Recent advances in periodontal plastic surgery techniques, such as periodontal regeneration, root coverage procedures with gum graft surgery, and procedures combined with dental extractions or post extraction for dental implant site development, have significantly improved the ability to restore damaged periodontal (gum) tissues. Early diagnosis is critical to periodontal disease management and offers a patient the best chance of preserving their natural teeth.
Options for gum graft surgery continue to increase as new technologies advance in the marketplace. It is important to assess the evidence of newer therapies in comparison to well-documented procedures such as the free gingival graft for gingival augmentation, and the connective tissue graft for root coverage.
Langer and Langer introduced the connective tissue graft for root coverage procedures in 1985. When the treatment goal for gum recession is a combination of providing root coverage and augmenting the zone of attached gingiva, the connective tissue graft is the gold standard procedure.
The added vascular supply available utilizing a connective tissue graft allows for successful, predictable root coverage procedures,a s it is a layered procedure with the primary flap advanced coronally over the graft to achieve partial or complete primary closure. In comparison to the connective tissue graft, a free gingival graft has only a periosteal blood supply and is therfore more limited in achieving root coverage.
Connective tissue grafts can be harvested from either the maxillary palate or the maxillary tuberosity. A variety of successful incision designs have been developed over the years that, depending on the tissue thickness of the palate, are indicated to allow adequate graft thickness and potential primary closure of the donor site wound.
To promote longevity of the therapeutic result recent breakthroughs in combining the application of biologic agents such as Enamel Matrix Derivative (Emdogain) or recombinant human platelet-derived growth factor (Gem 21S) to stimulate healing with advanced surgical techniques have been shown to improve early wound healing.