44-year journey of palatal connective tissue graft harvest: A narrative review
Journal name: Journal of Indian Society of Periodontology
Original article title: 44-year journey of palatal connective tissue graft harvest: A narrative review
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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Komal Puri, Ashish Kumar, Manish Khatri, Mansi Bansal, Mohd. Rehan, Srinivasa Tenkasale Siddeshappa
Journal of Indian Society of Periodontology:
(A bimonthly open-access journal)
Full text available for: 44-year journey of palatal connective tissue graft harvest: A narrative review
Year: 2019 | Doi: 10.4103/jisp.jisp_288
Copyright (license): CC BY-NC-SA
Summary of article contents:
Introduction
Connective tissue graft (CTG) has emerged as a gold standard treatment for various periodontal plastic surgeries over the past 44 years, primarily for augmenting the width of keratinized gingiva and root coverage. Initially described by Edel in 1974, CTG harvesting has since evolved through numerous techniques aimed at minimizing donor site trauma, postoperative discomfort, and complications. This review consolidates various graft harvesting techniques applied to the palate, highlighting both traditional and newly innovated methodologies, while emphasizing the need for increased expertise and skills in executing these procedures.
The Evolving Techniques of CTG Harvesting
CTG harvesting techniques have undergone significant transformations to enhance patient comfort and surgical outcomes. The early trapdoor methods, characterized by multiple incisions, have been largely superseded by minimally invasive single-incision techniques that rely on strategic access to subepithelial connective tissue without disturbing the vascular supply. Techniques such as the envelope flap and various single-incision methods have been developed to procure sufficient graft size while minimizing postoperative complications, as well as optimizing healing time. The ongoing refinement of CTG techniques focuses not only on the efficacy of graft procurement but also on facilitating smoother healing processes, ultimately enhancing aesthetic results for patients experiencing gingival recession.
Conclusion
CTG harvesting remains a cornerstone in periodontal therapy due to its reliability in treating soft-tissue deficiencies, particularly in cases of gingival recession. With continuous advancements in surgical techniques and a better understanding of healing processes, CTG harvesting has become less invasive and more predictable. However, the execution of these techniques requires high levels of skill and expertise to navigate potential limitations and complications associated with each method. As research continues to evolve, further exploration will be necessary to solidify the long-term stability of the grafts obtained through these various harvesting strategies, ensuring optimal outcomes for patients undergoing periodontal treatments.
FAQ section (important questions/answers):
What is a connective tissue graft (CTG) used for?
CTG is primarily used for soft-tissue correction and augmentation surgeries, including increasing keratinized gingiva width, root coverage, and treating furcation defects and peri-implant tissue abnormalities.
What are the benefits of modern CTG harvesting techniques?
Modern CTG techniques are minimally invasive, resulting in reduced incision lines, less compromised blood supply, accelerated healing, and no sloughing of the overlying flap, although they require higher expertise.
Why is the palate a common donor site for CTG?
The palate is preferred for CTG harvesting due to its larger size, histological similarity to the alveolar ridge, and its accessibility for obtaining connective tissue without significant complications.
What considerations impact the choice of CTG harvesting technique?
Surgeons consider graft size, patient comfort, anatomical limitations, and potential complications, with the ideal technique ensuring adequate graft size while minimizing pain and improving healing.
How has the technique for CTG harvesting evolved over time?
CTG harvesting techniques have evolved from Edel's trapdoor method in 1974 to more refined minimally invasive techniques, focusing on reducing trauma and improving graft predictability and success.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “44-year journey of palatal connective tissue graft harvest: A narrative review”. 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:
Incision refers to a surgical cut made in the skin or tissues to access underlying structures, particularly during procedures like connective tissue graft harvesting. Accurate incisions are crucial for minimizing trauma and ensuring proper healing, and various incision techniques can affect graft accessibility and patient comfort post-surgery.
