Soft tissue graft – Periodontal soft tissue grafting – Gum graft

Soft tissue graft procedures can fix many tooth and implant issues. To see more about cervical lesions and recession or implant soft tissue grafting just click the links.

When to use a soft tissue graft technique. — Sabri 2024 IJPRD

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.

A modified coronally advanced flap secured with brackets. — A modified coronally advanced flap can use brackets but just a tab of composite is better as it more esthetic.

Pedicle graft or lateral sliding flap or laterally positioned flap

We have a page on pedicle grafts.

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

The modified apically repositioned flap (MARF) technique uses a single horizontal incision within the keratinized tissue (KT), elevating a split-thickness flap, and suturing of the flap to the periosteum in an apical position. Periosteum is left exposed in the area between the initial horizontal incision and the coronal margin of the flap. The full perimeter of the exposed periosteal area is completely surrounded by KT. Therefore, keratinized epithelial cells migrate over the periosteum during the wound healing, resulting in the formation of keratinized attached tissue in the area of the previously exposed periosteum. Contraindicated if less than .5mm of attached gingiva. This beats a FGG in terms of pain and accomplishes same task.