Is a soft tissue graft harvested from the maxillary tuberosity the approach of choice in an isolated site?

Abstract

Soft tissue augmentation procedures are becoming more popular these days. Different soft tissue graft harvesting approaches have been proposed. Nonetheless, the location of the donor site (whether anterior‐, lateral‐, superficial‐, deep‐palate or the maxillary tuberosity) can affect the graft shape and its composition. Soft tissue grafts from the maxillary tuberosity are rich in connective tissue fibers, with minimal presence of fatty or glandular components. Clinical, histological, and molecular evidence shows that a soft tissue graft obtained from the maxillary tuberosity has unique properties. In addition, harvesting from this area presents minimal risk for intra‐ or postoperative complications, leading to reduced patient morbidity. The aim of this commentary is to discuss the advantages and disadvantages of harvesting a soft tissue graft from the tuberosity and to compare it with the traditional palatal graft, while highlighting functional, esthetic, and patient‐related outcomes.

Autogenous soft tissue grafting for periodontal and peri‐implant plastic surgical reconstruction

“…This dissimilar nature of the graft renders a CTG distinctively different from the FGG by being firmer, more stable, and easier to manage than a CTG that is harvested from a deep palate . Furthermore, since CTG can promote the keratinization of the overlying epithelia, it has been suggested that the adipose and glandular tissue of the graft may act as barriers to the plasmatic diffusion and vascularization during the first phase of healing, and also impair their ability to induce epithelial keratinization …”

“…Molecular analyses also confirmed different cellular and tissue behaviors of CTGs harvested from the maxillary tuberosity compared with the palate . Given its tendency for a hyperplastic response, it may be suggested that CTG from the tuberosity may be used for increasing soft tissue volume and KTW, when esthetics are not the primary goal …”

Long term assessment of root coverage stability using connective tissue graft with or without an epithelial collar for gingival recession treatment. A 12‐year follow‐up from a randomized clinical trial

“…The possibility of leaving the coronal part of a CTG exposed has been explored by several authors (Cordioli, Mortarino, Chierico, Grusovin, & Majzoub, 2001;Han, John, Blanchard, Kowolik, & Eckert, 2008;Salhi, Lecloux, Seidel, Rompen, & Lambert, 2014;Tavelli, Barootchi, Greenwell, et al, 2019). The suggested advantages of this approach are the better initial graft tissue fluid seal during the healing process, and the faster healing and increased gain in KTW (Byun et al, 2009).…”

“…It has been suggested that several factors, including the addition of a connective tissue graft (CTG) and patient maintenance and motivation, have an impact on the long term stability of the gingival margin (McGuire, Scheyer, & Snyder, 2014;Pini Prato et al, 2011;Rasperini et al, 2018;Tavelli, Barootchi, Greenwell, & Wang, 2019). Nickles, Ratka-Kruger, Neukranz, Raetzke, and Eickholz (2010) compared the long term outcomes of treated isolated GRs either with a CTG or guided tissue regeneration.…”

The influence of tooth location on the outcomes of multiple adjacent gingival recessions treated with coronally advanced flap: A multicenter re‐analysis study

“…In agreement with previous studies, 22,23 the addition of CTG was able to enhance the outcomes of CAF (94.13% ± 12.7% versus 87.4% ± 18.7% for mRC; and 78.9% versus 63.1% for CRC). Among the advantages of CTG compared with treatment with flap alone, it has been speculated that the CTG acts as a biological scaffold that enhances flap adaptation to the root surface, 22 providing added increased soft tissue thickness 37 which has been correlated with higher CRC 38 and long-term stability. 39,40 A recent article from our group has corroborated the importance of tooth location in CAF for isolated GRs, reporting that canines and incisors were related to a higher mRC and CRC than posterior teeth.…”