Trap door

 

"L" Technique

 

Envelope/ Single incision

 

Area of premolars - anterior palate, it has a lot of fat, called submucosa

 

Molar area is better

 

Only 1 1.2mm of thickness is needed.

 

If you need thicker graft you don't go deeper!

 

HARVESTING

horizontal incision

vertical incisions

the mesial vertical incision is used to calibrate the thickness of the graft being harvested

 

GRAFT

You have to remove not only the keratinized part but also the basal layer, this means removing 0.2mm of thickness.

Make a perpendicular incision to make sure you remove the epithelium facing the teeth.

 

The desepithelialized free gingival graft provides stability to the CAF, it doesn't cover the root. The root is covered by the CAF.

What are the clinical situations where you need to stabilize the CAF?

When there is not enough amount of keratinized tissue, apically to the recession, less than 2mm in height and less than 1mm in thickness.

When there is something so near the recession's margin, as a frenum, to impair the stability of the CAF. You never need to remove the frenum externally. If you have a basal big height of keratinized attached gingiva prognosis will be better.

Whenever you have one o two opposing situations: either a very deep root abrasion or a very prominent root.

 

A deep incision to release the flap is in fact not needed. The superficial incision is key to an effective release: it separates the submucosa from the alveolar mucosa.

 

Planing the root

EDTA gel 2 minutes, 24%, to remove the smear layer.

 

DIMENSIONS OF THE HARVESTED GRAFT

5mm in height and 10mm in length (mesiodistal dimension).

 

 

DONOR SITE CLOSURE

Close the knot  apical distal