Soft Tissue Graft: a clinical guide step by step

Pedicle Graft: When and How to Use It

The pedicle graft is a periodontal surgical technique used to treat gum recession by repositioning adjacent healthy gum tissue over the exposed root. Unlike other grafting methods that require tissue to be harvested from a different site (such as the palate), the pedicle graft utilizes the patient’s own gum tissue from the surrounding area. This technique is most suitable for patients who have enough adjacent gum tissue near the recession site.

1. The Procedure

The pedicle graft involves carefully mobilizing nearby gum tissue, known as the "pedicle," and repositioning it to cover the exposed root. Here’s how the process works:

• Incision: The periodontist creates a partial incision around the area of healthy gum tissue adjacent to the recession. This tissue is left attached at one end to maintain its blood supply.
• Repositioning the Tissue: The pedicle tissue is then gently pulled or "slid" over the area of exposed root and sutured into place. Because the blood supply remains intact, the healing process is typically quicker compared to other grafting methods.
• Stabilization: Sutures are placed to secure the pedicle graft in its new position, ensuring that it stays in place while healing.

2. Advantages of Pedicle Grafts

• No Second Surgical Site: Unlike connective tissue grafts or free gingival grafts, the pedicle graft does not require tissue to be harvested from another part of the mouth, such as the palate. This reduces patient discomfort and eliminates the need for a second surgical site.
• Quicker Healing Time: Since the blood supply to the grafted tissue is maintained, healing is generally faster than with other grafting techniques that rely on newly transplanted tissue.
• High Success Rate: When performed in ideal conditions, pedicle grafts provide effective root coverage and long-lasting results.
• Aesthetic Results: The use of local tissue allows for a natural appearance, as the graft blends seamlessly with the surrounding gums.

3. When to Use a Pedicle Graft

Pedicle grafts are most appropriate for specific cases where the surrounding gum tissue is healthy and sufficient. Ideal indications for this technique include:

• Localized Recession: Pedicle grafts are typically used for localized areas of gum recession affecting one or two teeth. For widespread recession, other grafting techniques may be more appropriate.
• Ample Adjacent Gum Tissue: The key to the success of a pedicle graft is the availability of healthy gum tissue near the recession site. If the adjacent tissue is thin or compromised, other grafting methods may be required.
• Patients with High Aesthetic Needs: Since pedicle grafts use local tissue, the aesthetic result is often superior, making this technique ideal for patients who are particularly concerned about the appearance of their gum line.

4. Limitations of Pedicle Grafts

While the pedicle graft offers several advantages, it also has some limitations that must be considered:

• Limited Application: The technique is only viable when there is an abundance of healthy tissue near the area of recession. In cases of generalized recession or insufficient adjacent tissue, this method cannot be used.
• Technical Difficulty: The pedicle graft is a technically demanding procedure that requires precise surgical skill to ensure that the tissue remains attached to its blood supply and is properly repositioned.

5. Post-Operative Care for Pedicle Grafts

After the procedure, patients need to follow specific care instructions to ensure successful healing and minimize the risk of complications:

• Avoid Disturbing the Graft: Patients should avoid brushing the grafted area for at least 1-2 weeks post-surgery. Instead, they may use a soft antibacterial mouthwash to keep the area clean.
• Dietary Restrictions: A soft food diet is recommended for the first week to prevent trauma to the surgical site. Foods like yogurt, mashed potatoes, and soups are ideal.
• Smoking Cessation: Patients who smoke should stop during the healing period, as smoking can delay healing and increase the risk of graft failure.

6. Long-Term Success and Outcomes

Pedicle grafts are highly successful when applied under the right conditions. Because the graft maintains its blood supply, it tends to integrate well with the surrounding tissue, providing durable root coverage and enhancing both function and appearance. Long-term studies show stable results, particularly when patients adhere to proper oral hygiene practices and attend regular dental check-ups.

