Soft Tissue Graft
What is a Soft Tissue Graft?
Creating supportive soft tissue environment for implant longevity
A soft tissue graft involves moving tissue from one part of the mouth (the donor site) to another (the recipient site) to improve gum health at the recipient site. In implant dentistry, soft tissue grafting may be needed when the existing tissue is insufficient or weak, such as to cover dental implants and reduce thread exposure, to thicken gum tissue for a secure seal and prevention of recession, and to increase vestibule depth for implant-supported dentures. Augmenting the soft tissue around implants creates a stable environment that promotes optimal healing, improves aesthetic outcomes, and supports the long-term success of dental implants. Adequate, healthy soft tissue is crucial for maintaining a solid foundation and achieving a natural-looking result.
When is Soft Tissue Graft Needed?
Situations that may require a soft tissue graft:
Insufficient gum coverage: When gum coverage is inadequate over dental implants, a connective tissue graft or free gingival graft is used to reduce thread exposure and improve aesthetics.
Thin gum tissue: Thin gum tissue around an implant can lead to complications. A connective tissue graft or free gingival graft thickens the tissue, ensuring a secure fit and preventing future recession.
Gum recession: For exposed implant threads due to gum recession, a sub-epithelial connective tissue graft or pedicle graft can be used to restore lost tissue and protects the implant.
Insufficient vestibule depth: To enhance stability and function for implant-supported dentures, a vestibuloplasty or a combination of free gingival graft and vestibuloplasty increases the vestibule depth.
Soft Tissue Graft Complications
Potential complications and management for soft tissue grafting
Insufficient Soft Tissue Growth: A common situation that the graft may be successful partially but fail to provide full coverage. If needed, a additional graft can be added later to enhance coverage.
Infection: If a soft tissue graft is not securely placed and food particles enter the area, infection may develop. Infected grafts can be managed with antibiotics or by repeating the grafting procedure.
Graft Failure: When a graft does not receive sufficient blood supply, it may fail to integrate with the existing tissue. In such cases, the procedure may need to be repeated with a larger graft area to ensure better blood supply.
Aesthetic Issues: When the graft does not blend well with the surrounding tissue, it may appear different from the adjacent area. In aesthetic zones, additional procedures may be required to refine the appearance.
Types of Soft Tissue Graft
Connective Tissue Graft: A connective tissue graft involves taking tissue from the palate (the donor site) beneath the mucosa. A flap is created to access the connective tissue, which is then removed and placed over the recipient site around the implant. The flap is stitched back, and the graft integrates with the surrounding tissue over time.
Free Gingival Graft: A free gingival graft involves removing a small section of gum tissue from the palate or another donor site. This tissue is then directly transplanted to the recipient site where it's stitched into place. The graft integrates with the surrounding gums, providing coverage and thickness.
Sub-epithelial Connective Tissue Graft: Similar to a connective tissue graft, this technique also uses tissue from beneath the mucosa but is often used for areas needing more substantial tissue volume. A flap is created to access and remove the connective tissue, which is then placed under the existing gum tissue at the recipient site and sutured in place.
Pedicle Graft: A pedicle graft involves moving a flap of gum tissue from an adjacent area (the donor site) to cover the recipient site. The flap remains attached at one end, which preserves its blood supply, and is repositioned to cover the exposed area. The graft area is then sutured into place.
Vestibuloplasty: This procedure involves reshaping the vestibule (the space between the gums and the inside of the lip or cheek) to increase depth. The surgeon makes an incision to reposition the tissue, and often a free gingival graft is used to augment the area. The procedure is typically combined with a free gingival graft to improve the depth and contour.