See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/310612715

The versatile subepithelial connective tissue graft: A literature update

Article  in  General dentistry · November 2016

CITATIONS READS

3 1,972

4 authors, including:

Munivenkatappa L V Prabhuji D. Khanna

krishnadevaraya college of dental sciences krishnadevaraya college of dental sciences
63 PUBLICATIONS   241 CITATIONS    6 PUBLICATIONS   8 CITATIONS   

SEE PROFILE SEE PROFILE

Kamedh Chowdhary

7 PUBLICATIONS   15 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Immunity View project

Case report View project

All content following this page was uploaded by Kamedh Chowdhary on 04 August 2018.

The user has requested enhancement of the downloaded file.

 The versatile subepithelial connective
tissue graft: a literature update
Karthikeyan B.V., MDS ¢ Divya Khanna, MDS ¢ Kamedh Yashawant Chowdhary, MDS ¢ Prabhuji M.L.V., MDS
Harmony between hard and soft tissue morphologies is
essential for form, function, and a good esthetic outlook.
Replacement grafts for correction of soft tissue defects
around the teeth have become important to periodontal
plastic and implant surgical procedures. Among a multi-
tude of surgical techniques and graft materials reported
in the literature, the subepithelial connective tissue graft
(SCTG) has gained wide popularity and acceptance. The
purpose of this article is to acquaint clinicians with the
current understanding of the versatile SCTG. Key factors
associated with graft harvesting as well as applications,
limitations, and complications of SCTGs are discussed.
This connective tissue has shown excellent short- and
long-term stability, is easily available, and is economical
to use. The SCTG should be considered as an alternative
in all periodontal reconstruction surgeries.
Received: August 17, 2015
Revised: December 30, 2015
Accepted: January 19, 2016
Key words: donor sites, graft harvesting, soft tissue
augmentation, subepithelial connective tissue graft
Published with permission of the Academy of General Dentistry.
© Copyright 2016 by the Academy of General Dentistry.
All rights reserved. For printed and electronic reprints of this
article for distribution, please contact jillk@fosterprinting.com.
e28 GENERAL DENTISTRY November/December 2016
P eriodontal and peri-implant plastic surgeries have
been defined as “procedures performed to prevent
or correct anatomical, developmental, traumatic, or
disease-induced defects” of the oral soft and hard tissues.1
In recent decades, with the development of soft tissue
autografts, classic mucogingival surgery has evolved to
become periodontal plastic surgery. Earlier procedures were
devised to establish and maintain the dentition; now they
are designed to create an environment with optimal form,
function, and esthetics.
Periodontal disease starts early in life and can lead to dire
consequences, such as gingival recession, loss of involved
teeth, and consequently, alveolar ridge defects.2 A number
of procedures have been used to regenerate supporting
tooth structures. Among them, the subepithelial connective
tissue graft (SCTG) has been regarded as a reliable and
predictable procedure that provides a satisfactory esthetic
outcome, making it a popular alternative for clinicians. Major
advantages of the SCTG are that it is inexpensive, versatile,
and easily available; it provides successful outcomes; it is less
invasive than other autogenous harvesting techniques; and it
has a shorter healing period.3-5 Other benefits of the SCTG are
listed in Box 1.
Over the last few years, the SCTG has become the backbone
of various treatment options for gingival recession coverage,
existing or impending ridge deficiencies, management of peri-
implant tissue anomalies, and treatment of furcation involve-
ment and thin gingiva.6 Currently, the SCTG is considered
the gold standard for soft tissue correction and augmentation
surgeries.7 The objective of the present article is to review the
current understanding of the SCTG and its versatile applica-
tions in interdisciplinary dental care.
History
Langer & Calagna introduced the SCTG procedure for soft
tissue augmentation in 1980.8 The technique overcame mul-
tiple limitations associated with free gingival graft techniques,
including unsatisfactory quantitative (insufficient augmenta-
tion volume) and qualitative outcomes (poor esthetic integra-
tion, surface texture, and color; scarring).4 Later, Langer &
Calagna presented a variant of the same procedure for obtain-
ing root coverage.9 Since then, many modifications have been
presented for harvesting the graft as well as its use at the recipi-
ent site. Over time, the SCTG technique has produced the most
predictable results for obtaining root coverage.7
The SCTG is a versatile procedure. It has multiple applica-
tions, ranging from extensive soft tissue ridge augmentation to
procedures as small as papilla reconstruction (Box 2).4,8,10-23
The SCTG does have several limitations:
•• Harvesting is contraindicated in the presence of a narrow
palatal vault, thin palatal tissue, or bony exostosis.24,25
 A A
Box 1. Benefits of the subepithelial connective tissue
graft (SCTG).