Post-Operative Care for Soft Tissue Grafts

Post-operative care is critical to the success of soft tissue grafting procedures, ensuring proper healing and long-term stability of the graft. Patients need to follow specific instructions to avoid disturbing the grafted tissue, reduce discomfort, and prevent complications. Below are the key aspects of post-operative care following soft tissue graft procedures:

1. Oral Hygiene

After a soft tissue graft, maintaining oral hygiene is essential, but special precautions must be taken around the grafted area to prevent disruption of the healing process:

• Avoid Brushing the Grafted Area: Patients should avoid brushing the graft site for the first 1-2 weeks. Aggressive brushing or flossing can dislodge the graft and interfere with healing.
• Use Antibacterial Mouthwash: To keep the area clean without disturbing the graft, dentists often recommend using a prescribed antimicrobial or antibacterial mouthwash (such as chlorhexidine). This helps prevent infection and keeps harmful bacteria in check during the healing process.
• Brush the Unaffected Areas: It is important to continue brushing the rest of the mouth, avoiding the grafted area, to maintain overall oral hygiene.

2. Dietary Modifications

Patients should modify their diet to avoid irritating or damaging the graft. Certain foods and eating habits can slow healing or increase discomfort:

• Soft Diet: A soft diet is recommended for the first 1-2 weeks. Foods like yogurt, scrambled eggs, mashed potatoes, soups, and smoothies are ideal choices. Avoid hard, crunchy, or sticky foods that could dislodge or traumatize the graft.
• Avoid Hot and Spicy Foods: Hot or spicy foods can irritate the surgical site, leading to increased discomfort and delayed healing. Cool or lukewarm foods are recommended.
• Chew on the Opposite Side: Patients should chew on the side of the mouth opposite to the graft site to prevent disturbing the graft and causing trauma to the area.

3. Pain Management

Some discomfort and swelling are expected after soft tissue grafting, but these can be managed effectively:

• Medications: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage post-operative discomfort. In some cases, the dentist may prescribe stronger pain medications or anti-inflammatory drugs.
• Cold Compresses: Applying a cold compress or ice pack to the outside of the face near the surgical site can help reduce swelling and numb discomfort during the first 24-48 hours after the procedure. Use 10-15 minutes on, followed by 10-15 minutes off, to avoid overexposure to cold.

4. Avoiding Physical Activity

Patients should avoid strenuous physical activities, such as heavy exercise, for the first few days following surgery. Excessive activity can increase blood flow to the area, which may lead to bleeding or interfere with graft stabilization.

5. Post-Surgical Appointments

Follow-up appointments are crucial to monitor the healing progress and ensure that the graft is integrating well with the surrounding tissue:

• First Follow-Up Visit: Typically, the first follow-up appointment occurs about 1 week after the procedure. The dentist will check the grafted area, remove any sutures (if needed), and assess healing.
• Subsequent Check-Ups: Additional follow-up appointments may be scheduled to ensure long-term success. The dentist will evaluate the integration of the graft and provide ongoing care recommendations.

6. Smoking Cessation

Smoking significantly impairs healing and increases the risk of graft failure. Patients should refrain from smoking before and after the procedure to promote proper healing. Smoking reduces blood flow to the graft site, which can delay healing and compromise the success of the graft.

7. Signs of Complications

While most soft tissue grafts heal without complications, patients should be aware of potential warning signs that require immediate attention from their dentist:

• Excessive Bleeding: Some bleeding is normal, but persistent or excessive bleeding may indicate an issue with the graft. Patients should contact their dentist if this occurs.
• Severe Pain or Swelling: While mild discomfort and swelling are normal, severe or increasing pain, swelling, or fever may indicate an infection or graft failure.
• Graft Displacement: If the graft appears to shift, become loose, or detach from the surrounding tissue, patients should contact their dentist immediately for evaluation.

Success Rates and Long-Term Outcomes of Soft Tissue Grafts for Root Coverage

Soft tissue grafting is a reliable and effective treatment for managing gingival recession, with high success rates and excellent long-term outcomes when proper protocols are followed. Understanding the factors that influence success and the expectations for long-term graft stability helps both dentists and patients ensure optimal results.

1. Success Rates of Soft Tissue Grafts

Studies consistently show that soft tissue grafting, particularly connective tissue grafts, has high success rates for root coverage:

• Complete Root Coverage: Clinical research indicates that soft tissue grafting achieves complete root coverage in 80% to 100% of cases, depending on the type of graft and patient factors. Success is typically higher for isolated areas of recession compared to multiple or generalized recession sites.
• Tissue Integration: The transplanted tissue generally integrates well with the surrounding gums, blending naturally and restoring both function and appearance.
• Reduction in Root Sensitivity: Patients experience a significant reduction in root sensitivity following grafting, as the exposed root surface is covered, insulating it from external stimuli.