2) Table:
In a medical context, a table often refers to a structured presentation of data, such as techniques and their comparisons presented in a tabular format. Tables help summarize, organize, and clarify information for easier analysis and reference, particularly in literature reviews, studies or clinical findings.
3) Harvesting (Harvest):
Harvesting refers to the process of collecting tissue from a donor site for grafting procedures. This technique is fundamental in periodontal and reconstructive surgeries, where sufficient and viable connective tissue must be obtained to ensure effective treatment outcomes, emphasizing the importance of the harvesting technique used.
4) Surface:
Surface describes the outer layer or boundary of a structure, which in surgical practices pertains to the skin or mucosal interface. The characteristics of the surface tissue play a vital role in healing, graft adherence, and aesthetic outcomes in reconstructive surgeries, influencing overall treatment success.
5) Blood:
Blood is essential for providing nutrients and oxygen to tissues, particularly during healing and graft integration. Maintaining adequate blood supply to both the donor and recipient sites is crucial for successful graft acceptance, influencing tissue viability and regeneration. Surgical techniques aim to preserve this supply during procedures.
6) Line:
Line, in the surgical context, often refers to the incision line created during tissue harvesting. The design and placement of incision lines significantly impact healing, aesthetic outcomes, and the complications associated with grafting procedures. Surgical precision in line creation minimizes tissue trauma and promotes healing.
7) Relative:
Relative refers to the comparison of techniques, outcomes, or measurements in a study. In surgical literature, relative factors are significant when assessing the effectiveness or reliability of various graft harvesting methods, allowing for objective analysis of results across different studies to enhance best practices.
8) Bleeding:
Bleeding is a critical concern during surgical procedures, particularly in tissue harvesting, as excessive blood loss can complicate surgery and impact overall health. Managing bleeding effectively is crucial to maintaining a stable environment for grafting, influencing recovery time, patient comfort, and minimizing the risk of postoperative complications.
9) Kumar:
Kumar likely references a researcher or author associated with a significant study or technique in the context of connective tissue grafting. Contributions from various named researchers provide insights into advancements and treatments, serving as a reference for improved methodologies and the evolution of surgical practices.
10) Dressing:
Dressing denotes a sterile covering applied to a wound or surgical site after a procedure. Adequate dressing is crucial for protecting the healing area, preventing infection, and ensuring a proper environment for graft integration, contributing to enhanced healing and overall patient recovery following surgery.
11) Gold (Golden):
Gold in a surgical context signifies a standard or benchmark of excellence. The term may refer to 'the gold standard' in grafting procedures, indicating that connective tissue grafting techniques are widely recognized for their effectiveness and reliability in various soft-tissue augmentation applications.
12) Reflecting:
Reflecting involves lifting or moving back layers of tissue during surgery to expose underlying areas for grafting. It is a critical step in ensuring adequate access to the donor tissue and promoting successful graft integration while minimizing trauma to surrounding tissues.
13) Cutting:
Cutting refers to the precise division of tissues during surgical procedures. It is fundamental in creating incisions for graft harvesting and influences the characteristics of the resulting graft, recovery, and healing processes. Effective cutting techniques are crucial for minimizing complications and optimizing graft outcomes.
14) Tearing:
Tearing implies unintentional damage to tissues during surgical procedures, which can occur if instruments are not used carefully. Minimizing tearing is essential to preserve tissue integrity, promote healing, and ensure successful graft integration. Surgical techniques aim to reduce the risk of tissue tearing during harvesting.
15) Nature:
Nature may refer to the innate characteristics or properties of the tissues involved in grafting. Understanding the nature of connective tissue, such as its vascularity and cellular composition, is essential for developing successful grafting techniques and ensuring effective treatment outcomes in surgical practice.
16) Indian:
Indian may refer to the author or researchers in the context of the study or literature review, particularly if relating to methods or practices in India. Acknowledging regional practices, cultural perceptions, and contributions helps provide context to the advancements in grafting techniques within specific populations.
