This article describes a mucogingival grafting procedure that has been developed to completely cover recession. The procedure, the subpedicle connective tissue graft, consists of a bilaminar reconstruction of the gingiva using both free and pedicle layers to preserve graft viability over denuded root surfaces.
14 patients age 12 to 52. All with gingival recession and a thin or absent band of keratinized tissue. Procedure. Exposed root surface curetted. 2 vertical incisions were made from the bordering interdental papillae to the base of the vestibule. Full thickness mucogingival flaps were reflected to allow repositioning of the pedicles to the CEJ of the affected tooth. Connective tissue graft was obtained from the palate using a trap door approach. Graft was including the periosteum. Graft placed adjacent to CEJ. The pedicles are sutured together with interrupt sutures and the pedicles are suture into placed over the denuded root. With more than one tooth a lateral siding flap will be one of the pedicles. Followed for 3, 6, 12 weeks. Recession grouped as advanced 7-10 mm, moderate 4-6 mm, slight 3 or less mm.
The advanced group of 20 teeth- 66-100% coverage. avg. 88%, Moderate group of 3 teeth- 75-100% coverage, avg. 92%. Slight group of 6 teeth - 100% coverage. Final pocket depths for all groups were 3 mm or less. One case had poor plaque control-with partial coverage.
With multiple teeth the pedicle graft can combine a lateral sliding interdental papilla graft with a double papilla pedicle graft. The esthetics were superior because of the similar color match. For success, the connective tissue graft should be 1.5 to 2.0 mm in thickness, the interdental papillae should be retained as much as possible in the pedicle flap, the pedicle should be positioned correctly over the avascular root to be covered.
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