Soft tissue graft – Periodontal soft tissue grafting – Gum graft
Free gingival graft FGG
Steps for a free gingival graft
- Split thickness flap at mucogingival junction about 7mm down.
- Stabilize with multiple interrupted gut 5/0 sutures
- De-epithelialize remaining attached mucosa
- Donor site 1.5mm thick is not too thick and not too thin. The graft should match the recipient site in size.
- Suture only coronal position of graft to site. 5 prolene 6/0 sutures, starting at the 2 ends, then the middle, then the middles of those areas.
- Place periacryl at edges of graft.
- Remove sutures at 2 weeks
To decrease pain at donor site.
- Suture collagen over the top of site
- Have stent that covers the donor site and have patient leave in first morning. Clean stent and teeth. Then leave stent in at all times except brushing for next week. After that patient can determine time needed.
What do you do if there is a failure?
Subepithelial connective tissue graft
Remove all restorative materials. Glass ionomer is only restorative material that allows some attachment.
Tunnel connective tissue graft
The methods to accomplish a tunnel connective tissue graft vary. We have a page on tunnel connective tissue graft.
Coronally advanced flap or coronally positioned flap
You can treat a class I Miller recession with a coronally advanced flap, add in a SECTG or FGG for class II Miller recession. A modified coronally advanced flap will use attachments of some sort to secure the flap coronally in place.
Pedicle graft or lateral sliding flap or laterally positioned flap
Apically repositioned flap
Split thickness apically repositioned flap
Can do around implants without the graft to let fill in with more attached gingiva as seen below under modified apically repositioned flap.
Modified apically repositioned flap