dentistry Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of ...

, the subepithelial connective tissue graft (SECT graft, and sometimes referred to simply as a ''connective tissue (CT) graft'') is an oral and maxillofacial surgical procedure first described by Alan Edel in 1974. Currently, it is generally used to obtain root coverage following

gingival recession Gingival recession, also known as receding gums, is the exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crown of the teeth.free gingival graft A free gingival graft is a type of gingival grafting performed to correct acquired deficiencies of the gum tissue around teeth or dental implants. Besides autologous tissues, xenogeneic collagen matrices are using for gingival augmentation after d ...

, the SECT graft can be described as a free autogenous graft. * The term free describes how the graft is completely removed from the donor site rather than remaining attached via a pedicle. * The term autogenous, from the

Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...

root ''auto-'' ("self"), describes how the individual who receives the graft is the same individual who provides the donor tissue. The connective tissue is generally taken from the

hard palate The hard palate is a thin horizontal bony plate made up of two bones of the facial skeleton, located in the roof of the mouth. The bones are the palatine process of the maxilla and the horizontal plate of palatine bone. The hard palate spans t ...

, although it may be taken from other sites as well, such as the maxillary tuberosity area. Because the

connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...

for the graft is transplanted without the superficial

epithelium Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellul ...

from the donor site, it is termed ''subepithelial''.

History

As initially described by Edel, the treatment objective was to increase the zone of keratinized tissue. Others, including Broome and Taggert and Donn also described the use of SECT grafts for increasing the zone of keratinized tissue. Of the various ways of preparing the graft recipient site, Edel described using two vertical incisions,

mesial This is a list of definitions of commonly used terms of location and direction in dentistry. This set of terms provides orientation within the oral cavity, much as anatomical terms of location provide orientation throughout the body. Terms ...

and

distal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

to the teeth at which the zone of keratinized tissue was intended to be widened. Subepithelial graft

At the donor site, Edel described three methods for choosing and preparing the donor site to obtain connective tissue for the SECT graft: # palatal partial thickness flap # palatal full-partial thickness flap # tuberosity partial thickness flap Contrary to the donor site for a

free gingival graft A free gingival graft is a type of gingival grafting performed to correct acquired deficiencies of the gum tissue around teeth or dental implants. Besides autologous tissues, xenogeneic collagen matrices are using for gingival augmentation after d ...

, the surgeon is able to achieve primary closure at the donor site for a SECT. Langer later described the SECT as a method by which to augment concavities and irregularities of the alveolar ridge following traumatic extractions, advanced

periodontitis Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cau ...

or developmental defects. Currently, though, such augmentation of hard tissue defects tends to be done with hard tissue replacements, namely bone graft materials. However, it was only in 1985 that Langer proposed the SECT for root coverage following

Advantages

The SECT graft is a sort of hybrid procedure that combines the pedicle flap with the

and enjoys the benefits of both. Pedicle flaps alone, such as the coronally advanced flap, frequently suffer from retraction and muscle pull.

Technique

Although there are various ways in which to carry out this procedure, all share a common sequence of steps: # Prepare the recipient site of tissue exhibiting recession by incising the gingivae # Obtain the SECT from the donor site # Secure the SECT at the recipient site # Suture the incised gingival tissue at both the donor and recipient sites The donor site might be sutured closed either before or after securing the donor tissue to the recipient site

References

{{Periodontology Dentistry