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Global Translational Medicine Connective tissue harvest techniques

lacks experience. In addition, the emergence of multiple This article summarizes the available methods for
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harvesting techniques – each with its own advantages and harvesting SCTGs, comparing the advantages and
disadvantages – has increased the complexity of treatment disadvantages of each technique. In addition, author
planning in periodontal plastic surgery. preferences for SCTG harvesting methods in specific
clinical situations are described. To identify relevant
Following the introduction of SCTG for root coverage,
multiple authors identified the area of the palate between articles on SCTG harvesting, a literature search was
conducted in May of 2024 using the PubMed database. The
the mesial of the first molar and the distal of the canine search strategy included the following terms: “subepithelial
as the optimal anatomic location for SCTG harvests. 8-11 connective tissue graft” OR “connective tissue graft”
Within this limited zone, SCTGs were typically sufficient OR “autologous soft tissue graft” OR “free soft-tissue
for addressing isolated defects or two adjacent sites autograft” OR “de-epithelialized gingival graft” OR “free
exhibiting gingival recession. More recently, Tavelli gingival graft,” AND “harvest technique” OR “harvest.”
7
et al., using an updated review of palatal anatomy The bibliographies of identified articles were manually
6,12
literature, defined an evidence-based safety zone for reviewed to identify additional publications, and this
palatal tissue harvesting. Newly identified anatomic details search strategy was applied recursively. Articles describing
– such as the mean distances between the greater palatine SCTG harvesting methods and comparing the clinical
artery and the maxillary posterior teeth – have expanded performance of various graft types were included in the
the safe harvesting zone to include the second molar area, study. No restrictions were placed on the study design. The
provided that the apicocoronal dimension of the safety identified articles were critically appraised.
zone (10.9 mm in the second molar area) is respected.
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This expanded safety zone permits SCTG harvests 3. SCTG harvesting techniques
with greater mesiodistal width, allowing clinicians to
Although minor intracategory variations exist, an
address multiple adjacent recession defects over a wider operator harvesting an SCTG for root coverage or gingival/
span. Moreover, graft-splitting techniques can, in some mucosal augmentation generally has four options: a single-
cases, double the mesiodistal dimension of the SCTG, incision technique (SIT), a multiple-incision technique
9,16
substantially increasing the number of defects treatable in (MIT), 17,18 a DGG technique, or an SCTG harvest from
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a single procedure. 13
the maxillary tuberosity SCTG (tSCTG). 19
Although evidence on this topic is limited, variations
in graft composition, patient outcomes, and complication 3.1. SIT
risks have been observed across different SCTG harvesting The SIT involves making a single horizontal incision
methods. 4,6,7 Therefore, practitioners who are familiar with through which the underlying connective tissue is harvested
all available harvesting methods are better equipped to (Figures 1 and 2). The incision is oriented orthogonally to
9,16
tailor treatment to the specific needs of each patient and the surface of the palatal mucosa, approximately 2 – 3 mm
site. The purpose of this paper is to propose a preferred apical to the gingival margin. Depending on the required
SCTG harvesting technique applicable to most root graft dimensions, the horizontal incision may extend
coverage and gingival augmentation cases, and to identify from the canine to the second molar area. However, the
6,12
clinical scenarios in which alternative approaches may be safely obtainable apicocoronal graft dimension narrows
more appropriate. from posterior to anterior: 8 mm in the molar and second
premolar areas, 7.6 mm in the first premolar area, and
2. Methods 5 mm in the canine area. 12
Due to terminological heterogeneity among authors, it is In inexperienced surgeons, the risk of overthinning
necessary to define the terms used in this paper. For the the superficial tissue or perforating the palatal mucosa
purposes of this article, an SCTG refers to autogenous may increase as the scalpel is advanced apically during
connective tissue removed from the hard palate or maxillary sharp dissection. This risk of primary flap laceration can
tuberosity area for gingival/mucosal augmentation or root be minimized by performing the harvest in a stepwise
coverage. The epithelial layer is either not harvested manner (Table 1). When the intended primary flap
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or removed secondarily before graft implantation. thickness is 1.5 – 2 mm, grafts harvested using the SIT
A de-epithelialized gingival graft (DGG) is a specific type are predominantly composed of tissue originating deep to
of SCTG, harvested as a traditional free gingival graft the lamina propria. 20-22 Substantial interpatient variability
(FGG). However, unlike an FGG, the preparation of a exists in both the composition of the submucosa and the
15
DGG involves removing the epithelium extraorally or overall thickness of palatal soft tissue. 20-22 Consequently,
intraorally using a scalpel or other instrument. the clinical quality of the graft depends in part on the

Volume 4 Issue 1 (2025) 36 doi: 10.36922/gtm.4860