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Alternatives to the Autologous Connective Tissue Graft: Challenging the Gold Standard
Lieutenant Caitlin D. Darcey, DC, USN and Commander John H. Wilson, DC, USN
Introduction
The sub-epithelial connective tissue graft (SECTG) is a periodontal surgical modality utilizing autologous connective tissue to correct mucogingival deformities around teeth and implants. First described by Langer in the 1980’s, the SECTG revolutionized periodontal surgery as an improvement over the free gingival graft (FGG) – achieving more predictable root coverage, with greater esthetic results and less post-operative discomfort. Classically, the outcome measures when treating recession defects have included percent root coverage (%RC), the percent of the recession defect that becomes covered by gingiva, and complete root coverage (CRC), the frequency in which complete root coverage is obtained. The SECTG is considered to be the gold standard for the treatment of gingival recession (GR) with reported mean %RC of up to 98% and CRC up to 89%2 and remain stable long term. Unlike the FGG, only the connective tissue layer is harvested, leaving the epithelium and a supportive layer of connective tissue to aid in primary closure at the donor site (fig 1). While the literature supports reduced post operative sequellae when compared to a FGG, reports exist of donor site morbidity associated with the SECTG, such as post-operative pain, bleeding, flap necrosis, infection and paresthesia. These complications may cause hesitation in a patient or practitioner to proceed with a SECTG. Alternatives exist that spare the patient the donor site morbidity associated with SECTG harvest, yet produce acceptable root coverage outcomes. The purpose of this clinical update is to review the currently available “off-the-shelf” SECTG alternatives that preclude the need for a second surgical site to obtain the donor tissue; specifically acellular dermal matrix, xenogeneic collagen matrix, enamel matrix proteins and guided tissue regeneration.
Lieutenant Caitlin D. Darcey, DC, USN and Commander John H. Wilson, DC, USN
Introduction
The sub-epithelial connective tissue graft (SECTG) is a periodontal surgical modality utilizing autologous connective tissue to correct mucogingival deformities around teeth and implants. First described by Langer in the 1980’s, the SECTG revolutionized periodontal surgery as an improvement over the free gingival graft (FGG) – achieving more predictable root coverage, with greater esthetic results and less post-operative discomfort. Classically, the outcome measures when treating recession defects have included percent root coverage (%RC), the percent of the recession defect that becomes covered by gingiva, and complete root coverage (CRC), the frequency in which complete root coverage is obtained. The SECTG is considered to be the gold standard for the treatment of gingival recession (GR) with reported mean %RC of up to 98% and CRC up to 89%2 and remain stable long term. Unlike the FGG, only the connective tissue layer is harvested, leaving the epithelium and a supportive layer of connective tissue to aid in primary closure at the donor site (fig 1). While the literature supports reduced post operative sequellae when compared to a FGG, reports exist of donor site morbidity associated with the SECTG, such as post-operative pain, bleeding, flap necrosis, infection and paresthesia. These complications may cause hesitation in a patient or practitioner to proceed with a SECTG. Alternatives exist that spare the patient the donor site morbidity associated with SECTG harvest, yet produce acceptable root coverage outcomes. The purpose of this clinical update is to review the currently available “off-the-shelf” SECTG alternatives that preclude the need for a second surgical site to obtain the donor tissue; specifically acellular dermal matrix, xenogeneic collagen matrix, enamel matrix proteins and guided tissue regeneration.
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