Free gingival graft - donor site analysis: A literature review
DOI:
https://doi.org/10.33448/rsd-v14i10.49470Keywords:
Free gingival graft, Connective tissue graft, Gingival recession, Palate, Plastic surgery.Abstract
Free gingival graft is a widely established procedure in periodontal plastic surgery, essential for gaining quality, quantity, width, and thickness of keratinized gingiva. Its indication is important for both the stability of implants— specifically, keratinized tissue for peri-implant health—and for the prevention and treatment of gingival recessions in natural teeth. Mucogingival deficiency in teeth can lead to inflammation, aesthetic discomfort, hypersensitivity, root caries, and difficulty in biofilm control. Currently, the autogenous connective tissue graft from the palate is considered the gold standard treatment due to its predictability for root coverage and benefits for maintenance and prognosis in periodontal surgeries. Knowledge of the palatal anatomy is of utmost importance for the dental surgeon to safely apply the chosen surgical technique during incision, respecting noble areas. The objective of this study was to analyze the conditions of the donor site in free gingival grafts.
References
Aguirre-Zorzano, L., Garcia-De La Fuente, A., Estefania-Fresco, R., & Marichalar-Mendia, X. (2017). Complications of harvesting a connective tissue graft from the palate. A retrospective study and description of a new technique. Journal of Clinical and Experimental Dentistry, 0–0. https://doi.org/10.4317/jced.54337
Bhatavadekar, N. B., & Gharpure, A. S. (2018). Controlled Palatal Harvest Technique for Harvesting a Palatal Subepithelial Connective Tissue Graft.
Compendium of Continuing Education in Dentistry (Jamesburg, N.J.: 1995), 39(2), e9–e12.
Bittencourt, S., Del Peloso Ribeiro, É., Sallum, E. A., Sallum, A. W., Nociti, F. H., & Casati, M. Z. (2006). Comparative 6‐Month Clinical Study of a Semilunar Coronally Positioned Flap and Subepithelial Connective Tissue Graft for the Treatment of Gingival Recession. Journal of Periodontology, 77(2), 174–181. https://doi.org/10.1902/jop.2006.050114
Bosco, A. F., & Bosco, J. M. D. (2007). An alternative technique to the harvesting of a connective tissue graft from a thin palate: Enhanced wound healing. The International Journal of Periodontics & Restorative Dentistry, 27(2), 133–139.
Broome, W. C., & Taggart, E. J. (1976). Free Autogenous Connective Tissue Grafting: Report of Two Cases. Journal of Periodontology, 47(10), 580–585. https://doi.org/10.1902/jop.1976.47.10.580
Cairo, F., Nieri, M., & Pagliaro, U. (2014). Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. Journal of Clinical Periodontology, 41(s15). https://doi.org/10.1111/jcpe.12182
Çetiner, D., Bodur, A., & Uraz, A. (2004). Expanded Mesh Connective Tissue Graft for the Treatment of Multiple Gingival Recessions. Journal of Periodontology, 75(8), 1167–1172. https://doi.org/10.1902/jop.2004.75.8.1167
Chambrone, L., Chambrone, D., Pustiglioni, F. E., Chambrone, L. A., & Lima, L. A. (2008). Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller Class I and II recession-type defects? Journal of Dentistry, 36(9), 659–671. https://doi.org/10.1016/j.jdent.2008.05.007
Consolaro, A., Rebellato Júnior, V., Consolaro, M. F. M.-O., & Carvalho Júnior, J. A. R. D. (2009). Lesões necróticas na disjunção palatina: Explicação e prevenção. Revista Dental Press de Ortodontia e Ortopedia Facial, 14(5), 20–26. https://doi.org/10.1590/S1415-54192009000500004
Del Pizzo, M., Modica, F., Bethaz, N., Priotto, P., & Romagnoli, R. (2002). The connective tissue graft: A comparative clinical evaluation of wound healing at the palatal donor site: A preliminary study. Journal of Clinical Periodontology, 29(9), 848–854. https://doi.org/10.1034/j.1600-051X.2002.290910.x
Edel, A. (1974). Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. Journal of Clinical Periodontology, 1(4), 185–196. https://doi.org/10.1111/j.1600-051X.1974.tb01257.x
Farnoush, A. (1978). Techniques for the Protection and Coverage of the Donor Sites in Free Soft Tissue Grafts. Journal of Periodontology, 49(8), 403–405. https://doi.org/10.1902/jop.1978.49.8.403
Han, T. J., Takei, H. H., & Carranza, F. A. (1993). The strip gingival autograft technique. The International Journal of Periodontics & Restorative Dentistry, 13(2), 180–187.
