Transcript TACD MEMBERS NIGHT

Subepithelial Connective Tissue Graft for
Root Coverage
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Brief history of the technique
Etiology and indications for using a
subepithelial connective graft (CTG)
Advantages and limitations
Miller’s classification and procedure
predictability
Materials, instruments and surgical technique
Visit with patients who have undergone the
procedure
Live demonstration
ROOT COVERAGE
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Corrective or preventive (acts as a fiber
barrier)
Increased susceptibility to root caries
Tooth hypersensitivity from exposed dentin
Aesthetic concerns of exposed dentin and/or
crown margins
RIDGE AUGMENTATION
Type I
 No interdental bone loss
 Defect is coronal to the mucogingival junction
(MGJ)
Type II
 No interdental bone loss
 Defect extends to or beyond MGJ
Highly predictable complete root coverage
Type III
 Interdental bone loss (mild to moderate) with
accompanying loss of papillary height
 Defect at or apical to the MGJ
Type IV
 Severe interdental bone loss with
accompanying loss of papilla
 Defect at or apical to the MGJ
Complete root coverage impossible
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Highly predictable
Highly successful due to enhanced blood
supply
Aesthetic
Used on single or multiple sites
Good healing potential for palate donor site
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Technically demanding
Anatomy may limit volume of available
tissue-shallow palatal vault, greater palatine
vessels, nasopalatine vessels
Multiple sites may need multiple
appointments due to tissue volume
limitations
Previous surgeries and scar tissue formation
Microsurgical Kit
Mirror, probe, cotton pliers, suture pliers, Castroviejo suture forceps,
scissors, microsurgery elevators, Orban knife, #15 & 15c blades and
round handle, Harris knife, scalers, EDTA or tetracycline, saline, glass
slab and gauze
Gut 5-0, Polypropylene 6-0 and Vicryl 4-0 sutures
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Thorough oral hygiene work up
Review procedure with patient
Pre op meds
Pre-surgical rinse
Local anaesthetic (Citanest 4% plain, Lidocaine 2% 1:100,00/50,000)
Prepare recipient site-floss, root plane and smear layer treatment,
pouch/envelope flap preparation(blunt then sharp dissection)
Harvest graft tissue from palate (premolar or retromolar) and close
Place and secure graft (sling suture)
Ice area
 Review procedure
Post-op Recommendations
 Ice on and off every 10 minutes
 Limited activity for 24 hours
 No brushing or manipulating area for 4-6 weeks
 Maintain good oral hygiene and take meds
(antibiotic, anti-inflammatory, Peridex)
 Call patient
 Remove palatal sutures in 1 week and grafted
site sutures in 2-3 weeks
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QUESTIONS ?
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Lisa: CTG lower anteriors lingual
first surgery 2005, second surgery 2006
Robert: CTG #33 facial
Oct. 2010
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Armando: CTG #16 buccal one week ago
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Adrian: CTG #23 facial today
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Kathy: CTG #33 facial Feb. 2011