• The graft has a dual blood supply.

• The SCTG provides better color matching and
surface topography and hence improved esthetic
integration.4
• The donor site heals with primary intention,
resulting in less scarring.4 B
• The SCTG has greater predictability.
• The procedure causes minimal discomfort to
the patient, and the site heals rapidly.
• The SCTG is quick, user friendly, and easy to
utilize in various situations.5 B

Box 2. Indications for the subepithelial connective

tissue graft.
C

• Treatment of soft tissue recession at teeth and

implants (Fig 1)4,10
• Augmentation of the width of keratinized gingiva10
• Augmentation of the ridge using soft tissue C
(Fig 2)8
• Preservation of the ridge with implant and fixed
partial dentures procedure4 D
• Augmentation of gingival thickness following or
prior to orthodontic therapy12,13
• Augmentation of gingival thickness following or
prior to restorative therapy14
• Reconstruction of soft tissue and coverage of
maxillary defects15
• Surgical reconstruction of interdental papilla16-18
• Management of peri-implant tissues19
Fig 1. Treatment of soft tissue recession. Fig 2. Ridge augmentation.
• Closure of defects following apicoectomy20
A. Miller Class I recession. B. Connective A. Seibert Class III ridge defect.
• Intraosseous subperiosteal connective tissue
tissue harvesting by the trapdoor technique.10 B. Stabilization of the connective
graft for reduction of pockets and management
C. Connective tissue graft stabilized on the tissue graft in a prepared buccal
of furcations as combined procedures21
recipient bed, which was prepared by the pouch. C. Follow-up at 1 year
• Correction of localized gingival pigmentation22
Langer & Langer technique.11 D. Follow-up at showing stable results and
• Masking of discolored roots or visible implant
1 year showing stable results and complete almost complete augmentation
components23
root coverage. of the defect.

•• Production of an adequately sized graft is not always possible.
•• Patient morbidity is increased due to the existence of a
second surgical site.
Surgical considerations and harvesting
techniques
Edel first described the technique of harvesting SCTGs from the
palate to increase the width of the attached gingiva.10 Subsequently,
various techniques for harvesting the graft from different oral
sites have been proposed. Intraoral donor sites selected for SCTG
harvesting must offer adequate obtainable tissue. SCTGs are most
commonly harvested from the palatal mucosa, but other areas,
such as the maxillary tuberosity, can also be utilized.26
The maximum amount of SCTG can be harvested from a
U-shaped palatal vault. Soft tissues that extend about 2-4 mm
from the cementoenamel junction of maxillary posterior teeth
contain a dense lamina propria; beyond this region, glandular
structures and submucosa are encountered.27 SCTGs from the
posterior palate are usually denser but limited in size, whereas
SCTGs from the anterior palate are loose in consistency but
can be larger.4 Clinical experience recommends that SCTGs
be harvested from the posterior part of the palate when better
volume stability over time is desirable, such as in soft tissue
augmentation procedures. On the other hand, this type of
graft seems to be more sensitive to the local blood supply for
its revascularization.4

