In modern surgical periodontal treatment, soft tissue grafts can be used for various reasons such as:
- To cover an exposed root of a tooth (recession).
- To change the thickness of the tissue around a tooth to improve their behaviour in daily brushing and use.
- Around implants to increase the zone of keratinized gingiva, thereby improving their long-term prognosis .
- To facilitate patients who wear dentures by creating conditions for better seating and stability of their dentures.
- Under fixed prosthodontics improving aesthetics.
With the proper techniques we can increase the thickness or volume of soft tissue, or even change the type of tissue (eg to increase the amount of keratinised gingiva which is very resistant to plaque retention and injuries) .
Soft tissue grafts, depending on their origin, can be divided into three categories :
- Autografts, i.e. grafts from the patient himself. It is tissue that we get from another area of the mouth (usually from the palate) and typically consists of epithelium and/or connective tissue, depending on the desired use .
- Allografts, grafts from other human donors. The grafts are composed of connective tissue appropriately treated so as not to have any antigenic properties but also having removed the donor cells. They are therefore essentially a scaffold of collagen fibres, onto which the organism of he recipient will “build” new connective tissue.
- Xenografts, grafts derived from the animal kingdom. They again are like the human-derived grafts, a network of collagen fibres . The difference is in the quality of collagen and in the presence of growth factors which are present in the human grafts but not an element of grafts derived from animals.
Although graft tissue from the patient himself is always of better quality, there are advantages to the use of grafts from other donors. The key is to avoid the second incision for harvesting the graft, and hence the procedure becomes less invasive. An other issue to take into consideration is of course the required amount of tissue needed, wherea tints available tissue is limited, while the graft from other donors is of unlimited quantity. Various research projects that have compared the results after the use of various grafts and all come to the conclusion that the “gold standard” is autograft followed by allograft and then xenograft.