Connective tissue grafts your general dentist may have told you that you have gum recession, or you you may have noticed you are having hotcold sensitivity when you eat and drink. The most widelyused plastic surgery procedure today is the subepithelial connective tissue graft because its high predictability in achieving root coverage. In addition, the excel lent tissue blend that can be obtained provides the patient with. When a subepithelial connective tissue graft d4273 is submitted, some delta dental plans will pay an alternate benefit allowance for a free soft tissue graft d4271. Esthetic assessment of immediately restored implants combined. Reports on postoperative periodontal patient outcomes are limited. Based on this study, the parallel incision method meets more of the goals of an ideal technique for harvesting a connective tissue graft than the free gingival graft knife method. Nov 11, 20 free gingival graft fgg a soft tissue graft that is completely detached from one site and transferred to a remote site. Your periodontist removes a small piece of tissue from the roof of your mouth and suture stitch it to the area that needs gum tissue. Subepithelial connective tissue graft ctg a detached connective tissue graft that is placed beneath a partial thickness flap. It comprised of free connective tissue graft placed underneath a split thickness flap without making any attempt to completely cover the exposed connective tissue.
This variation of the free gingival graft provides the tissue graft with a nutrient supply on two surfaces 6. A casecontrol, retrospective study involving 34 patients treated with maxillary anterior single implants, immediately placed and restored. The subpedicle connective tissue graft nelson 1987. Pedicle soft tissue graft, autogenous connective tissue graft, nonautogenous connective tissue graft and combined connective tissue and double pedicle graft procedures are indicated for the following.
Fggs include an epithelial and a connective tissue component and are primarily used to increase the width of keratinized tissue. Sullivan and atkins described the possibility of attaining root coverage by using free grafts at the site of gingival recessions 2,3. With the microscope, he can see up to 26 times more accurately than with using the naked eye alone. Aug 21, 2012 the free gingival grafts harvested from the maxillary tuberosity area have a trapezoidal shape, with the major base showing a more or less pronounced concavity. Root coverage with connective tissue grafts periodontal. This type of graft is composed by a thin epithelium supported by a thick fibrous connective tissue. Free gingival and subepithelial grafts can be harvested from the palate or edentulous ridge sites. This case report highlights the management of a isolated gingival recession using lateral pedicle and connective tissue graft. The free gingival grafts harvested from the maxillary tuberosity area have a trapezoidal shape, with the major base showing a more or less pronounced concavity. Wessel currently, periodontics department, naval dental clinic norfolk, dental corps, united states navy, norfolk, va.
Labial incision has been carried to the depth of the vestibule. Free gingival autograft and subepithelial connective tissue. 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. Pdf free gingival autograft and subepithelial connective. Sometimes roots of teeth can be exposed through the gum tissue. Connective tissue graft harvesting techniques dental xp. A free gingival graft will work nicely as described. Nov 25, 2008 the free connective tissue graft is a bilaminar procedure designed to maximize the supraperiosteal and gingival blood supply to the grafted tissue. In this video, dr kuljeet mehtaperiodontist, demonstrates the periodontal surgery. Is it time to retire the free gingival graft procedure in. Connective tissue graft in place after labial vestibular extension. This can cause an esthetic concern as the teeth may appear long, or can cause paindiscomfort if the root is sensitive to hot or cold. Coverage of gingival recession using tunnel connective. The first surgery included a connective tissue graft to increase the width of the keratinized gingival tissue.
The functional and aesthetic indications for soft tissue. Pdf connective tissue grafts in periodontal surgery researchgate. The graft is placed over the recession area, while nutrients and revascularization are derived from the. The pedicle can be a coronally positioned pedicle, as suggested by langer and langer. Esthetic assessment of immediately restored implants combined with gbr and free connective tissue ct graft. Palatal harvesting technique modification for better. The use of a free connective tissue graft to increase the. Material and methods a retrospective clinical study was carried out in. Complications of harvesting a connective tissue graft from.
Pdf complications of harvesting a connective tissue. Surgical management of gingival recession using autogenous soft. Autogenous graft is considered as a gold standard material for mucogingival procedures due to its clinical predictability. 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. There are 2 types of palatal harvests, a free gingival graft or a connective tissue graft.
The connective tissue graft, with periosteum attached, was harvested from the tuberosity area. 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. The term autogenous, from the greek root autoself, describes how the individual who receives the graft is the same individual who provides the donor tissue. The type of graft taken depends on the type of gum defect present as well as the purpose of the graft. Ppt connective tissue graft powerpoint presentation free.
