In the treatment of gingival recession around lower incisors by applying free connective tissue graft along the area of recession, how it is possible to pull the alveolar mucosal flap from the vestibule and inner mucosa of lower lip with the purpose of covering the connective tissue graft over the gingival recession?
Hi Doctor, Basically selection of case for recession coverage is important. Yes when your using CT graft it must be covered with flap, hence selection of case and the technique to be used for recession coverage place a vital role. Here in your case the type of recession is not mentioned.
Yes its very difficult to drag labial mucosa to cover as it will have more tension. But in some situations u can go with two step surgeries (one to increase width of AG or vestibular deepening and later recession coverage procedure). And periosteal sutures in cases if u want slightly pull labial mucosa can resist labial tension but not always.
Increased chance of failure without flap closure. If you can maintain partial closure and a blood supply it may still work
it should be covered with labial mucosa or it will brings poor resullts
If your question is regarding to use CTG as a FGG, yes you can. However the quality of CTG is very important. It should be dense and thick enough to be stable in place. The results would be more esthetic than FGG.
- Stability of the graft is very important. Pulling the inner mucosa of the lip to cover CTG in case of lower incisors will just increase the tension and make it unstable.
- In my view if the recession is minimal, non-symptomatic and non progressive. And does not hamper aesthetics its better to be left untreated.
Beautiful suggestions! From my experience, your dilemma seems to have arisen from insufficient keratinized gingiva. In such instances, I have found a two- stage procedure useful. Stage 1 will be to increase the zone of keratinized gingiva achievable with a free gingival graft. Allow a few weeks to heal then proceed to stage two. Harvest your CTG and suture to the prepared recipient site.Complete the process with an immediate coronally-advanced flap. Alternatively, place the CTG using the tunnelling technique. Cheers!
Covering CT grafts over receded tisuues is essential for CT free grafts survival. Since the graft gas no organic blood supply, the only main source of sifussion suply at the area of denuded root surface is the covering flap. The plap should cover at least 50-60% of the graft surface.
According the above answers, can we conclude that the use of free graft (epithelium free graft) is prefer to cover the gingival recession around lower anterior incisors class II or class III according to Miller, rather than use connective tissue graft which have challenge of difficulty of covering.
No Mohammaed. I think it's the exact opposite. Good CTGs are more reliable and more predictable than FGGs.
Solmon O Nwhator I know that the CTGs are more reliable and more predictable than FGGs. but i mean in the lower anterior recession where it is difficult to cover the connective tissue graft by the flap.
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