44-year journey of palatal connective tissue graft harvest: A narrative review

Abstract

Connective tissue graft (CTG) is considered the gold standard for soft-tissue correction and augmentation surgeries, but involves a secondary donor area and its associated complications. The techniques to harvest CTG have undergone a large number of modifications over a period of 44 years since the time it was introduced by Edel in 1974 to increase the width of keratinized gingiva. This review compiles all the techniques of graft harvest from the palate and their modifications which have been introduced in the last 44 years till date. This review is based on systematic reviews, comparative human studies, and case reports describing any new technique of graft harvest. Publications till April 2018 were selected and further reviewed. In addition, specific related journals and books were searched upon. In order to minimize the pain, bleeding, and morbidity associated with donor site, several researchers proposed harvesting of the connective tissue by means of different techniques, each precisely different from others in terms of design, incisions, and procedure of harvest. Although the latest techniques are minimally invasive with reduced incision lines, less compromised blood supply, accelerated healing, and no sloughing of the overlying flap, they are technique sensitive which requires higher expertise to execute.

Peri-Implant Soft Tissue Augmentation

“…The harvesting technique of the CTG has a direct influence on the graft dimension, histological composition, harvesting complications, morbidity, healing dynamics of the donor site, healing dynamics of the recipient site, and outcome of the grafting procedure. The ideal technique should enable the maximum volume and quality of the graft to be harvested, while concurrently limiting trauma, postoperative morbidity, and possible complications connected with CTG harvesting [43]. A variety number of techniques have been described in the literature for connective tissue graft harvesting.…”

“…All the techniques can be divided into two groups-(1) connective tissue harvesting with the preparation of the primary flap (offend referred to as subepithelial connective tissue graft, sCTG) and ( 2) free gingival graft harvesting with extraoral de-epithelization. The first group can be further subdivided into free CTG or pedicle CTG depending if the CTG is completely dissected or remains attached by one side of the palatal soft tissue [26,40,[42][43][44][45].…”

Clinical outcomes of root coverage using porcine-derived collagen matrix with modified coronally advanced tunnel technique (MCAT) in multiple gingival recessions in smokers — a randomized controlled clinical trial

“…Various surgical approaches have been evaluated in recent decades to accomplish root coverage for numerous adjacent gingival recessions with predictability and consistency.Sub-epithelial connective tissue graft(SCTG) is considered as a gold standard [2] as it provides the best outcomes for clinical practice because of its more signi cant percentages of mean and complete root coverage and considerable increase of keratinized tissue. [3] However, longer surgical time and increased patient morbidity in treating multiple adjacent gingival recessions using SCTG have become a challenge to both clinician and patient. [4] To overcome the drawbacks of patient morbidity during the harvest of SCTG other alternatives such as Allografts and Guided tissue regeneration are available but have their own limitations.…”

The Viability of Palatal Connective Tissue Graft Using Single Incision Versus De-Epithelialization Harvesting Technique in New Zealand Rabbits.

“…Connective tissue grafts (CTGs) have expanded acceptance and are widely used for recession management, widening the keratinized gingiva. Additionally, it can be used in controlling the soft tissue around the implant, management of furcation, alveolar ridge deficiencies, and papillary loss management 1 .…”