01 September 2020

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Periodontal and peri-implant surgical reconstruction of soft tissues with autogenous grafts

Lara Figini

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This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites.

Object of the study

Since its early introduction over 50 years ago, soft tissue grafting has been increasingly used in clinical practice for augmenting tissue thickness, re-establishing an adequate width of keratinized tissue, correcting mucogingival deformities, and improving esthetics, at teeth and dental implant sites. We can have free gingival graft and connective graft.

Materials and Methods
In a recent review, published on the Journal of Periodontology, January 2020, the authors presented the most recent studies and the current status of autogenous soft tissue grafts to increase the level of soft tissue to cover recessions for both natural teeth and in implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their clinical and aesthetic results. CTGs can be taken from the maxillary tuberosity or from the palate with different approaches that can impact the quality of the graft and the patient's morbidity. The influence of CTGs on the thickness of soft tissues and on the width of keratinized tissues is also discussed.

Results
Post-operative complications in cases of autogenous soft tissue grafts include:

- hemorrhage in the donor site,

- palatal sensibility alteration

- infection.
In particular, prolonged intraoperative and postoperative bleeding from the palate is not a rare event regardless of the technique performed. Furthermore, given that the collection of soft tissues should be limited from the canine region to the root of the first molar (or al, max to the area of the second molar / tuberosity) often the availability of grafting can be inadequate in the treatment of multiple aesthetic sites. In addition, the thickness of the palatal mucosa is another potential limiting factor for palatal collection, since the minimal residual thickness of the soft tissues on the bone has been linked to an increased consumption of analgesics. A fine palatal mucosa can increase the risk of hyper-thinning of the primary flap (when performing techniques with a hatch, envelope or parallel incisions). In this scenario, clinicians have shown a greater interest in autologous graft substitutes, such as ADM, or collagen matrix.

Conclusions
From the data of this review, which must be confirmed in other similar studies, it can be concluded that  several significant tests support the execution of autologous soft tissue grafts for the periodontal and peri-implant plastic surgical reconstruction and for the health and aesthetics of soft tissue. Adequate tissue thickness and width of keratinized tissue appear to be crucial factors for peri-implant health. Autogenous grafting techniques can be considered the most effective for obtaining peri-implant soft tissue augmentation.

Clinical implications
While the free gingival grafting technique is still considered the first choice approach to increase the thickness of soft tissues and keratinized mucosa in the teeth and implant sites, the connective tissue grafting technique offers maximum predictability to obtain a full root coverage, and high aesthetic results.

For additional information: Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction.