A new technique in harvesting connective tissue graft

Background

Implants are routinely used for the rehabilitation of partially and fully edentulous patients. However, a successfully osseointegrated implant can still result in poor esthetics in case of ridge resorption, inadequate keratinized tissue and gingival recession leading to an unsuccessful outcome. For this reason, mucogingival surgery was introduced to correct defects in morphology, position, and or amount of tissue surrounding the teeth to help and restore anatomic form and function. Connective tissue grafts help correct soft tissue defects and are commonly used for root coverage. However, these procedures are technique sensitive and can sometimes result in unpredictable results. Post-operative bleeding, infection and swelling are major drawbacks in the use of connective tissue grafts as well as the difficulty in harvesting tissue. As a result, alloderm was introduced as an effective alternative to harvesting connective tissue grafts in the same surgical site. In comparison to the conventional technique, alloderm eliminates the secondary surgical site, as well as reducing the post-operative complications. From this, the patient recovers from the healing process faster with less pain. This procedure would be ideal under these circumstances+ however human immune response can respond adversely in the presence of alloderm grafts. As a result, connective tissue graft remains as a gold standard in harvesting tissue.

Aim/Hypothesis

Therefore, the purpose of this case report is to discuss the benefits of using an alternative connective tissue graft technique which is more user friendly and simpler.

Material and Methods

Ten consecutive clinical cases with maxillary buccal concavity deficiency were selected to perform a connective tissue graft and corrected the soft tissue defect. Donor site: First, a 5-0 suture was used to catch the graft tissue at the soft palatal tissue and tie a surgical knot in ease of holding the graft. Second, No. 15 blade was used to create partial thickness flap. Graft was harvested, leaving periosteum intact. Remove all movable tissue through de-epithelization, including the epithelium and muscle fibers. Lastly, donor site was sutured with 4-0 Chromic gut. Graft Harvesting: The graft was outline, extended from the soft palatal tissue to distal line angle of canine. The graft that was harvested was a long narrow graft. Recipient Site: These patients presented with alveolar ridge resorption in the maxillary buccal area. After the connective tissue graft was done, coronal, buccal and lingual measurements of soft tissue thickness were performed on these defects.

Results

After the connective tissue graft procedure was done, a post-surgical recall was done in 1 week, 2 week, 3 week, and 1 month. The ridge augmentation restore and allow the soft tissue contouring before implants were placed. The patient did not have pain during post-surgical visits. No complications were found. The patient is very happy with the result.

Conclusion and Clinical Implications

The use of the new novel technique allow the success of providing volume of the soft tissue architecture. This correction of defect ensure that the final implant will be in the ideal esthetic position. The harvested graft design was long narrow strip which allowed faster healing period reducing the risk of infection and complications. However, more evidence needs to be collected via long term studies with randomized control trails.