Harris, R. J. (1992). The Connective Tissue and Partial Thickness Double Pedicle Graft: A Predictable Method of Obtaining Root Coverage. Journal of Periodontology, 63(5), 477–486. https://doi.org/10.1902/jop.1992.63.5.477
Hürzeler, M. B., & Weng, D. (1999). A single-incision technique to harvest subepithelial connective tissue grafts from the palate. The International Journal of Periodontics & Restorative Dentistry, 19(3), 279–287.
Kim, D. M., & Neiva, R. (2015). Periodontal Soft Tissue Non–Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop. Journal of Periodontology, 86(2S). https://doi.org/10.1902/jop.2015.130684
Kumar, A., Sood, V., Masamatti, S., Triveni, M., Mehta, D., Khatri, M., & Agarwal, V. (2013). Modified single incision technique to harvest subepithelial connective tissue graft. Journal of Indian Society of Periodontology, 17(5), 676. https://doi.org/10.4103/0972-124X.119294
Langer, B., & Calagna, L. (1980). The subepithelial connective tissue graft. The Journal of Prosthetic Dentistry, 44(4), 363–367. https://doi.org/10.1016/0022- 3913(80)90090-6
Langer, B., & Calagna, L. J. (1982). The subepithelial connective tissue graft. A new approach to the enhancement of anterior cosmetics. The International Journal of Periodontics & Restorative Dentistry, 2(2), 22–33.
Langer, B., & Langer, L. (1985). Subepithelial Connective Tissue Graft Technique for Root Coverage. Journal of Periodontology, 56(12), 715–720. https://doi.org/10.1902/jop.1985.56.12.715
Liu, C.-L., & Weisgold, A. S. (2002). Connective tissue graft: A classification for incision design from the palatal site and clinical case reports. The International Journal of Periodontics & Restorative Dentistry, 22(4), 373–379.
Lorenzana, E. R., & Allen, E. P. (2000). The single-incision palatal harvest technique: A strategy for esthetics and patient comfort. The International Journal of Periodontics & Restorative Dentistry, 20(3), 297–305.
McLeod, D. E., Reyes, E., & Branch‐Mays, G. (2009). Treatment of Multiple Areas of Gingival Recession Using a Simple Harvesting Technique for Autogenous Connective Tissue Graft. Journal of Periodontology, 80(10), 1680–1687. https://doi.org/10.1902/jop.2009.090187
Midda, M. (1992). The use of lasers in periodontology. Current Opinion in Dentistry, 2, 104–108.
Moraschini, V., Luz, D., Velloso, G., & Barboza, E. dS. P. (2017). Quality assessment of systematic reviews of the significance of keratinized mucosa on implant health. International Journal of Oral and Maxillofacial Surgery, 46(6), 774–781. https://doi.org/10.1016/j.ijom.2017.02.1274
Newman, M. G. et al. (2017). Carranza periodontia clínica. Elsevier.
Pini Prato, G. P., Franceschi, D., Cortellini, P., & Chambrone, L. (2018). Long‐term evaluation (20 years) of the outcomes of subepithelial connective tissue graft plus coronally advanced flap in the treatment of maxillary single recession‐type defects. Journal of Periodontology, 89(11), 1290–1299. https://doi.org/10.1002/JPER.17-0619
Raetzke, P. B. (1985). Covering Localized Areas of Root Exposure Employing the “Envelope” Technique. Journal of Periodontology, 56(7), 397–402. https://doi.org/10.1902/jop.1985.56.7.397
Ramakrishnan, T., Kaur, M., & Aggarwal, K. (2011). Root coverage using epithelial embossed connective tissue graft. Indian Journal of Dental Research, 22(5), 726. https://doi.org/10.4103/0970-9290.93466
Reino, D. M., Novaes Jr., A. B., Grisi, M. F. D. M., Maia, L. P., & Souza, S. L. S. D. (2013). Palatal Harvesting Technique Modification for Better Control of the Connective Tissue Graft Dimensions. Brazilian Dental Journal, 24(6), 565–568. https://doi.org/10.1590/0103-6440201302343
Ribeiro, F. S., Zandim, D. L., Pontes, A. E. F., Mantovani, R. V., Sampaio, J. E. C., & Marcantonio, E. (2008). Tunnel Technique With a Surgical Maneuver to Increase the Graft Extension: Case Report With a 3‐Year Follow‐Up. Journal of Periodontology, 79(4), 753–758. https://doi.org/10.1902/jop.2008.070274
Schmitt, C. M., Matta, R. E., Moest, T., Humann, J., Gammel, L., Neukam, F. W., & Schlegel, K. A. (2016). Soft tissue volume alterations after connective tissue grafting at teeth: The subepithelial autologous connective tissue graft versus a porcine collagen matrix – a pre‐clinical volumetric analysis. Journal of Clinical Periodontology, 43(7), 609–617. https://doi.org/10.1111/jcpe.12547
Stimmelmayr, M., Allen, E. P., Gernet, W., Edelhoff, D., Beuer, F., Schlee, M., & Iglhaut, G. (2011). Treatment of gingival recession in the anterior mandible using the tunnel technique and a combination epithelialized-subepithelial connective tissue graft-a case series. The International Journal of Periodontics & Restorative Dentistry, 31(2), 165–173.
