Evaluation Of Minimally Invasive Harvest Technique For Subepithelial Connective Tissue

IntroductionFor gingival recession,SCTG is a predictable procedure and golden standard.It was also used widely to obtain esthetics in anterior areas in implants in recent years.In SCTG process,harvesting connective tissue is an important procedure and the palate still remains the most common donor site.The aim of this paper was to refine the modified minimal invasive single incision technique(r-MSIT)into six steps which could easier to emulate and execute.And the advantage of the modification was evaluated comparing with traditional trap-door incision technique(TDIT).Several previous harvest techniques,suture technique,indications,contraindication and limitation were also summarized.MethodsForty patients with gingival recession between 21 and 65 years old were recruited in this study.They randomly assigned averagely to both r-MSIT group and traditional TDIT group to harvest subepithelial connective tissue.The donor area was anesthetized by block anesthesia of the greater palatine and nasopalatine nerves with local anesthetic agent.TDIT group was employed with 3 incisions to raise a split-thickness trap.Several interrupted sutures were used to suture the horizontal incision and two vertical incisions.For r-MSIT group,the procedure was refined into the following six steps to harvest subepithelial connective tissue with a #15c or #15 blade and a common periodontal elevator.4-0 absorbable suture and crossed horizontal suspension suture method were recommended for close the wound.Harvesting and suture time,verbal rating scale(VRS)and an early-wound healing index(EHI)were recorded.ResultsHarvesting time in r-MSIT group was similar to TDIT group.For suture time,it is much less in r-MSIT group than TDIT group(p<0.05).Total operation time in r-MSIT group is shorter than TDIT group,especially in suture time.And the difference was statistically significant(p<0.05).However there is no significant difference for pain levels between two groups through VRS evaluation(p>0.05).One week post-surgery,the EHI of r-MSIT group was significantly lower than which is in TDIT group(p<0.05).ConclusionThe continuous improvement of harvesting subepithelial connective tissue is summarized in this article.And a predictable minimal invasive procedure is also demonstrated,which is refined into six steps with the common periodontal instruments and the practical crossed horizontal suspension sutures.This procedure can effectively shorten the operation time,alleviate the pain and discomfort of patients,and achieve primary wound healing.Consequently,Six-step r-MSIT is more predictable and easier to handle which decrease the challenge for the both dentists and patients.Favorable outcome was shown due to streamlined minimally invasive procedure and favorable postoperative recovery.