The following is a medical media production from 

WRAMC-TV

The periodontist service of the department of 

dentistry at walter reed Army Medical 

center presents 

reconstructive ginger herbal surgery.

The free mucosal graft with 

Colonel Ronald L.

Van Swole.

Chief periodontist service 

walter reed.

We now come to a most exciting phase of the 

reconstructive ginger bill surgery story that 

is the free ginger photographed or more 

correctly,

the free new coastal graph.

Now the advent of this procedure has really closed 

the circle for the clinician 

who is managing periodontal disease and 

specifically paradigm of disease where we have a ginger 

involvement.

The procedure was first brought to life 

from the Paradigm Point of View at least by King and 

Panel in Philadelphia in 

1964.

However Dr.

John Neighbours in the Journal of Gerontology in 

1966 really 

focused our attention on this 

procedure and 

brought the clinician at large 

into thinking about this procedure in the management of 

these most difficult cases.

Now when dealing with the free 

mucosal graph,

we must remember that there are definite 

indications for its use.

We must be aware of the fact 

that this this procedure should be used in 

cases where the width of attached 

from the free ginger ale margin to the mucus 

ginger ville junction is very narrow and 

generally this would involve one or more teeth 

and when I say more teeth we can do these up to four or five 

teeth in with or even more for that matter.

It can be used in cases where there is a very shallow 

vestibule with high muscle attachments.

In other words we can use it in cases 

where we have shallow vestibules to 

deepen the vestibule and it can be used in cases where 

we have friend um problems especially in the lower anterior 

region where along with this we have 

a thin zone of attached ginger or a complete 

lack of attached and many times we 

can use this in cases where a combination of these three 

indications are present.

The main objectives of this procedure is to 

restore a zone of attached 

ginger which previously was lost and 

also in many cases to deepen the vestibule.

The one big disadvantage of this procedure is 

that in most cases it cannot be used to 

cover denuded root surfaces.

Uh If you remember however we do 

have other procedures to handle this problem.

Dia grammatically.

Let's go through the steps of this procedure 

especially in the preparation of 

the recipient bed.

Now,

pre operatively generally this case would present with a 

zone of minimal attached ginger bill or complete 

lack of attached ginger.

But on one or more teeth along 

with us Many times we would have a positive friend um 

that is a friend um which attaches in the marginal 

tissue or in the propeller and 

is creating a movement in this marginal tissue 

in preparing the recipient bed.

We like to start with with 

sharp tissue dissection at 

or slightly corona to the changeable junction.

We carry this down into the 

vestibule via split thickness 

dissection.

Being very careful that we leave 

connective tissue and perry Ostrom on the cortical plate.

We want to be sure that this dissection is 

very smooth so that we do not 

create any areas where pooling 

of blood can occur.

We carry this to the desired depth and to the 

desired width.

We then secure the graph from either the 

palette or another.

Any other area that we may have available,

such as tissue removed in the course of 

ginger ectomy and carry this then to 

the previously prepared recipient 

bed and suture it into place as 

desired.

Again being very careful that we 

immobilize this graph.

One of the main principles to keep in mind 

is that we should place our 

futures and our surgical dressing in such a manner that we 

will secure complete immobilization of the 

graph during the initial three or four day 

healing phase.

We then would cover our graft with a suitable paradigm 

dressing such as co pack and post 

healing.

We should see a re 

development of a zone of attached ginger and 

repositioning of the previously involved 

at a much lower level.

I'd like to demonstrate this procedure then on a 

case so that we get the steps down in mind before we 

go to our patient.

This is a 55 year old male who is 

about to undergo complete prosthetic 

reconstruction.

Prior to this though we felt that we must re 

establish a zone of attached 

on tooth number 20 through 22.

In addition to this,

we would like to deepen the vestibule slightly and 

reposition this presently positive friend um at a 

much lower level at this time.

As you can see by the blanching on the label aspect of 

tooth number 21.

We do have a positive friend.