www.agd.org/generaldentistry e29
The versatile subepithelial connective tissue graft: a literature update
Table 1. Techniques for harvesting a subepithelial connective tissue graft (SCTG) from the palate.
Author (year)
Edel (1974) 10
Langer & Calagna (1980)8
Langer & Langer (1985)11
Raetzke (1985)29
Harris (1992)30
Hürzeler & Weng (1999)6
Bruno (1994)31
Lorenzana & Allen (2000)32
Del Pizzo et al (2002)33
Bosco & Bosco (2007)34
Ribeiro et al (2008)35
McLeod et al (2009)36
e30 GENERAL DENTISTRY November/December 2016
Harvesting technique
Trapdoor technique. The palatal portion opposite to the molars is selected for harvesting the graft. A
primary incision is made along the long axis of the teeth, near the gingival margin. A total of 1 horizontal
and 2 vertical incisions are made, the flap is raised, and the graft is harvested. The undersurface of an
edentulous region can also be used for harvesting the graft. Complete wound closure is achieved (Fig 3).
If the periodontium is normal, a horizontal bevel incision is made on the palate 1 mm apical to the free
gingival margin of the posterior teeth. This is followed by vertical incisions at either end, and the graft is
harvested from the palatal side (Fig 4).
In the presence of periodontal pockets, an internal bevel flap is created for pocket elimination. From
the excised pocket wall, connective tissue and epithelium are recovered. The band of epithelium in the
harvested tissue is discarded, while connective tissue is retained.
A rectangular design, with 2 horizontal and 2 vertical incisions, results in an SCTG with an epithelial
collar of 1.5-2.0 mm in width (Fig 5).
This technique employs no vertical incisions but 2 converging horizontal, crescent-shaped incisions that
intersect deep within the palate, just shy of bone, producing a wedge of SCTG with an epithelial collar
(Fig 6).
Graft knife technique/Harris double-blade technique. In this modification of the original trapdoor
technique, a graft knife is used to elevate a split-thickness flap, which is attached to the palate distally.
The knife is then pulled mesially under the trapdoor flap, starting at the distal edge of the connective
tissue, to elevate an SCTG. The technique can be simplified by utilizing a Harris double-bladed graft knife,
an instrument with two blades mounted 1.5 mm apart.
Single-incision technique. A single horizontal incision is made on the palate, 2 mm from marginal
gingiva. Initially the blade is angled to 90 degrees, and then it is angled to 135 degrees to undermine the
flap. The SCTG is removed by making the incision to the bone on all sides of the uncovered SCTG.
This approach has several advantages: Sloughing of epithelium due to an unfavorable relationship
between the flap base and pedicle length will be avoided, postoperative healing is better, and patient
morbidity is decreased.4
Double-incision technique. The first incision is made perpendicular to the long axis of the teeth about
2-3 mm apical to the gingival margin of the maxillary teeth, falling just short of the bone. The second
incision is made parallel to the long axis of the teeth but 1-2 mm apical to the first incision. A small
periosteal elevator is used to raise a full-thickness periosteal SCTG (Fig 7).
This method is similar to the technique described by Hürzeler & Weng, except that vertical (mesial
and distal) and medial incisions are not made to relieve the graft.6 Instead, careful manipulation of the
graft with Corn suture pliers or other delicate tissue forceps is required. Care must be taken to prevent
compression or tearing of the graft.
A single incision for access is extended up to the bone perpendicular to the palatal tissue surface. Through
this incision, a split-thickness dissection is made parallel to the long axis of the teeth to dissect the graft
from underlying bone and superficial tissues. No blunt dissection with periosteal elevator is made, leaving
the periosteum on the bone surface. This approach aids in the formation of granulation tissue at the
wound and hastens the repair of the palatal donor site.
A split-thickness flap is raised from the edges of a 1.5-mm incision, keeping the periosteum intact. A thick
graft, consisting of the epithelium and connective tissue, is harvested. The graft is placed on a sterile cloth
and bisected. One of the resulting grafts consists of epithelium with connective tissue, while the other
consists only of connective tissue. The epithelial graft is repositioned at the donor site like a free gingival
graft and periodontal dressing is placed, with or without compression sutures.
A single-incision technique is used to harvest the SCTG with maximum thickness so that it can be split
cross-sectionally. However, the graft is not divided completely into 2 parts; therefore, it is almost double
the length of the original graft and has a thickness of approximately 1.5 mm.
A sharp back-action periodontal surgical chisel is used to deepithelialize the palatal donor site from the
mesial aspect of the canine to the distal aspect of the first molar. After deepithelialization, the SCTG is
harvested with a surgical blade in the manner used to harvest a conventional free gingival graft.
A B A B

Fig 3. Trapdoor technique for connective tissue graft harvesting.10 Fig 4. Langer & Calagna technique for connective tissue graft
A. Harvest site. B. Surgical closure. harvesting. 8 A. Harvest site. B. Surgical closure.

Fig 5. Langer & Langer technique for graft Fig 6. Graft harvested by the Raetzke
harvesting.11 technique. 29

A B C

Fig 7. Bruno double-incision technique. 31 A. Parallel incisions. B. Harvesting of connective tissue. C. Surgical stabilization of the harvested
site with a hemostatic agent.

