Question

Trap door technique for connective tissue graft

Answer 1

Dental therapy in general and periodontal therapy in particular is directed increasingly at the esthetic outcome for patients. Gingival recession is one of the most common esthetic concerns associated with periodontal tissues. Although various treatment modalities have been developed, subepithelial connective tissue grafting remains the most successful and predictable technique for treatment of gingival recession. Harvesting a connective tissue graft from the palate is many times not only traumatic, but also very painful for the patient. Use of single incision to harvest the subepithelial connective tissue graft is one of the least traumatic, but relatively difficult technique to accomplish. This article presents a modified single incision technique, which is not only less traumatic and painful, but comparatively simple to employ and master. Two new instruments have been introduced to make harvesting of the connective tissue graft easier.

Keywords: Cementoenamel junction, connective tissue, grafts, gingival recession, subepithelial

Reconstructive surgery is performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve the function, but may also be performed to approximate a normal appearance.[1]

Periodontal reconstructive surgery consists of a variety of mucogingival procedures including root coverage, crown lengthening, vestibular deepening, papilla reconstruction, and ridge augmentation. Even as the primary objective of these procedures is to benefit periodontal health through the reconstruction of lost hard and soft tissues or by preventing further loss, they also augment the patient's appearance.

As dentistry in general and periodontology in particular are making headway, patients are becoming increasingly aware of periodontal problems. Specifically, gingival recession is becoming a greater concern for patients. The loss of gingival tissue can not only lead to root sensitivity, unnatural restorative contours, cemental erosion, and root caries, but also leads to poor esthetics.

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 for root coverage. The advent of SECTG, as described by Langer and Langer, predictably increased the root coverage of Miller's Class I and II recession to around 90%. Due to superior esthetics and the consistent results achieved, SECTG has been clearly recognized as a highly effective means of covering recession defects.