2. Factors Influencing Success

Several factors can influence the success rates of soft tissue grafts, including:

• Surgical Technique: The experience and skill of the dentist or periodontist performing the procedure are critical to the success of the graft. Proper preparation of the graft site, precise placement of the graft, and meticulous suturing all contribute to positive outcomes.
• Patient Health: Systemic health conditions, such as diabetes or autoimmune disorders, can affect healing and graft success. Patients with these conditions require close monitoring and may need additional precautions to ensure successful integration.
• Oral Hygiene: Post-operative care and maintaining good oral hygiene are essential for graft success. Patients who adhere to the recommended care routine have better outcomes and reduced risk of complications.
• Non-Smokers: Studies show that non-smokers have higher success rates in soft tissue grafting. Smoking impairs blood flow and delays healing, which can lead to graft failure.

3. Long-Term Outcomes

Soft tissue grafting procedures provide durable and long-lasting results when proper care is maintained. Long-term studies show that patients who undergo grafting typically enjoy several benefits over time:

• Stable Gum Line: In most cases, the grafted tissue remains stable for years after the procedure, providing long-term root coverage and preventing further gum recession.
• Improved Aesthetics: The natural appearance of the grafted tissue usually blends well with the surrounding gums, ensuring that the patient’s smile remains aesthetically pleasing. Over time, the graft matures and integrates fully with the native tissue, making the result virtually indistinguishable from the surrounding gums.
• Ongoing Root Protection: The covering of the exposed roots protects them from further wear, decay, or damage, reducing the need for future treatments related to sensitivity or root caries.

4. Patient Compliance and Maintenance

• Regular Dental Checkups: For long-term success, patients must attend regular dental checkups to monitor the health of their gums and ensure that no additional recession or periodontal issues arise.
• Good Oral Hygiene: Patients should continue to practice good oral hygiene, including gentle brushing and flossing, to prevent gum disease, which could compromise the grafted area.
• Avoiding Trauma: Habits such as aggressive brushing or using a hard-bristled toothbrush should be avoided to protect the graft and prevent further recession.

5. Potential Risks and Complications

While soft tissue grafts have a high success rate, there are some potential risks to be aware of:

• Partial Graft Failure: In some cases, part of the graft may fail to integrate fully, leading to incomplete root coverage. This can result from poor blood supply, trauma to the graft, or patient non-compliance with post-operative care instructions.
• Recurrence of Recession: Although rare, recession may recur in the long term, particularly if the underlying cause of the recession (such as aggressive brushing or untreated periodontal disease) is not addressed.

6. Outlook for Advanced Techniques

New techniques, such as minimally invasive approaches (e.g., tunnel or pinhole techniques) and the use of growth factors or biologically active materials, are enhancing the success rates and long-term outcomes of soft tissue grafting. These advances offer less invasive procedures, quicker healing times, and even better integration of grafts.

Challenges and Complications in Soft Tissue Grafting

While soft tissue grafting is a reliable and effective treatment for managing gingival recession, it comes with certain challenges and potential complications that both dentists and patients should be aware of. Understanding these risks can help in planning the procedure and managing patient expectations, ensuring optimal outcomes.

1. Graft Rejection or Failure

One of the most significant complications in soft tissue grafting is graft failure, where the transplanted tissue does not properly integrate with the surrounding gums.

• Causes: Poor blood supply, trauma to the graft site, or inadequate healing conditions can lead to graft failure. In some cases, improper handling of the graft during surgery may also contribute to rejection.
• Signs: Symptoms of graft failure include severe pain, persistent bleeding, inflammation, or necrosis (tissue death) at the graft site.
• Prevention: Ensuring meticulous surgical technique, maintaining a stable blood supply to the graft, and following proper post-operative care can significantly reduce the risk of graft rejection.

2. Infection

Infection is a common risk with any surgical procedure, and soft tissue grafting is no exception. Post-operative infections can delay healing and, in severe cases, lead to graft failure.

• Causes: Bacterial contamination of the surgical site, poor oral hygiene after the procedure, or pre-existing periodontal disease can increase the risk of infection.
• Signs: Symptoms include swelling, redness, increased pain, pus formation, and fever.
• Prevention: Maintaining a sterile surgical environment, prescribing antibiotics (if necessary), and ensuring patients follow a strict oral hygiene routine, including the use of antibacterial mouthwash, can help prevent infections.