The various harvesting techniques that have been proposed
result in different graft characteristics, in terms of both size and
histologic composition. Clinically it is sometimes difficult to
obtain an adequate graft, which has necessitated the invention
of new or modified harvesting techniques and led to contin-
ued research. The techniques used to harvest SCTGs differ in
number and type of surface incisions, ways to gain access to
the graft, and flap designs. Flap design depends on the quantity
and quality of masticatory mucosal tissues and their vascularity;
therefore, the flap design represents a 3-dimensional tissue in
which the wound bed and flap tissue are independent.1
Each SCTG procedure has pros and cons, and the tech-
nique selected depends on various parameters, such as the
goal of the procedure, expected morbidity, existing anatomi-
cal limitations, and the surgeon’s expertise.1 Liu & Weisgold
have proposed a classification for graft harvesting from the
palate, based on the number of incisions.28 Various tech-
niques for graft harvesting, by donor site, are summarized in
Tables 1 and 2.6,8,10,11,26,29-38
The main disadvantage of harvesting techniques that result in
an SCTG that include a part of epithelium is that the epithelium
has negative consequences for the esthetic treatment outcomes.

www.agd.org/generaldentistry e31
The versatile subepithelial connective tissue graft: a literature update
Table 2. Techniques for harvesting a subepithelial connective
tissue graft (SCTG) from the tuberosity.
Author (year) Harvesting technique
Hirsch et al The SCTG is harvested from the tuberosity
(2001)26 region as a combined procedure of pocket
reduction and esthetic root coverage. When
the 2 approaches are combined like this, it
eliminates the need for a second surgical site.
Jung et al The authors advocate use of an SCTG from the
(2008)37 tuberosity area, obtained by gingivectomy.
The donor soft tissue is deepithelialized and
trimmed. This technique results in fewer
complications, rapid hemostasis, and minimal
tissue contraction (dense connective tissue)
of the graft; tissue contraction commonly
occurs with palatal grafts.
Zuhr & Hürzeler Two converging incisions are made as far
(2012)38 distal to the last molar as possible while
remaining within the masticatory mucosa.
The incisions are perpendicular to the
tissue surface and 1.0-1.5 mm deep. Then
a partial-thickness incision is made buccally
and palatally, up to the mesial surface of
the last molar, to yield a uniform partial-
thickness flap. A supraperiosteal incision
is made, and a wedge-shaped SCTG is
removed by sharp dissection.
Complications and failure
Certain complications that may lead to graft failure have been
reported.1,39-47 These complications can be related to either the
donor site or the recipient site (Box 3). The various causes of
failure of the graft or failure to achieve root coverage are sum-
marized in Box 4.
Future research
A number of aspects of SCTGs require additional research. A
detailed understanding of the healing characteristics of SCTGs
placed at restored teeth or implant surfaces and the long-term
volume stability resulting from different techniques and from
grafts taken from different areas of the palate is essential.1
Moreover, the biological effects of SCTGs in various clinical
indications and the effects of combining SCTGs with bioactive
substances still need to be evaluated with standardized long-
term clinical trials.1
Conclusion
The unique nature of this tissue enables its use in multiple clini-
cal scenarios. The easy availability, low cost, and proven efficacy
e32 GENERAL DENTISTRY November/December 2016
Box 3. Potential complications of the subepithelial connective
tissue graft.
Donor site complications39
• Necrosis of graft and palatal site
• Pain and excessive hemorrhage
• Protracted discomfort
• Increased chances of infection at donor site
• In rare cases, loss of sensation in palate
Recipient site complications
• Postsurgical swelling and ecchymosis40
• External root resorption41
• Gingival cysts42
• Gingival soft tissue abscess42
• Exostosis43
• Graft loss40
• Epithelial cell discharge44
• Reaction to suture material45
• Gingival cul-de-sac defects46
• Suturing under tension, thereby impinging on microcirculation1
Box 4. Causes of subepithelial connective tissue graft failure or
failure to provide root coverage.47
• Insufficient height of interdental bone
• Reflection of all interdental papilla
• Horizontal incision placed apical to cementoenamel junction
• Flap penetration
