Chapter-15 Subepithelial Connective Tissue Grafting for Implant Aesthetics

BOOK TITLE: Clinical Guide to Oral Implantology: Step by Step Procedures

1. Turner Porus S
2. Vazifdar Ferzin Turner
3. Turner Ashdin P.
4. Vazifdar Danesh R.
Publishing Year
Author Affiliations
1. A.B. Shetty Institute of Dental Sciences, Nitte University, Mangaluru, Karnataka, India
2. Mumbai, Maharashtra, India
3. Mumbai, Maharashtra, India
4. Adaro Dental Labs.
Chapter keywords
Subepithelial connective tissue grafting, CTG, implant aesthetics, single incision technique, modified tunnel technique, posterior superior palatine artery, PSPA


The palate is the most preferred site for harvesting a subepithelial connective tissue graft. The subepithelial connective tissue graft contains collagen fibers and varying amounts of fatty and glandular tissues. The palatine artery should be protected as it is an extremely important anatomical structure. To reliably prevent damage to the posterior superior palatine artery (PSPA) the distal extension of the incision should end no further than the anterior surface of the first molar. The single incision technique is the recommended method of choice for harvesting the subepithelial connective tissue graft. The main challenge is to achieve good healing of the donor site. If this is achieved, postoperative complications are reduced. It is better to harvest the graft with the periosteum because of better clinical handling while adapting to the recipient site or when the graft is sutured to the defect to prevent dehydration the graft should be immediately transferred to the receipt site or kept hydrated with normal saline. A detailed discussion on modified tunnel technique to thicken mucosa around implants has been provided in the chapter with the help of 15 clinical images.

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