Topic

[Surgery]  CTG harvesting


Hi Bernard

 

I really enjoyed your soft tissue course in the fall.  I have been doing some grafts since with good success!  Your technique works great and patients are responding very well....  The splint has been the biggest aid, patients are not finding much postop discomfort at all. 

 

I had a couple of quick questions for you:

 

1)  I'm still a little confused as to when to choose a FGG over a CTG.  I am approaching them on the basis that if I want to cover the root, I do a CTG.  If I am just looking to bulk up the tissue to prevent recession, a FGG is my choice.  Do you have any further tips?  When is a CTG not indicated?

 

2)  Do you have any tips for harvesting the CTG from the palate of an edentulous patient, for a graft on the lower arch.  I have done two now and find there to be alot more tissue than normal (i.e. thicker palatal tissue)?   Do you need to go all the way down to bone?

 

Thanks alot!

 

Sean


by Sean Bicknell at Thu, Apr 14, 2011 6:56 PM

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Bernard Jin Replied at Sat, Apr 30, 2011 9:28 PM

Hi Sean, That's terrific. Glad to hear you're actively doing soft tissue grafts! :) I think what Mark commented on, is correct. FGGs are generally used establish a better band of attached gingiva (in zones of minimal attachment). However, a caution - rem: you'll always end up with a discolored 'tire patch' gingival appearance. So, my advise - don't use FGGs in zones of esthetic importance. Generally, lower anteriors are ok - so long as the person doesn't show the lower gingiva when smiling. I will also gauge the patient - if the patient is quite anxious - a FGG can be performed in about 1/3 of the time of a typical CTG. (especially if you can harvest in less than 30 seconds - like with a Paquette knife). Suturing the FGG is also a lot faster and simpler. I can typically do this for children who need preortho augmentation - in less than 5 min. Again - it depends on each case & patient. As for edentulous harvesting - typically you don't have to go all the way to the periostium to get a decent thickness of CT. It is a lot more comfortable for the patient if you can leave his/her periostium unscathed. 'Tis better for hemostasis and healing. Also, because the patient is edentulous, you have much better parallel access to the vault of the palate for a more uniform thickness of the CT. Hope that helps! Well done & thanks for the encouragement. Let us know if we can help in any way! Cheers, Bernard



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Mark Kwon Replied at Fri, Apr 29, 2011 5:16 PM

Hi, Sean. Good to hear from you. I'll give you my two cents. My guide line is similar to your. If you are strictly looking for attachment to prevent further recession , FGG is my choice, simply it is much easier to do. And they work very well. For edentulous harvesting, you are right they often have much thicker palate; therefore, you do NOT have to go all the way to the bone. This is nice because healing is quicker and bleeding is less at the donor site. - mark