Best donor site for connective tissue graft?

One of my patients needs a connective tissue graft for a periodontal problem.  I am unsure about performing a palatal harvest, because I am not an experienced surgeon and I wonder if it is a good idea to take the connective from an edentulous areas of the maxilla or mandible.  Does it works the same? Are there any contraindications?

Thanks for your advice.

14 thoughts on: Best donor site for connective tissue graft?

  1. DrT says:

    The BEST donor source for CT grafts is tuberosity, provided you have adequate M-D dimension.
    You can take a wedge of tissue and close the area completely to minimize post op discomfort. The mandibular retromolar area is usually not such a good sight because of the consistency of the soft tissue.

  2. Dr Manjunath P N says:

    We should consider two areas of interest:
    • Anterior palate: Extensive and large surface
    • Posterior palate (tuberosity and lateral palate):
    Tuberosity is very voluminous which is a good option for a alveolar ridge augmentation
    and lateral palate is well indicated for recession coverage. They are both too dense and firmer than the anterior palatal so graft from tuberosity and posterior lateral palate are very unlikely to undergo to a postoperative shrinkage but on the other hand they are more
    prone to undergo necrosis than anterior palate.

  3. Sam Markzar says:

    Well .. when you state the facts:
    1) you are not an expert surgeon ( which makes it difficult to harvest the graft from ANY site properly ..) and
    2) the patient has a problem needing graft treatment ;
    unless you are not within a 60 miles of a Periodontist , I would highly recommend to refer out . Since you don’t want to do something to a patient with an unknown prognosis, and then lose that patient’s trust . Right ? If you are not sure yet .. then imagine this patient is Your mom or dad .. now Shay would you like to happen ?
    Good luck .

    • Raul R Mena says:

      Dear all,
      My class was doing gingival grafts in the 2d year of dental school. Maybe I am bias to all this comments to refer to an specialist. This is not a Leforte , nor it is removing an Ameloblastoma or a Cruzon. We are talking about a simple gingival graft.
      In my dictionary it falls under “Gum Gardening”
      Of course not every dentist has spent 3 years reading articles published in Journals.
      I am not trying to offend any one, but in my opinion this forum is to exchange ideas with some that is asking for advice.
      Implant dentistry has a new Specialty that encompasses the surgical and prosthetic phases of implantology, so if you are going to advice refering to an Specialist you may have to include the new specialty.
      All of you that want to place dental implants, take implant courses, apply your knowledge from Dental School and use common sense.
      Use the Golden Rule and do no harm.
      “Waiting for arrows falling on my head”

      • Dr JLD says:

        No arrows. Question though: where did you go to dental school and when? I am a periodontist, but the closest my undergrad. Perio. Dept. would let us get to a connective graft was to watch one done by them. And not as an assistant. It is all about proper training. I was a general dentist for 12 years after graduating and did not do grafts; then I did my residency and learned how to do them, but slowing and guided by expert hands.

  4. Raul R Mena says:

    I graduated from the Medical College of Georgia School of Dentistry , Agusta Georgia.
    Dean Hickey was of the philosophy that a dentist should be able to treat patients in a comprehensive manner.
    I was luck enough to have many good professors that shared his same philosophy.
    To name a few in Perio , Buck Pennell and Fritz, Oral Surgery , Richard Topazian and Wade Hamer, Crown and Bridge, Dave Boudreau and Robert Kinzer, Anatomy, Mohamed Sharaway.
    Not only I did Free gingival graft, but we did Flap and Osseous Contouring, extractions including 3rd Molar and endodontics. And by the way we trained on Nitrous sedation and IV sedation, at the time Valium and Talwin.
    I understand that dental schools these days basically teach how to read ADA Insurance Codes and how to refer to the specialists.
    One of the main problems that must specialist have is that they didn’t receive a well rounded training in dentistry and their focus is only on their post graduate training.
    i am not trying to be critical of the specialist, I am critical of what dental schools have turn out to be.
    It use to be that a Dr. refer a case to specialist when he didn’t like doing the procedure, or because it was beyond the scope of its training.
    Dental Schools have focus so much on Post Graduate students that now there is an oversupply of Specialists. and they are all fighting to get the referral from the dumy GP next door. I do respect Specialist, and there is a place for them.
    Now Dental Implantology has been recognized as an specialty, in some states.
    I have trained many GPs and Specialist on different Dental Implant technics so I am very familiar even with the training that specialists receive in their post graduate training.
    In my opinion this forums are to exchange knowledge with those that ask for advice. We all benefit from exchanges of ideas, and many are very sound and we all can learn from them.

  5. Greg Kammeyer, DDS, MS says:

    I would suggest that you take a course on connective tissue and free gingival grafting. These can be routine procedures for a GP ( I did my first FGG in dental school) yet without the proper guidance you can cause harm. Since this isn’t an extension of your comfort zone (your question gives that away) you owe it to yourself and your patient to be properly trained. Diagnosis of what to do when and where is just as important as How to do the treatment.

    It isn’t about turf. There is more than enough dentistry for all of us to do. It is about putting the patients best interest first. ….Our oath.

  6. CRS says:

    Love the tuberosity, little post op pain that’s what the patients remember and guess what it grows back for more harvest. I’d recommend referal for most GPs headache in your restorative schedule and it can be a loss leader if there are complications.

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