3. Graft Shrinkage

Graft shrinkage is a complication where the grafted tissue retracts, leading to incomplete root coverage or aesthetic concerns.

• Causes: Graft shrinkage can result from poor handling of the graft, excessive tension during suturing, or compromised blood supply. Some degree of shrinkage is natural during the healing process, but excessive shrinkage may require additional treatment.
• Prevention: Using appropriate surgical techniques, ensuring minimal tension on the graft, and choosing the correct grafting material can help mitigate this risk.

4. Prolonged Healing and Discomfort

Some patients experience prolonged healing times or excessive discomfort following a soft tissue graft, which can affect overall satisfaction with the procedure.

• Causes: Underlying health conditions such as diabetes or autoimmune disorders, as well as smoking, can delay healing. In some cases, poor post-operative care or trauma to the graft site can also contribute to prolonged discomfort.
• Signs: Swelling, bleeding, and pain that persist beyond the typical healing period are indicators of delayed healing.
• Prevention: Ensuring patients follow post-operative instructions carefully, including maintaining a soft diet, avoiding smoking, and managing systemic health conditions, can promote faster healing.

5. Bleeding or Hematoma Formation

Excessive bleeding or the formation of a hematoma (a collection of blood under the tissue) can occur after the procedure, leading to discomfort or complications in healing.

• Causes: This may happen if the surgical site is not properly sutured or if the patient engages in activities that raise blood pressure, such as strenuous exercise, too soon after surgery.
• Prevention: Careful suturing, using pressure dressings if necessary, and advising patients to avoid strenuous activities for at least a few days post-surgery can help prevent bleeding complications.

6. Donor Site Complications

In procedures that require tissue to be harvested from the patient’s palate (such as a connective tissue graft or free gingival graft), the donor site may present its own set of complications:

• Pain and Discomfort: The palate can be sensitive, and patients often experience more discomfort at the donor site than at the graft site. Healing at the donor site can take several weeks.
• Infection: As with the graft site, the donor site is also at risk for infection if not properly cared for.
• Prevention: Dentists can use minimally invasive techniques to reduce the size of the donor site and prescribe pain relief and antibacterial mouth rinses to aid healing.

7. Aesthetic Concerns

In some cases, the final aesthetic outcome may not meet the patient’s expectations. While soft tissue grafting typically provides excellent aesthetic results, challenges can arise:

• Causes: Graft shrinkage, improper tissue blending, or incomplete root coverage can lead to a less-than-ideal appearance. In some cases, the color or texture of the grafted tissue may not perfectly match the surrounding gums.
• Prevention: Proper planning, technique, and communication with the patient about realistic outcomes are crucial. Dentists may also consider using adjunctive therapies like laser treatments to improve the aesthetic result.

8. Allergic Reactions to Anesthesia or Materials

Though rare, some patients may have an allergic reaction to the local anesthetics or materials (e.g., sutures) used during the procedure.

• Prevention: Taking a thorough medical history and being aware of any patient allergies can help prevent this complication. Alternative anesthetics or materials can be used if necessary.

Comparing Different Grafting Materials: Autografts vs. Allografts

When performing soft tissue grafting, periodontists have a choice of various grafting materials. The selection of graft material plays a crucial role in the success of the procedure. Two of the most commonly used materials are autografts (tissue from the patient) and allografts (donated human tissue). Each has its advantages and considerations that dentists must weigh based on the patient’s clinical needs, preferences, and overall treatment goals.

1. Autografts (Patient’s Own Tissue)

Autografts involve harvesting the patient’s own tissue, usually from the palate, and grafting it onto the site of gum recession. This is the most commonly used graft material, especially for procedures like connective tissue grafts (CTG) and free gingival grafts (FGG).

Advantages of Autografts:

• Best Biocompatibility: Since the tissue comes from the patient’s own body, there is no risk of rejection or immune response. Autografts integrate seamlessly with the surrounding gum tissue, ensuring a smooth healing process.
• Long-Term Stability: Autografts are known to provide long-lasting results, making them ideal for patients who require durable root coverage.
• High Success Rates: Numerous studies have shown that autografts yield predictable and reliable outcomes, particularly for complete root coverage and aesthetic improvement.

