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Global Translational Medicine Connective tissue harvest techniques

the discomfort and potential morbidity associated with When a portion of the graft remains exposed after surgery,
palatal donor sites. The present paper is relevant for both differences in esthetic outcomes achievable using deep
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practitioners and patients seeking to optimize clinical palatal tissue, DGG, and tSCTG have not been clarified
outcomes and ensure the stability of results through through controlled clinical research.
the selection of autogenous tissue for root coverage and Grafts harvested using the SIT and MIT are obtained
gingival/mucosal augmentation procedures. from the same anatomical location and are expected to
The choice of the SCTG harvest technique is a critical exhibit no significant differences in structure, composition,
clinical decision. The selected method may influence or clinical performance. However, the SIT is generally
the clinical behavior of the graft, donor-site morbidity, preferred due to potential differences in patient-reported
patient-oriented outcomes, and long-term stability. The outcomes 9,16,23 Nevertheless, clinicians new to palatal tissue
main complications associated with SCTG harvesting are harvesting may initially find the MIT easier to perform.
donor-site hemorrhage and excessive pain. 1,4-7 Primary Moreover, the presence of a transpalatal arch wire or other
flap laceration can occur at both the SIT and MIT harvest fixed appliance may necessitate the use of MIT.
sites; surgical trauma or overthinning of the primary Although there is a clear rationale for preferring the SIT
flap may result in necrosis and potentially, exposure in most situations, the advantages of alternative methods
of the underlying bone. Post-operative infections and warrant consideration in specific clinical scenarios. For
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donor-site neurosensory changes are rare but have been instance, a tSCTG may be favored at an isolated site where
reported. 6,44,45 Most studies comparing patient-reported tissue thickness is particularly important, and esthetics are
outcomes following SCTG harvesting focus primarily on not the primary concern. A tSCTG is an excellent choice
post-operative discomfort and analgesic consumption. 7,46,47 for augmenting peri-implant mucosa and masking slight
Zuhr et al. have noted that further research is needed alveolar ridge deficiencies at isolated dental implant sites,
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to clarify differences among graft types with regard to particularly those outside the esthetic zone. Importantly, the
recipient-site esthetics, volume stability, and other patient- clinician’s ability to harvest a tSCTG depends on the patient’s
centric concerns. Given the important unanswered anatomy. Some individuals – especially those with retained
questions related to this gold-standard procedure, expert maxillary third molars – may not be suitable candidates for
opinion and operator preference remain relevant factors this graft type. Similarly, patients with a shallow palatal vault
in the decision-making process when selecting an SCTG or thin palatal tissue may not be ideal candidates for palatal
harvesting technique. 48 SCTG harvesting through either SIT or MIT. In these cases,
In recent years, the defined safety zone for harvesting a DGG may be a superior option. Due to its higher content
palatal SCTGs has expanded considerably, due to updated of fibrous and lower content of adipose and glandular tissue,
investigations into human palatal anatomy. However, it is the DGG typically offers better clinical handling and is
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important to note that research related to SCTG harvesting easier to suture. Nevertheless, DGGs are associated with an
is still far from comprehensive. Only a few studies have increased risk of epithelial inclusion, which can lead to late
compared SCTGs obtained from deep palatal tissue, complications. 32-36 In addition, patient discomfort is known
tSCTGs, and DGGs at the mRNA and protein levels. 39-41 to correlate with the size of the DGG. 4,5,15 Thus, larger DGGs
Attempts to correlate existing molecular data with the may increase the risk of an unpleasant patient experience.
observed clinical performance of the various graft types While some studies suggest that the high clinical quality
remain largely speculative. 19,39-41 of DGGs may result in slightly superior clinical outcomes,
Nevertheless, an argument can be made that the further research is needed to confirm this hypothesis. 28-31
SIT represents the presumptive technique of choice, It is important to acknowledge the limitations of this
based on limited data suggesting that this method may article. Few randomized controlled clinical trials (RCTs)
expedite healing, offer a superior patient experience, and comparing clinical and patient-reported outcomes of the
minimize the risk of late complications. 9,16,23 The use of a various SCTG harvesting methods are available for analysis.
tSCTG may reduce patient discomfort in cases involving Moreover, no RCT has included all four of the harvesting
isolated recipient sites. 19,38,40,42 However, the SIT allows the techniques described in this paper. The available studies
clinician to minimize donor-site morbidity when applying are subjected to several concerns, including a high risk of
an SCTG across a wide mesiodistal span. In some cases, bias. Common sources of bias include ambiguity in subject
graft splitting may reduce donor-site dimensions, thereby randomization and the potential for assessors to be aware
enhancing patient-reported outcomes. In addition, when of the interventions received by the study participants.
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esthetic concerns are paramount, SIT palatal harvests avoid As a result, the present commentary relies heavily on
the potential fibrosis associated with tSCTG placement. uncontrolled clinical research, comparative histologic

Volume 4 Issue 1 (2025) 43 doi: 10.36922/gtm.4860