Soft Tissue Grafting Techniques in Periodontal Plastic Surgery

Soft tissue grafting in periodontal plastic surgery encompasses a suite of surgical approaches designed to restore gingival form, function and aesthetics. Techniques vary according to the clinical goal, such as augmenting keratinised tissue, covering exposed roots or enhancing peri-implant mucosal thickness. Free gingival grafts (FGGs) involve harvesting a full-thickness epithelialised block from the palate to augment keratinised tissue, whereas subepithelial connective tissue grafts (CTGs) harvest only the underlying connective tissue, leaving the epithelial layer intact, and are often combined with a coronally advanced flap (CAF) to optimise root coverage. Xenogeneic or allogeneic acellular dermal matrices (ADMs) and porcine-derived acellular dermal matrices provide off-the-shelf alternatives to autografts, reducing donor-site morbidity. Adjunctive biological modifiers—such as platelet concentrates, hyaluronic acid and growth-factor-enriched membranes—are incorporated to accelerate healing and improve tissue integration. Advances in digital intraoral scanning and volumetric analysis afford objective quantification of tissue thickness gains, enabling precise treatment planning and outcome assessment. Contemporary research also delves into the molecular heterogeneity of graft tissues, suggesting personalised selection based on donor-site characteristics. Collectively, these developments underscore a shift towards minimally invasive, biologically enhanced and digitally guided soft tissue-augmentation strategies with global applicability in periodontal and implant dentistry.

Research from Nature Portfolio

Recent studies have demonstrated the superior accuracy and reliability of three-dimensional digital measurements over conventional probing in quantifying keratinised tissue width. By comparing digital scans with histological sections, digital measurements were shown to differ by less than 0.1 mm from true tissue dimensions, while probe-based readings deviated by over one millimetre. High intrarater and interrater reproducibility with intraoral scanners offers a non-invasive and standardised method for monitoring graft outcomes, paving the way for fully digital workflows in periodontal plastic surgery.

Soft Tissue Grafting Techniques in Periodontal Plastic Surgery publication trend

The graph below shows the total number of articles in soft tissue grafting techniques in periodontal plastic surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Subepithelial connective tissue graft (CTG): A graft comprising only the connective tissue layer beneath the palatal epithelium, used to thicken gingival tissues and cover recessions.

Free gingival graft (FGG): A graft of full-thickness gingival tissue, including epithelium, harvested from the palate to enlarge the zone of keratinised tissue.

Coronally advanced flap (CAF): A surgical technique in which marginal gingiva is repositioned coronally over a recession defect to achieve root coverage.

Acellular dermal matrix (ADM): A scaffold derived from processed human or animal dermis, devoid of cellular components, used as a substitute for autologous grafts.

Platelet-rich fibrin (PRF): An autologous fibrin-based biomaterial enriched with platelets and growth factors, employed to promote soft tissue healing and regeneration.

Keratinized tissue width (KTW): The buccolingual dimension of gingiva containing keratinised epithelium, measured from the mucogingival junction to the free gingival margin.

References

1. Differential molecular profiles and associated functionalities characterize connective tissue grafts obtained at different locations and depths in the human palate. International Journal of Oral Science (2023).
2. A Novel Prehydrated Porcine‐Derived Acellular Dermal Matrix: A Histological and Clinical Evaluation. International Journal of Biomaterials (2024).
3. Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial. Clinical Oral Investigations (2018).
4. Digital scanning is more accurate than using a periodontal probe to measure the keratinized tissue width. Scientific Reports (2020).
5. A novel, fully digital approach to quantifying volume gain after soft tissue graft surgery. A pilot study. Journal Of Clinical Periodontology (2020).
6. The Additional Effect of Autologous Platelet Concentrates to Coronally Advanced Flap in the Treatment of Gingival Recessions: A Systematic Review and Meta‐Analysis. BioMed Research International (2019).
7. Gingival recession treatment with concentrated growth factor membrane: a comparative clinical trial. Journal of Applied Oral Science (2020).