graft and help the area heal. Treatment of gingival recession with subepithelial connective. Dgg approaches have been investigated with a focus on postoperative. Evaluation of 2 techniques of epithelial removal in. Soft tissue grafting postop instructions esthetic tissue grafting, connective tissue grafts, alloderm, perioderm, etc. Pdf the subepithelial connective tissue graft palatal. Currently, it is generally used to obtain root coverage following gingival. The primary efficacy parameters for the study were rd, the distance between the cej to the free gingival margin at 3 months. Consent for connective tissue graft gum graft surgery.
This article reports a clinical case with a 3year followup in which a subepithelial connective tissue graft sctg was used with the tunnel technique to treat multiple gingival recessions, and. An esthetic implantsupported rehabilitation continues to be a major challenge in patients with a thin periodontium. In order to avoid displacement of sub epithelial connective tissue graft crown suspender sutures were applied to later perform flap displacement towards. D4273 autogenous subepithelial connective tissue graft procedures including donor and recipient surgical sites per first tooth, implant, or edentulous tooth position in graft this procedure is performed to create or augment gingiva, to obtain root coverage to eliminate sensitivity and to prevent root. A periosteal elevator was used to separate the graft periosteum from the bone. Dec 31, 2012 the aim of this study was to evaluate the clinical efficiency of the subepithelial connective tissue graft sctg with and without plasma rich in growth factor prgf in the treatment of gingival recessions. Pdf the subepithelial connective tissue graft palatal donor. The use of subepithelial connective tissue graft technique to. Review the effect of subepithelial connective tissue graft placement on esthetic outcomes after immediate implant placement. This dental procedure code refers to the type of grafting that takes tissue from within the mouth to cover teeth with receding gums. Jbr journal of interdisciplinary medicine and dental science. Consent for connective tissue graft gum graft surgery diagnosis. Careful case selection and surgical management are critical if a successful outcome is to be achieved.
A sub epithelial meaning below the skin connective tissue graft ct graft is one of four tissue grafts performed to correct hum tissue loss. When a connective tissue graft is used for root coverage it is combined with an overlaying pedicle graft subepithelial connective tissue graft. The subepithelial connective tissue graft sctg is frequently used at periodontal recession sites to increase the volume of soft tissue at a deficient site and also convert thin periodontal phenotype a 3,4 into a stable thick. Pdf treatment of multiple adjacent gingival recessions. T hirty 30 c lass i and c lass ii recessions in 30 subjects were treated with a subepithelial connective tissue graft procedure. Original article tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions. The success of these grafts has been attributed to the double.
Stratul, subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of miller class i and ii gingival recessions. The ct graft is the most common among the four, and is called sub epithelial because the tissue removed does not include the superficial epithelium. The use of subepithelial connective tissue graft for treatment of gingival recession in a snuff dipping user a case report abdelrahman magzoub. Subepithelial connective tissue graft was obtained figure 7 in the region of number 24 and number 25 from the palate with two incisions lshape figure 6, to prevent severe postoperative pain and discomfort and for early wound healing.
Introduction for many reasons, patients may present loss of gingival tissue, which can negatively affect esthetics and function. Ridge preservation and immediate implant placement are intended to preserve the hard tissue volume and prevent preimplant bone loss. In this dental procedure code description, the term donor site represents the place in the mouth from which the tissue is removed, and the recipient site represents the place. Care was taken to maintain a uniform thickness of the graft and to keep the periosteum as intact as possible. Department of periodontology, department of oral pathology and periodontology, dental clinical center, faculty of. 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. The graft was then placed in a saline soaked ribbon gauze until the recipient bed was prepared. Subepithelial connective tissue graft project gutenberg. The technique used created healthy functional and esthetic gingival unit that appeared resistant to further break down at a one year follow up.
Currently, it is generally used to obtain root coverage following gingival recession, which was a later development by. Comparison between subepithelial connective tissue. Subepithelial connective tissue grafting can be used for root coverage,1 to. T his article describes the use of the subepithelial connective tissue graft as a donor source for root coverage. Jul 01, 2014 both bone and soft tissue grafting techniques have been developed to address the loss in tissue volume. Free soft tissue grafts epithelialized free gingival grafts, subepithelial connective tissue grafts. The advantage of subepithelial connective tissue graft is a close approximation of donor and recipient site, convenient surgical access, color match with recipient site, and decreased donor site morbidity and cost. Pdf harmony between hard and soft tissue morphologies is essential for form, function, and a good esthetic outlook. Appropriate to correct advanced gingival recession. Using the combination of temporary acrylic resin restorations and connective tissue autografts, unattractive concavities and ridge irregularities can be corrected. The effect of subepithelial connective tissue graft placement on esthetic outcomes after immediate implant placement. Hence, an autogenous subepithelial connective tissue graft was used to augment the ridge defect.