Stübinger, S., Landes, C., Seitz, O., & Sader, R. (2007). Er:YAG Laser Osteotomy for Intraoral Bone Grafting Procedures: A Case Series With a Fiber‐Optic Delivery System. Journal of Periodontology, 78(12), 2389–2394. https://doi.org/10.1902/jop.2007.070162
Tatakis, D. N., Chambrone, L., Allen, E. P., Langer, B., McGuire, M. K., Richardson, C. R., Zabalegui, I., & Zadeh, H. H. (2015). Periodontal Soft Tissue Root Coverage Procedures: A Consensus Report From the AAP Regeneration Workshop. Journal of Periodontology, 86(2S). https://doi.org/10.1902/jop.2015.140376
Thoma, D. S., Zeltner, M., Hilbe, M., Hämmerle, C. H. F., Hüsler, J., & Jung, R. E. (2016). Randomized controlled clinical study evaluating effectiveness and safety of a volume‐stable collagen matrix compared to autogenous connective tissue grafts for soft tissue augmentation at implant sites. Journal of Clinical Periodontology, 43(10), 874–885. https://doi.org/10.1111/jcpe.12588
Tonetti, M. S., Cortellini, P., Pellegrini, G., Nieri, M., Bonaccini, D., Allegri, M., Bouchard, P., Cairo, F., Conforti, G., Fourmousis, I., Graziani, F., Guerrero, A., Halben, J., Malet, J., Rasperini, G., Topoll, H., Wachtel, H., Wallkamm, B., Zabalegui, I., & Zuhr, O. (2018). Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non‐inferiority in root coverage and superiority in oral health‐related quality of life. Journal of Clinical Periodontology, 45(1), 78–88. https://doi.org/10.1111/jcpe.12834
Wolf, H. F. (Org.). (2005). Periodontology (3rd rev. and expanded ed). Thieme.
Zegarra-Caceres, L., Orellano-Merluzzi, A., Muniz, F. W. M. G., De Souza, S. L. S., Faveri, M., & Meza-Mauricio, J. (2024). Xenogeneic collagen matrix vs. connective tissue graft for the treatment of multiple gingival recession: A systematic review and meta-analysis. Odontology, 112(2), 317–340. https://doi.org/10.1007/s10266-023-00863-4
Zucchelli, G., Amore, C., Sforza, N. M., Montebugnoli, L., & De Sanctis, M. (2003). Bilaminar techniques for the treatment of recession‐type defects. A comparative clinical study. Journal of Clinical Periodontology, 30(10), 862–870. https://doi.org/10.1034/j.1600-051X.2003.00397.x
Zucchelli, G., Mele, M., Stefanini, M., Mazzotti, C., Marzadori, M., Montebugnoli, L., & De Sanctis, M. (2010). Patient morbidity and root coverage outcome after subepithelial connective tissue and de‐epithelialized grafts: A comparative randomized‐controlled clinical trial. Journal of Clinical Periodontology, 37(8), 728–738. https://doi.org/10.1111/j.1600-051X.2010.01550.x
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Almerindo de Sousa Dias Junior, Sérgio Lobo, Sérgio Barbosa Ribeiro, Fernando dos Reis Cury, Luis Fernando Castro Valle
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
