A technique for obtaining thin split-thickness grafts in periodontal surgery

Abstract

I n 1869 Reverdin’ wrote of successfully transplanting small islands of epidermis onto a large granulating wound in order to speed the healing process. Since that time epidermal grafting has become a common plastic surgical procedure for hastening wound closure, but it has been used little for that purpose in periodontics. In recent years soft-tissue autografts have been advocated for periodontal surgical procedures. In 1963 Bjorn described a gingival transplantation procedure,2 and in 1964 King and Penne13 reported successful results with a free palatal graft placed on the facia.1 surface of a tooth with a denuded root surface. Other authors have reported using free mucosal autografts in vestibular extension procedures and to increase the zone of attached gingiva.4-8 In 1966 Nabersg reported that epithelial grafts placed on gingivectomy wound sites resulted in a marked increase in the rate of healing with a concomitant reduction in postoperative discomfort. He questioned the clinical value of this procedure, however, because of difficulties encountered in obtaining tissue of proper thickness and in placement and fixation of the free graft. Sullivan and Atkins2 recently reviewed the principles and technique of successful free autogenous gingival grafting. They did not consider the thin split-thickness graft, however, because of the inability to remove thin grafts consistently due to problems with tissue contour, poor access, and bulky instruments. Free grafts are classified as either full-thickness or split-thickness grafts. A full-thickness graft, by definition, consists of the epithelium and the entire zone of lamina propria. Split-thickness grafts are those containing epithelium and less than the full thickness of lamina propria. Split-thickness grafts are subdivided, according to the width of lamina propria included in