The subepithelial connective tissue graft with a cornonally advanced flap is gold standard grafting procedure. Regardless of the amount of attached gingiva present, the free autogenous connective tissue is readily available from palate or edentulous ridge and pedicle available from site is. Subepithelial connective tissue graft to increase the. Palatal harvesting technique department of oral and. 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. Therefore, a technique for reliable wound closure was developed. The subepithelial connective tissue graft sciencedirect. Case report esthetic root coverage with double papillary. Variations in the size and shape of the hard palate affect the dimensions of donor tissue harvested, as well as the location of the greater palatine neurovascular bundle. Treatment of gingival recession with subepithelial. Root coverage using subepithelial connective tissue graft with. The most widelyused plastic surgery procedure today is the subepithelial connective tissue graft because its high predictability in achieving root coverage. Recently, double papillary connective tissue gra has been used for the treatment of root coverage procedures for better esthetics and predictability.
The washing line suture technique for securing the. The most predictable technique used for gingival augmentation is the subepithelial connective tissue graft sctg. The harvested tissue was handled with utmost care and tucked into the pouch prepared at the recipient site. This report describes a case of a gingival recession managed with the use of subepithelial connective tissue graft. The use of the autogenous periosteal graft as biological barrier has been proposed for periodontal regeneration. General suggestions following connective tissue grafting. Subepithelial connective tissue sect graft procedure. Significance of the epithelial collar on the subepithelial. Oct 21, 2011 however, the subepithelial connective tissue graft has been shown to provide a greater percentage root coverage than the epithelialised free gingival graft.
Subepithelial connective tissue graft for root coverage. View of treated area 12 months after root coverage surgery. Nov 04, 2019 b flap containing epithelial tissue, connective tissue, and submucosal tissue being removed from the donor area. The effect of subepithelial connective tissue graft placement. No additional charge for the graft material is allowed. Clinical evaluation of subepithelial connective tissue graft. The amount of keratinized tissue was 5 mm and there was no difference in the probing depth before and after surgery table 1. When compared to other techniques, the modified tunnel technique is free of horizontal or vertical incisions, it is a minimally invasive method, blood. In one group 15 sites, the surgery was carried out in a traditional fashion. Gingival recession, root coverage procedure, connective tissue graft. 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 adm grafts, and guided tissue regeneration gtr have all been used to cover denuded root surfaces.
Pdf the versatile subepithelial connective tissue graft. The ideal techniques for the increase of the alveolar ridge, are the free grafts in the tunnel, interposed or inlay and superimposed or onlay. Prognosis amount of root coverage achieved will depend on the severity size of recession. The secondary efficacy parameters included the width of ke. Use of the stent will help to eliminate the risk of postsurgical bleeding and minimize discomfort associated with the donor site on the palate. Mucosa is like cheek tissue, and does not adhere to the roots of the teeth or underlying jawbone very well, as compared to gingiva, which is a more fibrous tissue. Surgical procedures using soft tissue autogenous graft, various alloplastic materials, autogenous bone graft, and guided tissue regeneration can correct such type of ridge defects. The technique utilizing a subepithelial soft tissue graft.
A variety of gingival grafting techniques have been advocated to treat gingival recession, like, lateral pedicle flaps, coronally positioned flaps, free gingival grafts, connective tissue grafts, and guided tissue regeneration, but the subepithelial connective tissue graft sectg technique remains one of the most common and accepted procedure. Subepithelial connective tissue grafts has been used to the treatment of gingival recession and can improved the high and width of the keratinized tissue providing satisfactory esthetic results for root coverage and it has been indicated in areas with cervical abrasions 3,69. Use of a combination epithelizedsubepithelial connective. Root coverage using the coronally positioned flap with or. Careful case selection and surgical management are critical if a. 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. 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. Subepithelial connective tissue graft technique for root coverage. Exploring the gingival recession surgical treatment. Subepithelial connective tissue canadian dental association.
The main reason for the surgical intervention was the concern of the patient and the tendency for progression of the recession. The present case report shows the use of subepithelial tissue graft combined with coronally flap to the treatment of premolar area where it had thin gingiva biotype. Primary closure was obtained at the donor site by placing aluminum foil over the incision area to avoid entanglement of suture within the periodontal. Subepithelial connective tissue grafts in the treatment of. One of the most generally used procedure for root coverage is the free soft tissue graft procedure. The addition of soft tissue, daniel baumer and replacement.
Gingival recession as a clinical entity has been described and documented since the last century. This technique employs a combined epithelizedsubepithelial connective tissue graft, leaves the mucogingival line in its place, and has the added advantage of thickening the buccal soft tissue with the resultant local conversion of a thin marginal gingiva to a thick marginal gingiva. This study aimed to compare the clinical efficacy of vestibular incisional subperiosteal tunnel access vista with subepithelial connective tissue graft versus a coronally advanced flap caf. Tunnel technique with enamel matrix derivative in addition. This procedure was first introduced by langer and langer in 19854 and has been refined over the last few years.
Of the various gra and nongra procedures used, this case report describes double papillary subepithelial connective tissue gra, a technique in whichbilateralpedicle apswithconnectivetissuegra were. Dec 17, 2017 the subepithelial connective tissue graft with a cornonally advanced flap is gold standard grafting procedure. A new approach to the enhancement of anterior cosmetics. The rationale behind using a subepithelial connective tissue graft for recession coverage is that this technique combines the free gingival graft and pedicle flap.
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