• Graft that is too thick or too thin
• Tension in graft
• Ineffective postsurgical biofilm control during healing
• Inadequate height and thickness of keratinized tissue1
of SCTGs compared to other regenerative techniques have made
this a valuable approach to periodontal plastic surgery. Since the
surgical procedure is technically demanding, the clinician has
to be well versed in diverse aspects of the procedure, including
handling of the tissue, knowing the potential limitations, and
avoiding complications associated with the technique.
Author information
Dr Karthikeyan B.V. is an associate professor, Dr Khanna is a
postgraduate student, Dr Chowdhary is a senior research fellow,
and Dr Prabhuji M.L.V. is a professor and the head, Department
of Periodontology, Krishnadevaraya College of Dental Sciences
& Hospital, Rajiv Gandhi University of Health Sciences,
Bangalore, India.
References
1. Sanz M, Simion M; Working Group 3 of the European Workshop on Periodontology. Surgical
techniques on periodontal plastic surgery and soft tissue regeneration: consensus report
of Group 3 of the 10th European Workshop on Periodontology. J Clin Periodontol. 2014;
41(Suppl 15):S92-S97.
2. Berns JM. Understanding Periodontal Diseases. 2nd ed. Hanover Park, IL: Quintessence; 1993.
 3. Harris RJ. Successful root coverage: a human histologic evaluation of a case. Int J Periodontics
Restorative Dent. 1999;19(5):439-447.
4. Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic perio-
dontal and implant surgery: critical elements in design and execution. J Clin Periodontol.
2014;41(Suppl 15):S123-S142.
5. Harris RJ. A comparison of two techniques for obtaining a connective tissue graft from the
palate. Int J Periodontics Restorative Dent. 1997;17(3):260-271.
6. Hürzeler MB, Weng D. A single-incision technique to harvest subepithelial connective tissue
grafts from the palate. Int J Periodontics Restorative Dent. 1999;19(3):279-287.
7. Bouchard P, Malet J, Borghetti A. Decision-making in aesthetics: root coverage revisited.
Periodontol 2000. 2001;27:97-120.
8. Langer B, Calagna L. The subepithelial connective tissue graft. J Prosthet Dent. 1980;44(4):
363-367.
9. Langer B, Calagna LJ. The subepithelial connective tissue graft. A new approach to the en-
hancement of anterior cosmetics. Int J Periodontics Restorative Dent. 1982;2(2):22-33.
10. Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of kera-
tinised gingiva. J Clin Periodontol. 1974;1(4):185-196.
11. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Perio-
dontol. 1985;56(12):715-720.
12. Steiner GG, Pearson JK, Ainamo J. Changes of the marginal periodontium as a result of labial
tooth movement in monkeys. J Periodontol. 1981;52(6):314-320.
13. Wennström JL, Lindhe J, Sinclair F, Thilander B. Some periodontal tissue reactions to orth-
odontic tooth movement in monkeys. J Clin Periodontol. 1987;14(3):121-129.
14. Ericsson I, Lindhe J. Recession in sites with inadequate width of the keratinized gingiva. An
experimental study in the dog. J Clin Periodontol. 1984;11(2):95-103.
15. Khoury F, Happe A. The palatal subepithelial connective tissue flap method for soft tissue
management to cover maxillary defects: a clinical report. Int J Oral Maxillofac Implants.
2000;15(3):415-418.
16. Carnio J. Surgical reconstruction of interdental papilla using an interposed subepithelial con-
nective tissue graft: a case report. Int J Periodontics Restorative Dent. 2004;24(1):31-37.
17. Nemcovsky CE. Interproximal papilla augmentation procedure: a novel surgical approach and
clinical evaluation of 10 consecutive procedures. Int J Periodontics Restorative Dent. 2001;
21(6):553-559.
18. Nordland WP, Sandhu HS, Perio C. Microsurgical technique for augmentation of the interden-
tal papilla: three case reports. Int J Periodontics Restorative Dent. 2008;28(6):543-549.
19. Silverstein LH, Kurtzman D, Garnick JJ, Trager PS, Waters PK. Connective tissue grafting for
improved implant esthetics: clinical technique. Implant Dent. 1994;3(4):231-234.
20. Kahn S, Egreja AM, Barceleiro Mde O. Subepithelial connective tissue graft associated with
apicoectomy and root-end fillings in the treatment of deep localized gingival recession with
apex root exposure: case report. Int J Periodontics Restorative Dent. 2009;29(4):445-449.
21. Nelson SW. Subperiosteal and intraosseous connective tissue grafts for pocket reduction: a
9- to 13-year retrospective case series report. J Periodontol. 2001;72(10):1424-1435.
22. Phillips GE, John V. Use of a subepithelial connective tissue graft to treat an area pigmented
