In this surgery Professor Dr. Hannes Wachtel, Munich/Germany, covers a frontal gingival recession around an implant by a subepithelial soft tissue graft placed into a prepared gingival pouch. Initially the tunnelling and mobilisation of the gingival aspects is performed by microsurgical blades and special instruments. It is of utmost importance to have a passively and fully mobilised tissue, including the papillae.
After final preparation of the receiving side a subepithelial connective tissue graft is taken from the palatal region. Care has to be taken not to hit the palatal artery and to leave a palatal epithelial thickness of approximately one millimetre to avoid healing problems. The palatal wound is closed by a running suture and a splint is placed to support the initial healing period. One suture per side is then moved underneath the papillae (one suture from the mesial end and one suture from the distal end).
With the help of the mesial suture the graft is pulled into the prepared pouch. The proximal contact points are etched and closed with flowable composite. When the final position of the graft has been ensured, sutures over the closed contact points are used to pull the entire situation up (like suspenders) and the recession is covered.