40
|
Volume1 Issue4
S
upporting
Y
our
P
ractice
3.
Ascertainwhichgraftingproced-
urewas completed:
•
A freegingival graft (FGG) isplaced
with thegoal of increasing the zone
of attachedgingiva.
•
Aconnective tissuegraft (CTG)
isplacedwith thegoal of both
increasing the zoneof attached
gingivaandachieving root coverage
of apreviouslyexposed root surface.
Diagnosis
Infection
•
Severe swellingof localized
facial tissues and intraoral site
approximating the surgical site
•
Localized lymphadenopathy
•
Evidenceof pus/exudate in thegraft
recipient site (maybe liberated from
sitewithgentlepressure)
SurgicalSite
•
Dislodgedor removeddressing
mayhaveevidenceof tissueon it.
Inmany instances, thismay just be
the sloughedepitheliumand the
remainingconnective tissuewill
have remained/survivedat the site
(
Figs. 1, 2
and
3
).
•
Most graftingprocedures can
withstandminor traumas. However,
significant traumas (i.e., blow to the
face, direct injury to the sitewith
utensil/toothbrush), particularly if
occurring in thefirst 24–48hours
postoperation, cancausegraft
necrosis.
•
Clinical evidenceof soft tissue
coveringperiosteum is indicativeof
graft survival, even in thepresenceof
persistent root exposure.
GraftType
•
A successful FGGwill show remaining
root surfacebut evidenceof healing
tissueapical to theexposed root
(
Figs. 4
and
5
).
•
A successful CTGwill haveevidence
of tissuecovering thepreviously
exposed root (
Figs. 6
and
7
).
❺
❻
❼
➊
Normal post-operativehealingof a freegingival graft. Note “whitish” colour that
patientsperceiveas “lost graft.” (PhotocourtesyofDr. PeterHalford)
➋
Normal post-operativehealingof a freegingival graft at 7days.Whitishareas are
sloughingepithelium. (PhotocourtesyofDr. PeterHalford)
➌
Normal post-operativehealingof a freegingival graft at 7days. Thewhitish tissue is
normal healingand is related toepithelial sloughing. There is remainingexposed root
surfaceas thegoal of the freegingival graft is toaugment the keratinizedgingiva.
➍
Healed freegingival graft 6weekspost-operative. Healing is successful, but there is
still root exposure.
➎
At 3monthspost-operative, there is still exposed root butmarkedevidenceof
keratinized tissue. This indicates a successful freegingival graft.
➏
Gingival recession, beforeconnective tissuegraft.
❼
Healingof gingival graft, 3monthspostoperation.
➊
➌
➋
❹