Connective tissue grafts have become an important part of periodontal. When a connective tissue graft is used for root coverage it is combined with an overlaying pedicle graft subepithelial connective tissue graft. While a free gingival graft is the chosen method to augment the zone of. Coverage of gingival recession using tunnel connective tissue. The connective tissue is generally taken from the hard. Final healing shows increased zone of attached gingiva and increased vestibular depth. Giovanni zucchelli develops a critical comparison between the different ctg harvesting techniques, and shows the correct management of this kind of graft as well as its use in coronally advanced flap surgical technique for the treatment of gingival recessions. Nov 11, 2019 it comprised of free connective tissue graft placed underneath a split thickness flap without making any attempt to completely cover the exposed connective tissue. However, instead of making a flap and removing tissue under the top layer of flesh, a small amount of tissue is removed directly from the roof of the mouth and then attached to the gum area being treated. 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. Soft tissue grafting postop instructions esthetic tissue grafting, connective tissue grafts, alloderm, perioderm, etc. 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.
Pdf complications of harvesting a connective tissue graft. The graft is placed over the recession area, while nutrients and revascularization are derived from the recipient bed, interdental papillae, and the overlying flap. 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. The free gingival graft technique, also allowed the possibility to har vest a controlled connective tissue graft, long, wide, thick with a regular amount, and desirable shape. By overlaying grafted free connective tissue with a pedicle, the otherwise compromised section of free graft which covers a denuded root surface is supplied by plasmatic circulation from. This procedure, the subpedicle connective tissue graft, is a bilaminar graft that is composed of a free connective tissue graft and an overlying pedicle graft. Areas with less than 2 mm of attached gingiva unresolved sensitivity in areas of recession. No connection with the donor site is maintained subepithelial connective tissue graft ctg a detached connective tissue graft that is. Connective tissue graft 1 connective tissue graft tunneling technique sequence of images showing a simple connective tissue graft procedure to cover exposed root surfaces. Recent studies have demonstrated that connective tissue grafting is an effective treatment of gingival. A subepithelial connective tissue graft takes tissue from under healthy gum tissue in the palate, which may be placed at the area of gum recession. This case report highlights the management of a isolated gingival recession using.
Free and connective tissue grafting sometimes roots of teeth can be exposed through the gum tissue. Mar 19, 2015 in this video, dr kuljeet mehtaperiodontist, demonstrates the periodontal surgery. Free gingival autograft and subepithelial connective. Pdf connective tissue grafts in periodontal surgery. It consists of a bilaminar reconstruction of the gingiva using both free and pedicle connective tissue layers to preserve graft viability over denuded root surfaces. This procedure has the advantage of excellent predictability of root coverage, 12 as well as decreased pain at the palatal donor site compared to. No connection with the donor site is maintained subepithelial connective tissue graft ctg a detached connective tissue graft that is placed beneath a partial thickness flap. Delta considers d4270 pedicle graft to include any frenectomy andor distal wedge performed in the same area on the same date. Connective tissue, free soft tissue, soft tissue allografts example when submitting for tissue grafts a short narrative describing the clinical findings should accompany the claim to aid in benefits determination. Keratinized tissue plays a major role around teeth and dental implants, helping to maintain and facilitate oral hygiene. The appropriate codes are d4273 subepithelial connective tissue graft procedures, per tooth, d4277 free soft tissue graft. D4285 nonautogenous connective tissue graft procedure including recipient surgical site and donor material each. Subepithelial connective tissue graft sctg has been extensively used for a variety of. In dentistry, alan edel first delineated ctg in 1974 for increasing the width of gingiva and since then its.
Background connective tissue graft ctg is considered as the gold standard for the treatment of gingival recessions gr. It has high predictability of postoperative tissue stability and graft survival. Esthetic assessment of immediately restored implants. Over the last few years, connective tissue graft ctg has become a reliable treatment modality for increasing the width of keratinized gingiva, root coverage,, treatment of furcation, alveolar ridge deficiencies,, management of periimplant tissue abnormalities, and papillary loss. Research has demonstrated superior esthetics and predictable outcomes in treating gingival recession in terms of the percentage of root coverage when a free autogenous connective tissue graft is utilized. Pdf on jan 1, 2016, jaishree a rijhwani and others published free gingival autograft and subepithelial connective tissue graft for the treatment of gingival recession. Not only will the grafted site protect the root and bone better, it will also look completely natural. Treatment of gingival recession with subepithelial. Afterwards, you may be a candidate to have a soft tissue graft to cover exposed roots, and to prevent additional recession and bone loss.
