INTRODUCTION
Autologous soft tissue grafts were first used for keratinized tissue (KT) augmentation around teeth. They have been considered an excellent alternative to tissue regeneration materials for their stable, long-term results.
AIM
This review aims to compare soft tissue grafts harvested from two different donor sites—the maxillary tuberosity and the hard palate, evaluate their advantages and disadvantages, and summarize the indications and limitations for their use.
MATERIALS AND METHODS
An electronic search using PubMed, Web of Science, Scopus, and Google Scholar databases was conducted until June 2024. This review includes 32 articles. It summarizes the knowledge on soft tissue grafts harvested from the hard palate and maxillary tuberosity.
RESULTS AND DISCUSSION
The palate and the maxillary tuberosity are the most common donor sites for soft tissue grafting in the oral cavity. They have various applications, such as soft tissue augmentation around teeth and implants, treatment of gingival recessions, and peri-implant dehiscence, and recently they have been suggested as a method for alveolar ridge preservation. The main differences between these grafts are their availability and structural and histological features.
CONCLUSION
The present review summarizes the advantages, disadvantages, applications, and limitations of soft tissue grafts harvested from the palate and the maxillary tuberosity. Various clinical assessments and histological and molecular analyses have highlighted their differences in structure and behavior.Goyal L, Gupta ND, Gupta N, Chawla K. Free Gingival Graft as a Single Step Procedure for Treatment of Mandibular Miller Class I and II Recession Defects. World J Plast Surg. 2019;8(1):12-17. doi: 10.29252/wjps.8.1.12.
Tavelli L, Barootchi S, Greenwell H, Wang HL. Is a soft tissue graft harvested from the maxillary tuberosity the approach of choice in an isolated site? J Periodontol. 2019;90(8):821-5. doi: 10.1002/JPER.18-0615.
Karring T, Lang NP, Löe H. The role of gingival connective tissue in determining epithelial differentiation. J Periodontal Res. 1975;10(1):1-11. doi: 10.1111/j.1600-0765.1975.tb00001.x.
Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics. 1968;6(3):121-9.
Sculean A, Gruber R, Bosshardt DD. Soft tissue wound healing around teeth and dental implants. J Clin Periodontol. 2014;41 Suppl 15:S6-22. doi: 10.1111/jcpe.12206.
Thoma DS, Buranawat B, Hämmerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol. 2014;41 Suppl 15:S77-91. doi: 10.1111/jcpe.12220.
Aldhanhani H, Kukreja BJ, Reddy S, D'souza J, Abdelmagyd H. Determination of Palatal Soft Tissue Thickness and Safe Zone for Palatal Soft Tissue Harvest Using CBCT: A Retrospective Study. Int J Dent. 2023;2023:8417073. doi: 10.1155/2023/8417073.
Zecca PA, Ronchetti A, Cangelosi D, Reguzzoni M, Farronato D. Histological Analysis of Oral Tissue Grafting: A Focus on Donor Site Selection. Dent J (Basel). 2024;12(9):288. doi: 10.3390/dj12090288.
Dellavia C, Ricci G, Pettinari L, Allievi C, Grizzi F, Gagliano N. Human palatal and tuberosity mucosa as donor sites for ridge augmentation. Int J Periodontics Restorative Dent. 2014;34(2):179-86. doi: 10.11607/prd.1929.
Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014;41 Suppl 15:S123-42. doi: 10.1111/jcpe.12185.
Roccuzzo M, Grasso G, Dalmasso P. Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study. Clin Oral Implants Res. 2016;27(4):491-6. doi: 10.1111/clr.12563.
Zucchelli G, Mazzotti C, Mounssif I, Mele M, Stefanini M, Montebugnoli L. A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant. Clin Oral Implants Res. 2013;24(9):957-62. doi: 10.1111/clr.12003.
Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol. 2010;37(8):728-38. doi: 10.1111/j.1600-051X.2010.01550.x.
Amin PN, Bissada NF, Ricchetti PA, Silva APB, Demko CA. Tuberosity versus palatal donor sites for soft tissue grafting: A split-mouth clinical study. Quintessence Int. 2018;49(7):589-98. doi: 10.3290/j.qi.a40510.
