Modified single incision for harvesting connective tissue grafts.
Journal name: Journal of Indian Society of Periodontology
Original article title: Modified single incision technique to harvest subepithelial connective tissue graft
The Journal of Indian Society of Periodontology (JISP) publishes original scientific articles on periodontology (the study of supporting structures of teeth) and oral implantology. It is a bimonthly open-access journal with special issues for specific occasions.
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Original source:
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Ashish Kumar, Vishal Sood, Sujata Surendra Masamatti, M. G. Triveni, D. S. Mehta, Manish Khatri, Vipin Agarwal
Journal of Indian Society of Periodontology:
(A bimonthly open-access journal)
Full text available for: Modified single incision technique to harvest subepithelial connective tissue graft
Year: 2013 | Doi: 10.4103/0972-124X.119294
Copyright (license): CC BY-NC-SA
Summary of article contents:
Introduction
As dental therapy evolves, the focus on aesthetic outcomes, particularly in periodontal treatment, has intensified. Gingival recession poses significant aesthetic concerns for patients and can lead to various clinical issues such as root sensitivity and increased risk of caries. Among diverse treatment approaches, subepithelial connective tissue grafting (SECTG) is considered the most effective for addressing gingival recession. Traditionally, harvesting grafts from the palate has been associated with patient trauma and significant pain. To mitigate these issues, a modified single incision technique has been introduced, aimed at simplifying the procedure while reducing discomfort for patients.
Modified Single Incision Technique
The modified single incision technique enhances the SECTG harvesting process by allowing for a partial thickness flap to be created first, which significantly improves visibility and reduces bleeding. Unlike previous methods that required an incision directly to the bone, this approach allows clinicians to assess the graft size and thickness accurately before proceeding further. The use of specialized instruments, such as the 'Barraquer cataract knife' for making mesial and distal vertical incisions and the newly developed 'AVS blade' for horizontal incision under the flap, addresses the challenges of visibility and maneuverability during graft harvesting. This modification maintains the advantages of primary closure at the donor site while minimizing pain and trauma reported by patients.
Conclusion
The modified single incision technique for harvesting subepithelial connective tissue grafts presents a noteworthy advancement in periodontal surgery. By prioritizing patient comfort through reduced trauma and pain, this technique not only enhances surgical outcomes but also improves overall patient satisfaction. It successfully combines ease of execution with improved visibility and precise graft sizing, making it a valuable alternative in reconstructive periodontal surgery. The positive results and patient responses reported from this approach underscore its potential as a standard technique in the management of gingival recession.
FAQ section (important questions/answers):
What is the main concern associated with gingival recession?
Gingival recession leads to esthetic issues, root sensitivity, and potential decay, which significantly affects patients' appearance and oral health.
What technique is considered most effective for treating gingival recession?
The subepithelial connective tissue grafting (SECTG) technique is recognized for achieving predictable and aesthetically pleasing root coverage results.
How does the modified single incision technique differ from traditional methods?
This modified technique emphasizes a partial thickness flap initially, improving visibility and reducing trauma, pain, and complications associated with graft harvesting.
What are the benefits of using new instruments in this technique?
The new instruments enhance precision when making incisions, reduce the risk of damaging the flap, and ensure better control during graft harvesting.
What was the postoperative experience for patients using this technique?
Patients reported mild pain on a visual analog scale, indicating good tolerance and enhanced comfort during recovery following the surgery.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Modified single incision for harvesting connective tissue grafts.”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Incision:
An incision refers to a surgical cut made in the skin or tissue. In periodontal therapy, incisions are crucial for accessing underlying tissues for graft harvesting. Specifically, the article discusses incisions made during subepithelial connective tissue grafting, emphasizing techniques that minimize trauma and allow effective donor site preparation.
2) Harvesting (Harvest):
Harvesting refers to the act of obtaining a tissue graft from a donor site, such as the palate, for transplantation. In periodontal therapy, careful harvesting techniques significantly influence postoperative outcomes, including healing and patient pain levels, making the discussion of harvesting techniques paramount for effective gingival recession treatment.
3) Bleeding:
Bleeding is an essential consideration in surgical procedures, including periodontal grafting. The article highlights the need for minimizing bleeding during incisions to improve visibility and maintain surgical precision. Controlling bleeding is vital for patient comfort and to enhance healing, particularly relevant in the context of graft harvesting techniques.
4) Grafting:
Grafting is a surgical procedure used to replace lost tissue by introducing grafts from donor sites. In the context of periodontal therapy, grafting specifically refers to subepithelial connective tissue grafting aimed at addressing gingival recession. The procedure is crucial for restoring esthetic outcomes and dental health.
