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Soft Tissue Augmentation

Soft tissue grafting is recommended when bone volume is sufficient, but there is a deficiency in the soft tissues.

The primary goals of soft tissue grafting are to enhance the volume of missing gingival tissues around prostheses to improve aesthetics, optimise soft tissue coverage, and, in some cases, increase the amount of keratinised tissue around restorations.

Alternatively, some patients may opt for the use of pink-coloured restorative materials to replace missing soft tissues, thereby avoiding the need for surgical ridge augmentation and soft tissue grafting. Various soft tissue grafting procedures are available, including:

 

Pedicle Graft Procedure:

  • Example: The roll flap technique (Abrams, 1980).
  • Indication: Suitable for short-span (single tooth/implant) ridge defects with minor loss of height and width.
  • Technique: This involves preparing a connective tissue pedicle graft from the palatal side of the ridge, which is then rotated and placed into a subepithelial pouch on the buccal side (Veisman, 1998).

 

Free Graft Procedures:

  • Indication: Primarily used for larger soft tissue defects (Lang and Lindhe, 2015).
  • Types of Free Grafts:
    • Pouch Grafts:
      • Indication: Best for Class I defects.
      • Technique: Involves creating a subepithelial pouch in the area of the ridge defect and placing a free connective tissue graft, harvested from the palate or tuberosity, into the pouch.
    • Interpositional Grafts:
      • Indication: Suitable for Class I and small to moderate Class II ridge defects.
      • Technique: The graft, consisting of both epithelium and connective tissue, is inserted with the connective tissue part placed into an envelope at the recipient site, leaving the epithelial side exposed.
    • Onlay Grafts:
      • Indication: Used for Class II and III defects to achieve additional ridge height.
      • Technique: This procedure involves placing an epithelialised free graft (harvested from the palate) onto de-epithelialised connective tissue at the recipient site.
      • Contraindications: Onlay grafts are not recommended when there are additional mucogingival issues, such as insufficient gingival width, a high frenum, or gingival scarring.
    • Combined Onlay-Interpositional Grafts:
      • Indication: Used for Class III defects to address more complex soft tissue needs.