Connective Tissue Graft around Natural Teeth

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Posted on By Hyun Jun Jung In Soft Tissue Enhancement

In some cases, soft tissue augmentation around the natural teeth seems to be more difficult than around the implant.



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Beautiful piece of CTG!! Usually we need way less, but you did find a lot!! However, I would have a different approach, more conservative in this case like VISTA. Here we are dealing with blunt papilla especially at the midline and we can tell that the bone is not setting the tone here. I would never raise a flap in a situation like this, as a matter in fact I don't raise at all anymore flaps involving midline, not even on gummy smile cases for passive altered eruption. Since you do have enough keratinzed tissue I will make a vista incision and I will drop that CTG in less amont and stabilized with a simple anchorage suture.I would advance the tunnel down.This way you would avoid papilla loss and this huge volume of tissue. My Gum drop Technique can work here dear Snjezana, I would add a lot of membranes and the papilla could look so much better. as well preserving natural dentition with no restorative work as well. Thank you for sharing so we can all learn from it. Warm regards, Delia


I agree with your advice. The CTG in this way is more prominent in horizontal recovery, but it is disadvantageous in papilla. Recently I am also trying VISTA. I think it is a smart way. Warm advice Thank you.
P.S: In recent years, VISTA cases have come up mainly, so I wanted to post old-fashioned cases this time ^^.


Hyun Jun Jung, but it looks so easy in your hands!
Great old connective tissue, blessed the one who came with the idea (Edel; Langer).
It`s interesting and sad that the most dentists performing implantology have never learned to harvest CTG!
If completely covered, non-autogenous grafts can be used for cases like this. Could we expect a soft tissue volume gain like this using PRF? The cases presented by Delia Tuttle show very nice thickness and also papilla improvement. Has anyone mid-term experience?
Best regards and thank you for sharing this beautiful case!


Dr. Snjezana pohl.
Thank you for your warm words. I have seen texts about non-autogenous grafts. I was wondering if I could control relapse without additional help such as growth factors.

I have seen the PRF cases in Xepert's lecture. I've seen beautiful results, but can not sure about mid-term and long-term relapse and have not tried it yet. It would be great if someone shared good case and follow up.
Thank you all the time Good friend!


Dear Hyun (my I call you just Hyun),
it`s nice to exchange ideas and opinions with you. Since 20 years I`ve been using solely CTG for mucogingival surgery, xeno only for edentulous ridge augmentation.
Only recently I`ve done few recession covering procedures with PRF, motivated by Dalia. To my knowledge, there are not mid - term data for this alternative, but initial results look promising.
Thank you again for our discussion!
Best regards


It's really encouraging. Patients may not require additional surgical site and pain! I'll try it in case.


Hi Hyun;
I would like to suggest that before you placed your permanent restorations you would have temporized the lateral and centrals and then extruded the maxillary laterals and centrals to create interdental papilla. Following extrusion, all 4 teeth would require restorations.
While your results are very nice, your patient still lacks normal soft tissue.
Best regards,


I completely agree. But the patient originally came to improve the # 11 tooth. Through counseling, we recommended # 22, # 21, # 11, # 12 treatment and additional CTG. But she refused treatment of # 22. Cost is a problem. I also recommended orthodontic treatment, but she wanted to treat it next time.
Thank you for your advice.


Hello Dr Hyun,

I first must commend you on this excellent result, especially that you are dealing with a class III/IV Miller recession.
I agree with previous comments regarding flap design. I try and stay away from severing papillae that have compromised IHB. Personally, I would have used autogenous tissue like you have done here. I do not believe we have the evidence yet to use blood derived products in challenging class III/IV defects. Literature shows evidence that thicker CTG are more successful in class III defects. Do you feel that this is the case?

Thank you for sharing !!


Sure Dr. Ehab.
I believed that autogeneous soft tissue was suitable for this case, harvested and grafted.
I agree with you^^

Thank you! friend.



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