Disadvantages of Autografts:

• Donor Site Morbidity: The need to harvest tissue from the palate introduces additional discomfort for the patient. The donor site may be more painful and take longer to heal than the grafted area.
• Limited Supply of Tissue: Autografts are limited by the amount of tissue available at the donor site. This can pose challenges in cases requiring extensive grafting or multiple procedures.
• Prolonged Healing Time: While the recipient site typically heals well, the donor site may take several weeks to fully recover, resulting in a longer overall healing process.

Best for:

• Patients requiring single-tooth or localized root coverage.
• Individuals with good overall oral and systemic health who can tolerate the donor site healing process.
• Cases where maximum biocompatibility and aesthetic outcomes are critical.

2. Allografts (Donor Tissue)

Allografts use donated human tissue that has been processed and sterilized to ensure safety. The use of allografts has become more common as advancements in tissue processing have made these materials more widely available and reliable.

Advantages of Allografts:

• No Donor Site Required: One of the most significant benefits of allografts is the elimination of a second surgical site. Patients do not experience discomfort or healing delays related to the palate, making the recovery process easier and faster.
• Sufficient Tissue Supply: Allografts are ideal for patients who require a larger amount of tissue or multiple grafting procedures. The availability of donor tissue is not restricted by the patient’s own anatomy, making it easier to perform extensive procedures.
• Reduced Surgical Time: Because there is no need to harvest tissue, the surgery time is shortened, reducing patient discomfort and overall stress during the procedure.

Disadvantages of Allografts:

• Slightly Lower Success Rates: Although allografts are highly effective, some studies suggest that they may not achieve the same level of long-term success or complete root coverage as autografts, particularly in terms of tissue stability and aesthetics.
• Risk of Disease Transmission: Despite rigorous screening and sterilization, there is always a minimal risk of disease transmission with donor tissue, although this risk is extremely low with modern processing techniques.
• Integration Challenges: While allografts are generally well-tolerated, they may take longer to integrate with the surrounding tissue compared to autografts. In some cases, this can affect the final aesthetic outcome.

Best for:

• Patients who cannot or prefer not to undergo tissue harvesting, such as those with medical conditions that make healing more challenging.
• Cases requiring extensive grafting, multiple sites, or when the patient’s own tissue supply is insufficient.
• Individuals looking for a quicker, less invasive procedure with minimal post-operative discomfort.

3. Key Factors in Choosing Between Autografts and Allografts

• Patient Health and Preferences: The patient’s overall health, tolerance for surgery, and personal preferences play a key role in deciding between autografts and allografts. For instance, patients with bleeding disorders or compromised healing abilities may benefit more from allografts to avoid a donor site.
• Extent of the Procedure: For large or multiple areas of recession, allografts may be more practical due to the unlimited tissue availability. However, autografts are often preferred when aesthetic outcomes and complete root coverage are paramount.
• Cost Considerations: Autografts typically have lower material costs since they use the patient’s own tissue. However, the additional time and complexity of surgery may increase overall costs. Allografts, on the other hand, are commercially available but can add to the cost of the procedure due to the processing and sterilization involved.

4. Emerging Alternatives: Xenografts and Synthetic Grafts

In addition to autografts and allografts, other grafting materials are also gaining traction, such as xenografts (tissue from an animal source) and synthetic grafts (lab-created biomaterials). These alternatives offer even more options for soft tissue grafting, especially in patients with specific preferences or medical needs. While they offer the advantage of unlimited supply and no risk of disease transmission, their long-term success rates and integration with the body are still under ongoing research.

Emerging Trends in Soft Tissue Grafting for Gingival Recession

Soft tissue grafting techniques have evolved significantly over the years, and emerging trends in periodontics are improving the outcomes, patient experience, and long-term success of these procedures. Below are some of the latest innovations and approaches shaping the field of soft tissue grafting for gingival recession:

1. Minimally Invasive Techniques

• Pinhole Surgical Technique (PST): This minimally invasive procedure allows for root coverage without making large incisions. A small hole is created in the gum above the recession area, and specialized tools are used to loosen the gum tissue and reposition it over the exposed roots.
  • Advantages: Reduced post-operative discomfort, faster healing times, no need for sutures, and excellent aesthetic outcomes.
  • Best for: Patients with multiple areas of recession who are seeking a less invasive solution.
• Tunneling Technique: In this method, small incisions are made near the recession site, and the gum tissue is separated to create a tunnel. A graft (either autograft or allograft) is placed within the tunnel and then advanced over the roots.
  • Advantages: Faster recovery, fewer incisions, and less post-operative discomfort.
  • Best for: Patients with generalized recession or those requiring multiple grafts.