Studer SP, Allen EP, Rees TC, Kouba A. The thickness of masticatory mucosa in the human hard palate and tuberosity as potential donor sites for ridge augmentation procedures. J Periodontol. 1997;68(2):145-51. doi: 10.1902/jop.1997.68.2.145.
Sanz-Martín I, Rojo E, Maldonado E, Stroppa G, Nart J, Sanz M. Structural and histological differences between connective tissue grafts harvested from the lateral palatal mucosa or from the tuberosity area. Clin Oral Investig. 2019;23(2):957-964. doi: 10.1007/s00784-018-2516-9.
Bertl K, Pifl M, Hirtler L, Rendl B, Nürnberger S, Stavropoulos A, Ulm C. Relative composition of fibrous connective and fatty/glandular tissue in connective tissue grafts depends on the harvesting technique but not the donor site of the hard palate. J Periodontol. 2015;86(12):1331-9. doi: 10.1902/jop.2015.150346.
Harris RJ. Histologic evaluation of connective tissue grafts in humans. Int J Periodontics Restorative Dent. 2003;23(6):575-83.
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):1572-9. doi: 10.1902/jop.2001.72.11.1572.
Rojo E, Stroppa G, Sanz-Martin I, Gonzalez-Martín O, Alemany AS, Nart J. Soft tissue volume gain around dental implants using autogenous subepithelial connective tissue grafts harvested from the lateral palate or tuberosity area. A randomized controlled clinical study. J Clin Periodontol. 2018;45(4):495-503. doi: 10.1111/jcpe.12869. Epub 2018 Feb 23.
Cosyn J, Eghbali A, Hermans A, Vervaeke S, De Bruyn H, Cleymaet R. A 5-year prospective study on single immediate implants in the aesthetic zone. J Clin Periodontol. 2016;43(8):702-9. doi: 10.1111/jcpe.12571.
Zuiderveld EG, Meijer HJA, den Hartog L, Vissink A, Raghoebar GM. Effect of connective tissue grafting on peri-implant tissue in single immediate implant sites: A RCT. J Clin Periodontol. 2018;45(2):253-64. doi: 10.1111/jcpe.12820.
Jung UW, Um YJ, Choi SH. Histologic observation of soft tissue acquired from maxillary tuberosity area for root coverage. J Periodontol. 2008;79(5):934-40. doi: 10.1902/jop.2008.070445.
Roccuzzo M, Gaudioso L, Bunino M, Dalmasso P. Surgical treatment of buccal soft tissue recessions around single implants: 1-year results from a prospective pilot study. Clin Oral Implants Res. 2014;25(6):641-6. doi: 10.1111/clr.12149.
Burkhardt R, Joss A, Lang NP. Soft tissue dehiscence coverage around endosseous implants: a prospective cohort study. Clin Oral Implants Res. 2008;19(5):451-7. doi: 10.1111/j.1600-0501.2007.01497.x.
Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative complications following gingival augmentation procedures. J Periodontol. 2006;77(12):2070-9. doi: 10.1902/jop.2006.050296.
Wessel JR, Tatakis DN. Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol. 2008;79(3):425-30. doi: 10.1902/jop.2008.070325.
Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R. The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site. A preliminary study. J Clin Periodontol. 2002;29(9):848-54. doi: 10.1034/j.1600-051x.2002.290910.x.
Burkhardt R, Hämmerle CH, Lang NP; Research Group on Oral Soft Tissue Biology & Wound Healing. Self-reported pain perception of patients after mucosal graft harvesting in the palatal area. J Clin Periodontol. 2015;42(3):281-7. doi: 10.1111/jcpe.12357.
Kotsailidi EA, Tatakis DN, Chen YW, Caton JG, Ercoli C, Barmak AB, Tsigarida A. Comparison of maxillary tuberosity and palatal donor sites for soft tissue augmentation at implant placement: A pilot controlled clinical study. Int J Oral Implantol (Berl). 2022;15(4):353-65.
Zufía J, Blasi G, Gómez-Meda R, Blasi A. The four-layer graft technique, a hard and soft tissue graft from the tuberosity in one piece. J Esthet Restor Dent. 2019;31(4):304-10. doi: 10.1111/jerd.12480.
Younes R, Khairallah CM. The "One Piece" Autologous Tuberosity Graft: A Contemporary Concept in Ridge Preservation. Case Rep Dent. 2020;2020:3945076. doi: 10.1155/2020/3945076.