I have seen decent results with alloderm, but my preference is a palatal graft. Developing narratives for soft tissue grafts ameridenti. Palatal harvesting technique department of oral and. You just had your soft tissue graft surgery done, now what. Treatment of gingival recession with subepithelial connective. Fgg is nowadays less frequently used for the treatment of gingival recessions. Cross may recommend that springfield patients receive connective tissue grafts to treat gingival recession and bone loss. When patients come in with gum recession, we can help regenerate the lost tissue with. Pdf connective tissue graft and root coverage a case. Surgical management of gingival recession using autogenous.
A connective tissue graft on a upper canine in combination with a coronally advanced flap to treat multiple adjacent recessions is showed. Jul 29, 2016 a connective tissue graft on a upper canine in combination with a coronally advanced flap to treat multiple adjacent recessions is showed. The free connective tissue graft is a bilaminar procedure designed to maximize the supraperiosteal and gingival blood supply to the grafted tissue. Subepithelial connective tissue grafts have been shown to be effective in. Currently, it is generally used to obtain root coverage following gingival recession, which was a later development by burt langer in the early 1980s. Ppt connective tissue graft powerpoint presentation. The connective tissue graft, with periosteum attached, was harvested from. For soft tissue grafting, tissue is taken from the roof of your mouth or other source and secures it in.
You want to be gentle with the surgery site, but you also want to keep it clean. 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. Surgical video for connective tissue graft from palate. The procedure places grafts of tissue over the areas of loss and sculpts these grafts to match your original gum line. Free soft tissue grafts epithelialized free gingival grafts, subepithelial connective tissue grafts. Place grafts more accurately, promoting their success. Nabers introduced this surgical technique almost 50 years ago in 1966. Pedicle soft tissue graft with the use of a membrane guided tissue regeneration. Free gingival graft fgg a soft tissue graft that is completely detached from one site and transferred to a remote site. Glandular or fat tissues are normally not present in this area.
Connective tissue graft in combination with coronally. The term free describes how the graft is completely removed from the donor site rather than remaining attached via a pedicle. Like a connective tissue graft, free gingival grafts involve the use of tissue from another area in the mouth. Lateral pedicle and connective tissue graft a combined. The aim of this observational trial was to compare patient. Developing narratives for soft tissue grafts ameridenti billing. Autogenous free soft tissue grafts are harvested from a remote and. Subepithelial connective tissue graft sctg for root coverage was introduced by langer and langer in 1985, with modifications described subsequently by other authors. Free grafts of connective tissue, without epithelium, were transplanted from either the keratinized gingiva or the nonkeratinized alveolar mucosa controls into areas of the alveolar mucosa in. Pdf the application of connective tissue grafts has become a widely. 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. There are two main types of autogenous grafts the free gingival graft fgg fig.
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. Several techniques for the management of gingival recession exist, that is, free grafts free gingival grafts fggs, subepithelial connective tissue graft. When patients come in with gum recession, we can help regenerate the lost tissue with a procedure called connective tissue grafting. This procedure has the advantage of excellent predictability of root coverage, 12 as well as decreased pain at the palatal donor site compared to the free gingival graft. Alloderm there are two types of autogenous or selfdonor gingival grafts. 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. Patient outcomes following subepithelial connective tissue. Connective tissue graft ctg is considered as the gold standard for the treatment of gingival recessions gr. Surgical techniques in combination with free gingival graft fgg and. Subepithelial connective tissue grafts ctgs and free gingival grafts fggs are common periodontal procedures with similar indications.
Although this patient normally wore a partial upper denture, it was left out for the purpose of this study so that the healing of the donor site without a dressing volume. The second surgery included the use of autografting connective tissue graft to coronally position the soft tissue and achieve implant coverage. Furthermore, a manual search through periodontics related journals. However, the subepithelial connective tissue graft has been shown to provide a greater percentage root coverage than the epithelialised free gingival graft. Autogenous grafts are mainly harvested from the palate. Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures jeffrey r. Nabers first used the term free gingival graft fgg. Pdf a comparison of two techniques for obtaining a connective. The optimal way to perform connective tissue grafts is microsurgery, and springfield patients benefit from dr.
890 1190 794 102 794 595 1397 454 320 1181 1435 41 747 891 7 957 564 1239 986 811 1202 1143 1258 687 760 1451 61 171 286 640 567 132 1029 794 917