Free Gingival Graft vs Connective Tissue Graft in the Lower Incisors

In this series of three videos, Dr. Simon discusses the free gingival graft, which is a common and important procedure. He reviews a case sent to him by another dentist, involving a 23-year old female with a Miller Class II recession on the lower incisors. The doctor was trying to decide between a free gingival graft and connective tissue (CT) graft. Dr. Simon points out the challenges involved with the lower incisor region when it comes to soft tissue grafting. In the 2nd video, Dr. Simon gets more specific about what the options are to treat the specific mucogingival issues, reviewing both pros and cons of the various treatment options. Finally, in the 3rd video, Dr. Simon reviews a particular flap design that he recommends.

Part I: The Case

**Part II: The Options**
**Part III: The Recommendation**
### About Ziv Simon, DMD, MSc

zivsimonDr. Simon practice is limited to periodontics and dental implant in Beverly Hills, CA. He obtained his dental degree and Bachelor of Medical Sciences degree from Tel Aviv University, where he held a teaching position in the Department of prosthodontics. He received his periodontal graduate degree from the University of Toronto with a Master of Science degree in Periodontology. He is a Diplomate of the American Board of Periodontology and a Fellow of the Royal College of Dentists of Canada in the specialty of periodontics. Dr. Simon is the president of the Beverly Hills Academy of Dentistry and the founder of the Multidisciplinary Dental Study Group of Beverly Hills. Dr. Simon teaches at the University of Southern California and lectures nationally and internationally on esthetic soft tissue procedures, computer guided implant surgery and tissue reconstruction. Dr. Simon is the creator of SurgicalMaster TM , a surgical training program for dentists.

6 Comments on Free Gingival Graft vs Connective Tissue Graft in the Lower Incisors

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Kaz
1/22/2016
Nice information as usual. Thanks
Devesh Oberai
1/23/2016
How do you harvest the FGG from the donor site?
Dorian Hatchuel
1/23/2016
Hi Ziv I use an Epithelial Embossed Subepithel Connective Tissue Graft in these cases. In one surgery you get rid of the frenum, get keratinized tissue over the root, thicken the tissue on adjacent roots, have ano aesthetic outcome and less morbidity. Only a shallow vestibule is a contraindication.
ziv
1/25/2016
thanks! Not easy to achieve
Spencer Bloom
1/25/2016
Dr. Simon, For this situation would the palatal donor tissue have the palatal epithelium attached or removed? Does it matter? How does one decide that issue? Is the graft sutured with 5/0 gut as used earlier to stabilize the split thickness flap?
ziv
1/25/2016
Hi Spencer, Thanks for the comments also on Vumedi from today. For a FGG yes, by definition. For a CT graft you can leave a collar of epithelium or not (depends on your grafting technique). I don't think it matter for a CT graft. I typically don't Graft is sutured with gut 5/0 or prolene 6/0

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