5) Pain (Paiṇ):
Pain is a significant concern for patients undergoing surgical procedures, including periodontal grafting. The article addresses pain associated with tissue harvesting from the palate and discusses strategies, such as the modified single incision technique, to minimize discomfort, promoting better experiences for patients and improving overall treatment acceptance.
6) Raising:
Raising refers to the act of elevating a flap of tissue during surgical procedures. In graft harvesting, raising a partial thickness flap is essential for accessing the underlying connective tissue while minimizing trauma. This technique contributes to achieving better grafting outcomes and enhances visibility, impacting overall surgery success.
7) Surface:
Surface pertains to the outermost layer of tissues, both at the donor site and the recipient site in grafting procedures. The discussion emphasizes the need for careful management of the tissue surface to maximize graft viability and healing, as well as to minimize complications such as tearing or sloughing.
8) Tearing:
Tearing refers to the accidental rupture or damage of tissues during surgical procedures. In the context of graft harvesting, the article warns against tearing the overlying partial thickness flap, which could compromise healing and graft efficacy. Strategies are discussed to prevent tearing, thus enhancing patient outcomes.
9) Blood:
Blood plays a critical role in wound healing and tissue viability. The article emphasizes minimizing blood flow during incisions to enhance visibility and control during graft harvesting. Effective management of blood is paramount in ensuring successful surgical outcomes and reducing postoperative complications related to healing.
10) Surrounding:
Surrounding refers to the tissues adjacent to the target area during surgical procedures. In the context of graft harvesting, managing the surrounding tissues is essential to prevent complications, such as tearing or ischemia. Effective surgical techniques aim to minimize disruption to surrounding tissues, ensuring better healing and graft survival.
11) Perception:
Perception relates to the patient's awareness of sensations, including pain. In the article, pain perception is evaluated using a visual analog scale (VAS) after surgery, demonstrating the importance of understanding patient experiences in terms of discomfort and recovery. Measuring perception helps clinicians refine their surgical techniques.
12) Relative:
In this context, 'relative' is used to describe the comparative aspects of surgical techniques and their outcomes. The discussion of various graft harvesting methods highlights the relative advantages and disadvantages, focusing on how modifications lead to improved efficacy, reduced trauma, and enhanced patient comfort throughout the procedure.
13) Cutting:
Cutting refers to the surgical action of dividing tissues to gain access to underlying structures. In the article, cutting techniques are analyzed in relation to the harvesting of grafts. The precision of cutting is vital for minimizing trauma and achieving optimal graft quality during periodontal procedures.
14) Line:
Line signifies the boundaries or edges of tissues involved in surgical procedures. In graft harvesting, establishing a clear line for incisions helps achieve accurate and controlled cuts. The article discusses maintaining proper alignment and delineation during graft harvesting to ensure effective and minimal traumatic procedures for patients.
15) Pur (Pūr):
Poor describes suboptimal conditions or outcomes. In the article, poor outcomes can relate to complications arising from improper surgical techniques or management. Emphasizing the importance of skilled techniques aims to mitigate poor results resulting from undue trauma, bleeding, or errors in graft harvesting.
16) Disease:
Disease refers to pathology affecting the body, including periodontal diseases that lead to tissue loss and gingival recession. The context within the article focuses on periodontal diseases and the necessity for reconstructive surgical procedures like grafting to restore periodontal health and improve patients' esthetic outcomes.
17) Kumar (Kumār):
Kumar references one of the authors of the classification system for connective tissue grafting techniques. His work, alongside Masamatti, provides critical context for understanding specific periodontal recession types and the effective techniques for treating them. Their classification helps guide clinicians in selecting appropriate methodologies.
18) Silk:
Silk is a type of suture material mentioned in the context of suturing the donor site post-harvesting. Its use is relevant for promoting proper closure of incisions, enhancing healing, and minimizing complications. The choice of suture material significantly affects patient comfort and surgical outcomes throughout recovery.
19) Fear:
Fear addresses patients' anxiety regarding surgical procedures, particularly the experience of pain and trauma. The article discusses patient apprehension about periodontal grafting and emphasizes the need for techniques that mitigate fear through less traumatic and painful approaches, promoting overall acceptance of periodontal treatments.
20) Tear:
Tear denotes a form of tissue damage, often unwanted during surgical procedures. In the article's context, preventing tears in the overlying flap during graft harvesting is crucial as it can lead to complications in healing. Strategies are outlined to minimize the risk of tears, enhancing surgical success.