The Subpedicle Connective Tissue Graft

TLDR

A mucogingival grafting technique, the subpedicle connective tissue graft, was developed to cover denuded root surfaces, especially when inadequate keratinized gingiva precludes a pedicle graft and free gingival graft prognosis is poor. The subpedicle graft is a bilaminar construct of a free connective tissue graft overlapped by a pedicle graft, which supplies plasmatic circulation from the pedicle’s capillaries to sustain the free graft; the technique was applied to 29 teeth and followed for up to 42 months. In patients with 7–10 mm recession, the subpedicle graft achieved an average 88 % root coverage and produced a healthy, functional, esthetic outcome that resisted further breakdown.

Abstract

A mucogingival grafting procedure has been developed to cover denuded root surfaces. This procedure, the subpedicle connective tissue graft, is a bilaminar graft that is composed of a free connective tissue graft and an overlying pedicle graft. By overlaying grafted free connective tissue with a pedicle, the otherwise compromised section of free graft which covers a denuded root surface is supplied by plasmatic circulation from capillaries in the vascular portion of the pedicle allowing it to survive. In this report 29 teeth were treated and monitored for as long as 42 months. In the group with advanced recession of 7 to 10 mm, there was an average of 88% coverage. The subpedicle graft created a healthy, functional, and esthetic result that appeared resistant to further breakdown. The subpedicle graft is indicated when a single surgical procedure is desired that will predictably cover denuded root surfaces when there is inadequate keratinized gingiva available for a pedicle graft and where the prognosis is poor for root coverage with a free gingival graft.