The Subepithelial Connective Tissue Graft
A person’s gum tissue is intended to protect the roots of the teeth and help hold the teeth in place in the mouth; healthy gum tissue hugs the surfaces of the teeth, keeping infectious bacteria and food debris from colonizing on the teeth. When the gum tissue recedes and the roots of the teeth are exposed, the tooth roots lose that protection and become more sensitive to extreme temperatures and more prone to dental cavities. It’s also worth mentioning that many patients consider receded or unnaturally thin gum tissue a cosmetic issue; many patients seek treatment for gum recession primarily because they want to improve the appearance of their smile. One of the more widely used treatments for gum recession or otherwise inadequate gum tissue is the subepithelial connective tissue graft, which is usually shortened to CTG.
Surgical procedures intended to preserve or restore gum tissue have been used since the 1950s for patients who seek to correct defects in the shape, size, position, or amount of gum tissue that surrounds the teeth. As surgical techniques have developed, they have become more and more natural-looking, convenient, and painless. The subepithelial CTG is the most popular gingival surgery in use today, providing predictable, consistent results in restoring the gingival tissue and returning it to use as protector of the tooth roots. This procedure is considered a vast improvement over previous types of gingival grafts, like the free gingival graft, specifically due to its predictability in providing root coverage, its optimal aesthetic results, and its minimally invasive nature and ease of recovery.
The subepithelial connective tissue graft is performed using a local anesthetic, following a comprehensive dental examination and consultation. First, the exposed surface of the root of the tooth is planed, removing any infection or decay. Then, the gums are prepared to receive the grafts. Your periodontal plastic surgeon will make incisions in the gums on either side of the tooth, raising a flap of gingival tissue between these incisions and exposing the epithelial layer of the tissue. The tissue used for a CTG is harvested in the same procedure, from the donor site on the patient’s hard palate just behind the top front teeth. Two incisions are made in the palate and the tissue between these incisions is harvested; the remaining edges are sutured together. The tissue that has been removed is shaped and prepared outside the mouth. Once the tissue has been thinned and the epithelial layer has been removed, the graft tissue is inserted into the graft site, under the previously made tissue flap. This tissue is precisely placed so that it covers the tooth root surface before being sutured to the tissue beneath the flap; once it is fixed to this internal tissue, the flap of epithelial tissue is closed and sutured into place. Both surgical sites are treated and dressed, and patients return for periodic follow-up visits to get their sutures removed and for evaluation after surgery. Because the subepithelial connective tissue graft replenishes the gingiva with tissue placed beneath the outer layer of the gums, the visible outer layer remains uniform in color throughout the gums. This procedure also allows the periodontal plastic surgeon to precisely sculpt the gingival tissue, improving the appearance of the gum line while helping restore the gums to their role as the first line of defense for good oral health.