Gingival recession is a common concern in periodontal practice, often leading to root exposure, hypersensitivity, and compromised aesthetics. Among the various soft tissue grafting techniques, pedicle grafts provide an effective, minimally invasive solution for patients with sufficient adjacent gum tissue. This procedure ensures natural tissue integration and rapid healing, making it a preferred choice in selected cases.
What Is a Pedicle Graft?
A pedicle graft is a periodontal surgical procedure that utilizes gum tissue from the area adjacent to the recession site instead of harvesting it from the palate. The flap remains partially attached, maintaining its original blood supply, which enhances graft survival and healing.
How It Works
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A partial-thickness incision is made, creating a pedicle flap from nearby keratinized gingiva.
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The flap is rotated or advanced to cover the exposed root surface.
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The tissue is sutured into place without disrupting its vascular supply.
Unlike connective tissue grafts (CTG) or free gingival grafts (FGG), pedicle grafts eliminate the need for a separate donor site, reducing patient discomfort and enhancing recovery.
Indications for Pedicle Grafts
Pedicle grafting is most effective in patients with:
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Miller Class I or II recession defects.
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Sufficient keratinized tissue adjacent to the affected tooth.
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Minimal interproximal bone loss.
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The need for aesthetic root coverage.
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Patients who prefer to avoid palatal donor site harvesting.
Types of Pedicle Grafts
1. Laterally Displaced (Sliding) Pedicle Graft
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The flap is mobilized from an adjacent area and slid over the exposed root.
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Best suited for isolated gingival recession with sufficient attached gingiva nearby.
2. Coronally Advanced Flap (CAF)
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The flap is elevated apically and repositioned coronally to cover the root surface.
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Often combined with enamel matrix derivatives (EMD) or platelet-rich fibrin (PRF) to enhance tissue regeneration.
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Ideal for multiple adjacent recession sites.
Surgical Technique of Pedicle Grafts
1. Preoperative Planning
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Comprehensive periodontal evaluation to assess keratinized tissue width and root exposure.
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Scaling and root planing (SRP) to remove bacterial deposits.
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Local anesthesia (2% lidocaine with epinephrine 1:100,000) for patient comfort.
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Use of antimicrobial rinses (chlorhexidine 0.12%) before surgery.
2. Flap Design and Preparation
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A split-thickness or full-thickness incision is made, creating a pedicle flap adjacent to the recession site.
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The recipient site is debrided to ensure a clean, vascularized bed.
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Root surface is conditioned with EDTA or citric acid to promote soft tissue attachment.
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Mr. Bur Degranulation Kit is essential in this step, ensuring thorough removal of granulation tissue while preserving bone integrity. Its precision burs allow for efficient site debridement, facilitating optimal graft integration and minimizing trauma to surrounding structures.
3. Graft Repositioning and Suturing
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The flap is gently repositioned over the exposed root and secured using resorbable sutures (6-0 or 7-0 PTFE/Vicryl®).
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A periodontal dressing may be applied to protect the graft and reduce postoperative discomfort.
Postoperative Healing and Care
1. Healing Timeline
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24–48 hours: Clot formation and initial attachment.
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Week 1: Epithelial proliferation and mild swelling.
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Weeks 2–4: Graft revascularization and integration.
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6+ Weeks: Complete healing with full root coverage and keratinized tissue formation.
2. Postoperative Instructions
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No brushing or flossing at the surgical site for 2 weeks.
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Use chlorhexidine (0.12%) mouth rinse twice daily for 2–4 weeks.
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Follow a soft diet for 7–10 days.
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Take NSAIDs (e.g., ibuprofen 400–600 mg every 6–8 hours) for pain.
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Avoid smoking, alcohol, and excessive lip movement.
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Attend follow-ups at 1 week, 1 month, and 3 months post-surgery.
Advantages of Pedicle Grafts
✔ Maintains blood supply, leading to faster healing.
✔ No secondary donor site, reducing patient discomfort.
✔ More predictable outcomes in well-selected cases.
✔ Effective root coverage with long-term periodontal stability.
Limitations
❌ Requires sufficient adjacent keratinized tissue.
❌ Higher risk of flap relapse if improperly sutured.
❌ Not suitable for generalized or severe gingival recession.
How Mr. Bur Degranulation Kit Enhances Pedicle Graft Success
For optimal site preparation, Mr. Bur Degranulation Kit offers:
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Efficient removal of inflamed granulation tissue, ensuring a clean recipient bed.
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Minimally invasive debridement, preserving alveolar bone integrity.
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Better flap adaptation, leading to improved graft survival and stability.
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Enhanced precision in debridement, reducing trauma and improving healing outcomes.
For a detailed comparison, check out our in-depth guide on Connective Tissue Grafting, which explores its applications, techniques, and clinical outcomes. Let’s discuss more evidence-based approaches!
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