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Global Translational Medicine Connective tissue harvest techniques

A B C

D E F

G H I

Figure 1. Single-incision SCTG harvest for root coverage at the maxillary central incisors. (A) Baseline clinical appearance, with recession defects
measuring 1.5 mm at tooth #8 and 2 mm at tooth #9. (B) Initial incisions; no vertical incisions were used. (C) Facial mucoperiosteal flap reflection, with
a spit-full-split flap design employed. (D) Coronal advancement of the flap. (E) SCTG harvest site before graft retrieval. (F) SCTG harvested. (G) Graft in
position and stabilized before closure. (H) Wound closure. (I) Post-operative appearance at 3 months.
Abbreviation: SCTG: Subepithelial connective tissue graft.
relative proportions of fibrous, adipose, and glandular door” approach. Alternatively, the operator may place a
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tissue present. single vertical incision at one boundary of the harvest site
Several authors suggest that the SIT promotes early and extend the horizontal incision mesially or distally to
donor site healing and enhances patient-centered ensure adequate access for graft harvesting. In his landmark
outcomes, although supporting evidence remains article on SCTG harvesting, Dr. Alan Edel described two
limited. 9,16,23 Compared to traditional techniques, the SIT methods for performing trap-door harvests. In Method
involves less disruption of the blood supply to the primary 1, the operator first establishes a partial-thickness palatal
flap, as vertical incisions are avoided. Moreover, the SIT pedicle flap and then harvests the underlying connective
17
may reduce flap movement during early healing and tissue. Method 2 involves extending the horizontal and
increase clot stability in the void created by graft removal. vertical incisions to the bone, reflecting a full-thickness
17
Therefore, the claim that single-incision harvests promote palatal pedicle, and thinning the flap to remove the SCTG.
donor-site healing is plausible. Further research comparing The use of multiple incisions for SCTG harvesting offers
clinical and patient-reported outcomes following different several advantages. Clinicians harvesting an SCTG for the
harvesting methods may identify a superior evidence- first time may face a steep learning curve. While many
based technique. Given the limited research available, new practitioners enter periodontics training with some
the SIT offers potential advantages in wound healing and experience in mucoperiosteal flaps, few have experience
patient comfort and is applicable in many root coverage harvesting palatal tissue, which is a substantially different
and gingival/mucosal augmentation procedures. Thus, the clinical skill. In addition, periodontists in training are well
SIT may be the preferred harvesting method when feasible. aware of the complications associated with autologous soft-
tissue harvesting. As a result, this procedure may induce
3.2. MIT anxiety in both the patient and the operator. Initially,
One or two vertical incisions may be added to the inexperienced clinicians may struggle to establish a palatal
horizontal incision at SCTG donor sites, with or without flap of appropriate thickness. If the primary partial-
retention of an epithelial band at the coronal aspect of the thickness access flap is too thin, necrosis may occur;
graft (Figures 3-5). 17,18 When two vertical incisions are conversely, excessive flap thickness may result in an SCTG
used, the technique is commonly referred to as the “trap- of unfavorable quality and thickness. Trap-door harvests –

Volume 4 Issue 1 (2025) 37 doi: 10.36922/gtm.4860