with graphite. J Periodontol. 2005;76(9):1572-1575.
23. Jung RE, Sailer I, Hämmerle CH, Attin T, Schmidlin P. In vitro color changes of soft tissues
caused by restorative materials. Int J Periodontics Restorative Dent. 2007;27(3):251-257.
24. Müller HP, Eger T. Masticatory mucosa and periodontal phenotype: a review. Int J Periodon-
tics Restorative Dent. 2002;22(2):172-183.
25. Reiser GM, Bruno JF, Mahan PE, Larkin LH. The subepithelial connective tissue graft palatal
donor site: anatomic considerations for surgeons. Int J Periodontics Restorative Dent. 1996;
16(2):130-137.
View publication stats
26. Hirsch A, Attal U, Chai E, Goultschin J, Boyan BD, Schwartz Z. Root coverage and pocket
reduction as combined surgical procedures. J Periodontol. 2001;72(11):1572-1579.
27. Sears SB, Rosenberg FA. Oral anatomy of clinical importance in periodontal and restorative
therapy. Int J Periodontics Restorative Dent. 1981;1(4):60-69.
28. Liu CL, Weisgold AS. Connective tissue graft: a classification for incision design from the pala-
tal site and clinical case reports. Int J Periodontics Restorative Dent. 2002;22(4):373-379.
29. Raetzke PB. Covering localized areas of root exposure employing the “envelope” technique. J
Periodontol. 1985;56(7):397-402.
30. Harris RJ. The connective tissue and partial thickness double pedicle graft: a predictable
method of obtaining root coverage. J Periodontol. 1992;63(5):477-486.
31. Bruno JF. Connective tissue graft technique assuring wide root coverage. Int J Periodontics
Restorative Dent. 1994;14(2):126-137.
32. Lorenzana ER, Allen EP. The single-incision palatal harvest technique: a strategy for esthetics
and patient comfort. Int J Periodontics Restorative Dent. 2000;20(3):297-305.
33. Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R. The connective tissue graft: a com-
parative clinical evaluation of wound healing at the palatal donor site. A preliminary study.
J Clin Periodontol. 2002;29(9):848-854.
34. Bosco AF, Bosco JM. An alternative technique to the harvesting of a connective tissue graft
from a thin palate: enhanced wound healing. Int J Periodontics Restorative Dent. 2007;27(2):
133-139.
35. Ribeiro FS, Zandim DL, Pontes AE, Mantovani RV, Sampaio JE, Marcantonio E. Tunnel tech-
nique with a surgical maneuver to increase the graft extension: case report with a 3-year fol-
low-up. J Periodontol. 2008;79(4):753-758.
36. McLeod DE, Reyes E, Branch-Mays G. Treatment of multiple areas of gingival recession using
a simple harvesting technique for autogenous connective tissue graft. J Periodontol. 2009;
80(10):1680-1687.
37. Jung UW, Um YJ, Choi SH. Histologic observation of soft tissue acquired from maxillary
tuberosity area for root coverage. J Periodontol. 2008;79(5):934-940.
38. Zuhr O, Hürzeler M. Plastic-Esthetic Periodontal and Implant Surgery: A Microsurgical Ap-
proach. Hanover Park, IL: Quintessence; 2012.
39. Petrungaro P. Using platelet rich plasma to accelerate soft tissue maturation in esthetic perio-
dontal surgery. Compend Contin Educ Dent. 2001;22(9):729-732, 734, 736 passim.
40. Müller HP, Stahl M, Eger T. Root coverage employing an envelope technique or guided tissue
regeneration with a bioabsorbable membrane. J Periodontol. 1999;70(7):743-751.
41. Hokett SD, Peacock ME, Burns WT, Swiec GD, Cuenin MF. External root resorption following
partial-thickness connective tissue graft placement: a case report. J Periodontol. 2002;73(3):
334-339.
42. Breault LG, Billman MA, Lewis DM. Report of a gingival “surgical cyst” developing secondarily
to a subepithelial connective tissue graft. J Periodontol. 1997;68(4):392-395.
43. Corsair AJ, Iacono VJ, Moss SS. Exostosis following a subepithelial connective tissue graft.
J Int Acad Periodontol. 2001;3(2):38-41.
44. Parashis AO, Tatakis DN. Subepithelial connective tissue graft for root coverage: a case report
of an unusual late complication of epithelial origin. J Periodontol. 2007;78(10):2051-2056.
45. Vastardis S, Yukna RA. Gingival/soft tissue abscess following subepithelial connective tissue
graft for root coverage: report of three cases. J Periodontol. 2003;74(11):1676-1681.
46. Wei PC, Geivelis M. A gingival cul-de-sac following a root coverage procedure with a subepi-
thelial connective tissue submerged graft. J Periodontol. 2003;74(9):1376-1380.
47. Langer L, Langer B. Mucogingival surgery: esthetic treatment of gingival recession. Clinical
application. In: Wilson TG, Kornman KS, Newman MG, eds. Advances in Periodontics. Hanover
Park, IL: Quintessence; 1992:248-260.
www.agd.org/generaldentistry e33