Soft Tissue Grafts Techniques

Periodontal Plastic Surgery:Fundamentals of

Soft Tissue Grafting Techniques

Jin Y. Kim, DDS, MPH, MS Diplomate, American Board of Periodontology

Lecturer, UCLA Periodontics

Periodontal Plastic Surgery:Fundamentals of

Soft Tissue Grafting Techniques

Jin Y. Kim, DDS, MPH, MS Diplomate, American Board of Periodontology

Lecturer, UCLA Periodontics

Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com

Periodontal Plastic SurgeryPeriodontal Plastic Surgery

• Augmentation of the dimensions of gingival tissue

• Frenectomy

• Root coverage procedures

• Reconstruction of the alveolar ridge

• Surgical crown lengthening for function and esthetics

• Surgical exposure of unerupted teeth

• Augmentation of the dimensions of gingival tissue

• Frenectomy

• Root coverage procedures

• Reconstruction of the alveolar ridge

• Surgical crown lengthening for function and esthetics

• Surgical exposure of unerupted teeth


Root Coverage ProceduresRoot Coverage Procedures

• Indications:– root sensitivity– esthetics– protect root surface from caries/abrasions– improved hygiene

• Indications:– root sensitivity– esthetics– protect root surface from caries/abrasions– improved hygiene


Root Coverage ProceduresRoot Coverage Procedures

• pedicle soft tissue grafts– rotational flaps– advanced flaps

• free soft tissue grafts– epithelized soft tissue graft– subepithelialized connective tissue graft

• combination graft– one-stage procedures– two-stage procedures

• pedicle soft tissue grafts– rotational flaps– advanced flaps

• free soft tissue grafts– epithelized soft tissue graft– subepithelialized connective tissue graft

• combination graft– one-stage procedures– two-stage procedures


Marginal Tissue RecessionMarginal Tissue Recession

• Class I– recession not extending to MGJ– no loss of interdental bone or soft tissue

• Class II– recession extends to, or beyond MGJ– no loss of interdental bone or soft tissue

• Class I– recession not extending to MGJ– no loss of interdental bone or soft tissue

• Class II– recession extends to, or beyond MGJ– no loss of interdental bone or soft tissue

Miller P.D. Int J Periodont Rest Dent 1985;2:8

II

IIII

IIIIII

IVIV


Marginal Tissue RecessionMarginal Tissue Recession

• Class III– recession extends to, or beyond MGJ– loss of interdental bone or soft tissue

apical to CEJ, but coronal to apical extent of marginal tissue recession

• Class IV – recession extends to, or beyond MGJ– loss of interdental bone or soft tissue

apical to the extent of marginal tissue recession

• Class III– recession extends to, or beyond MGJ– loss of interdental bone or soft tissue

apical to CEJ, but coronal to apical extent of marginal tissue recession

• Class IV – recession extends to, or beyond MGJ– loss of interdental bone or soft tissue

apical to the extent of marginal tissue recession

Miller P.D. Int J Periodont Rest Dent 1985;2:8

II

IIII

IIIIII

IVIV


Ridge Deficiency (Seibert)Ridge Deficiency (Seibert)

• Class I– buccolingual loss of tissue with normal ridge

height in a apicocoronal dimension

• Class II– apicocoronal loss of tissue with normal ridge

width in a buccolingual dimension

• Class III– combined buccolingual and apicocoronal loss of

tissue resulting in loss of normal height and width

• Class I– buccolingual loss of tissue with normal ridge

height in a apicocoronal dimension

• Class II– apicocoronal loss of tissue with normal ridge

width in a buccolingual dimension

• Class III– combined buccolingual and apicocoronal loss of

tissue resulting in loss of normal height and width

Seibert J.S. Compend Cont Educ Dent 1983;4:437


Ridge Deficiency (Allen)Ridge Deficiency (Allen)

• Type A– apicocoronal loss of ridge contour

• Type B– buccolingual loss of ridge contour

• Type C– combined buccolingual and apicocoronal

loss of ridge contour

• Type A– apicocoronal loss of ridge contour

• Type B– buccolingual loss of ridge contour

• Type C– combined buccolingual and apicocoronal

loss of ridge contourAllen P. et al J Periodontol 1985;4:195

Type


Ridge Deficiency (Allen)Ridge Deficiency (Allen)

• Mild– less than 3 mm

• Moderate– 3 to 6 mm

• Severe– greater than 6 mm

• Mild– less than 3 mm

• Moderate– 3 to 6 mm

• Severe– greater than 6 mm

Allen P. et al J Periodontol 1985;4:195

Severity


Cosmetic Root CoverageCosmetic Root Coverage

• classification 1968, 1985• coronally positioned flap 1976, 1986• free gingival grafts 1982, 1985• subepithelial C.T. graft 1985, 1986• envelope flap 1985• semilunal flap 1986• GTR (G-TAM) 1991, 1992

• classification 1968, 1985• coronally positioned flap 1976, 1986• free gingival grafts 1982, 1985• subepithelial C.T. graft 1985, 1986• envelope flap 1985• semilunal flap 1986• GTR (G-TAM) 1991, 1992

Historical Perspective


Ridge AugmentationRidge Augmentation

• classification 1983• roll technique 1979• onlay grafting 1979, 1983• subepithelial C.T. graft 1979, 1982• pouch procedure 1980, 1981• modified or improved technique 1985• socket preservation 1989• GTR 1988

• classification 1983• roll technique 1979• onlay grafting 1979, 1983• subepithelial C.T. graft 1979, 1982• pouch procedure 1980, 1981• modified or improved technique 1985• socket preservation 1989• GTR 1988

Historical Perspective


Graft ThicknessGraft Thickness

Thickness Primary(mm) contraction Immobilization Viability .

0.5-0.75 slight essential best “take”

0.75-1.25 moderate absolutely less assuredessential

1.25-1.75 greatest absolutely least assuredessential

Sullivan H.C., & Atkins J.H. Periodontics 1966;6:121


Palatal TissuePalatal Tissue

Soft Tissue Grafts Techniques

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