17) Rules:
Rules may refer to established guidelines or principles governing surgical procedures and tissue handling, including ethical considerations and best practices. Following such rules is essential for ensuring patient safety, effective treatment, and minimizing complications during connective tissue grafting surgeries.
18) Pain:
Pain is an important consideration during and after surgical procedures. Understanding the patient’s pain response is crucial for managing their comfort and providing adequate pain relief during connective tissue grafting. Techniques used during harvesting aim to minimize pain and enhance the overall patient experience.
19) Male:
Male could indicate a demographic aspect in studies concerning tissue properties and responses to surgery. Research may explore differences between genders concerning anatomical variations, healing capabilities, and responses to surgical procedures, contributing to personalized approaches in treatment based on gender-specific characteristics.
20) Surrounding:
Surrounding refers to the tissues and anatomical structures adjacent to the graft site. Understanding the surrounding environment is critical to surgical planning to ensure optimal graft harvesting and integration while avoiding damage to nearby structures, unintentional complications, or impaired healing post-procedure.
21) Measurement:
Measurement in surgical contexts usually refers to the precise quantification of graft dimensions during harvesting. Accurate measurements are vital for ensuring that sufficient tissue is procured and for anticipating the requirements of the graft. They contribute to effective planning and execution in grafting techniques.
22) Depression:
Depression may refer to specific anatomical areas treated with grafts, especially in the context of ridge augmentation in the palette. It is crucial to understand the characteristics and needs of depressed areas to accurately apply grafting techniques for successful functional and aesthetic outcomes.
23) Similarity:
Similarity denotes comparable characteristics or responses between different techniques or tissues. In surgical literature, recognizing similarities between various grafting approaches assists in identifying effective methodologies and treatments within diverse populations and anatomical variances, ultimately informing best practices in connective tissue graft harvesting.
24) Knowledge:
Knowledge signifies the understanding and expertise required to effectively perform surgical techniques. A thorough knowledge base assists clinicians in making informed decisions regarding grafting procedures, understanding complications, and ensuring optimal patient care and outcomes during soft-tissue augmentation.
25) Education:
Education relates to the training and learning experiences that healthcare professionals undergo to acquire the skills needed for surgical procedures. Ongoing education is vital in adapting to advancements in techniques and improving patient care standards within the domain of connective tissue grafting.
26) Study (Studying):
Study pertains to the systematic investigation of surgical techniques, including graft harvest methodologies and their outcomes. Clinical studies are essential to validate the effectiveness of different approaches and improve surgical practices, ultimately focusing on patient care and optimization of treatment results.
27) Grafting:
Grafting refers to the surgical procedure of transplanting tissue from one location to another. In the context of connective tissue grafting, it involves procuring tissue for augmentation, with various techniques developed to enhance outcomes, minimize trauma, and ensure optimal healing for better clinical results.
28) Company:
Company may refer to institutions or organizations involved in dental and surgical research or supply of surgical instruments. Collaboration with companies leading advancements in surgical techniques and research is vital for improving grafting methods and providing clinicians with the tools needed for effective patient care.
29) Glass:
Glass might refer to instruments or materials used in surgical settings, including glass slides for histological examination. Its usage emphasizes precision and attention to detail in surgical practices, aiding in the visualization and analysis of tissue characteristics where grafting procedures are concerned.
30) Wall:
Wall refers to the anatomical boundaries, such as surrounding structures and tissues in the mouth. Understanding the significance of the wall in surgical contexts assists clinicians in planning incisions and harvesting grafts while preserving relevant anatomical features that can impact overall surgical outcomes.
31) Hand:
Hand signifies a crucial tool in surgical techniques, representing manual dexterity and precision required for effective graft harvesting. Skillful hand movements during surgery influence the outcome, minimizing trauma, ensuring proper handling of tissues, and enhancing the overall success of the grafting procedure.