2. Use of Growth Factors and Platelet-Rich Fibrin (PRF)

• Growth Factor-Enriched Grafting: Incorporating growth factors, such as platelet-derived growth factor (PDGF) or enamel matrix proteins (EMD), into the grafting process stimulates faster healing and regeneration of gum tissue.
  • Advantages: Enhances tissue regeneration, accelerates healing, and improves long-term stability of the graft.
  • Best for: Patients with complex grafting needs or those with slower natural healing responses.
• Platelet-Rich Fibrin (PRF): PRF is derived from the patient’s own blood and is used to promote healing in soft tissue grafts. PRF acts as a scaffold, enhancing tissue regeneration and reducing post-operative discomfort.
  • Advantages: Natural, biocompatible, and effective in accelerating healing.
  • Best for: Patients who prefer natural, biologically-enhanced healing methods.

3. Xenografts and Biologics

• Xenografts: Tissue from animal sources, usually bovine (cow), are increasingly being used in place of autografts or allografts. Xenografts provide an abundant source of grafting material and eliminate the need for a second surgical site.
  • Advantages: No need for harvesting patient tissue, reduced surgical time, and reliable tissue regeneration.
  • Best for: Patients who need large areas of coverage or prefer not to use autografts.
• Biologics and Synthetic Grafts: Newer synthetic materials, such as bioactive glass or synthetic collagen scaffolds, are also being developed to provide an alternative to natural tissue grafts. These materials promote tissue regeneration and offer predictable results.
  • Advantages: Unlimited supply, no donor site, and reduced risk of disease transmission.
  • Best for: Patients who need extensive grafting or have allergies to human or animal graft materials.

4. Laser-Assisted Soft Tissue Grafting

Lasers are now being integrated into soft tissue grafting procedures to improve precision, reduce post-operative discomfort, and promote faster healing.

• Laser-Assisted New Attachment Procedure (LANAP): This method uses laser technology to remove diseased tissue and bacteria while preserving healthy tissue. Lasers help promote faster healing and minimize bleeding during soft tissue grafting.
  • Advantages: Minimally invasive, less post-operative pain, faster healing, and reduced risk of infection.
  • Best for: Patients with periodontal disease or those seeking a minimally invasive approach.

5. Allogeneic Dermal Matrix Grafts

Allogeneic dermal matrix grafts are human skin grafts that have been processed to remove all cellular components, leaving behind a collagen matrix. This matrix acts as a scaffold for the patient’s own cells to regenerate gum tissue.

• Advantages: No need for a second surgical site, faster healing, and predictable results.
• Best for: Patients with insufficient donor tissue or those who prefer a less invasive option.

6. Digital Technology and 3D Printing

The rise of digital technology and 3D printing is revolutionizing soft tissue grafting in several ways:

• 3D-Printed Scaffolds: Researchers are exploring the use of 3D-printed scaffolds for gum tissue regeneration. These scaffolds can be customized to fit the patient’s anatomy and promote tissue regeneration.

  • Advantages: Customization, precision, and reduced need for donor tissue.
  • Best for: Patients with complex recession cases or those needing tailored treatment solutions.

• Digital Imaging and Planning: Digital imaging technology allows periodontists to map out the procedure in detail before surgery, ensuring precise graft placement and better outcomes.

  • Advantages: Enhanced accuracy, better treatment planning, and improved patient outcomes.
  • Best for: Complex cases where precision and accuracy are essential.

7. Stem Cell Therapy

Stem cell therapy is emerging as a potential treatment for regenerating gum tissue in patients with severe gingival recession. By using the patient’s own stem cells, researchers aim to create new gum tissue to cover exposed roots.

• Advantages: Potential for natural, long-lasting tissue regeneration without the need for traditional grafting materials.
• Best for: Patients with severe tissue loss or those who are not candidates for traditional grafting procedures.

Conclusion:

The field of soft tissue grafting for gingival recession is rapidly evolving, with many new techniques and technologies improving outcomes and patient experiences. Minimally invasive procedures, biologically-enhanced grafts, laser technologies, and emerging materials like xenografts and synthetic scaffolds are making grafting more predictable, comfortable, and effective. By staying informed about these emerging trends, periodontists can offer patients the most up-to-date treatments to manage gingival recession and improve oral health outcomes.