Um in this area there's also insertion 

of this friend um into the marginal tissue on the 

labial Aspect of Tooth # 

22.

After securing or achieving the 

desired anesthesia,

we would prepare this area and 

for this particular case we have an excellent donor 

site that is the palette.

Since this patient is essential.

Ist in the maxillary arch we can choose either the 

right or left paddle area as the donor site.

In this case we chose the left side.

You can see the quality of the tissue which we have here 

which will make this procedure very nice.

We now begin to prepare 

the recipient bed using the 

bard parker number 15 blade.

Starting just coronal to 

the oval junction 

and we D.

Epithelial guys at this level as you can see here 

keeping the blade parallel to 

the cortical plate.

If we do this then we minimize the danger of 

penetrating the connective tissue and the Perrier.

Now I carry this down about two millimeters with the bard 

parker and then I go to 

a instruments such as the Kirkland 

instrument again,

keeping it parallel to the cortical plate and can 

continue to dissect 

down to the desired depth 

generally in this area we go down 

approximately 4 to 5 millimeters.

And here we see it,

the the recipient bed completely 

prepared and ready to receive the 

free mucosal graft again,

keeping in mind that we want this very smooth to 

minimize pooling of blood between the 

connective tissue fibers.

We want a very smooth bed when 

preparing the bed in the vicinity of the bicuspid.

We must keep in mind that we have the mental frame and 

and the Contents of the 

mental framing in this area.

And so we do not want to carry this much deeper than 4-5 

mm.

Or we may be impinging upon this very 

vital anatomical structure.

So this must be kept in mind when preparing the bed in 

this particular area.

Now,

as we prepare to achieve 

the graph from the palette,

the question comes to mind what type of instrument they are 

used to secure this.

Now,

initially back in the early 60 

or in the sixties when the graph was first 

introduced,

most clinicians,

I think was using the again,

number 15 Bard parker blade.

In the ensuing years,

various people came out with various 

types of graph knives.

This happens to be one of the pack went knives with 

a strip of razor blade 

secured in the holder here 

and this is used by many people to 

advantage.

I still prefer to use the number 15 Bard 

parker blade,

Since I feel I can control the shape of my graft much 

better.

We also know today that we would like to have our 

graft in the neighborhood of 1 to 1 and 

a quarter millimeters in thickness.

And I can also use the bevel of the 

bard parker blade as a guide in 

in securing the proper thickness.

Since this is approximately 1.5 

millimeters,

we can go 

through the initial incision 

or outlining incisions of the graft to 

just short of this bevel and we should then achieve the 

thickness that we desire.

So we've gone to the palette in this case then and secure the 

graft.

As you see here,

this is the epithelial side.

We have previously determined the shape and 

size that we desired.

Either by using a paranormal probe 

and marking off the width 

and length in millimeters or by making a 

dry foil template placing it on the palate and 

then outlining the graft.

Now this is the connective tissue side of the graph 

and this is a very important side and that we wish to have 

it very smooth,

much like we wish to have the recipient bed 

very smooth.

So that when the two connective tissues are placed together 

there will be no dead space for the pooling of blood.

One thing to keep in mind when you remove this graft 

is that you stay orientated because it's very easy to 

mistake the epithelial side for the 

connective tissue side.

And if we place the epithelium against the connective 

tissue,

we will not get a take.

And this is the donor site immediately 

after the graft was secured.

Again.

I would like to point out that this is a split thickness to section 

very thin a millimeter to a millimeter 

and a quarter inch thickness.

And so bleeding is very,

very minimal.

And healing is very rapid here in this particular 

case will use the patient's full upper denture as a 

surgical stint to cover this area during the 

healing phase.

We then carry the graph to the mouth and 

suture it in position as we see here.

Now generally I'll place this suture first and 

it's in at an angle from the middle to the distal.

We like to angle suture from the medial to the 

distal so that it is working in this 

direction.

Well then uh place the anterior 

suture again in a slight 

uh distal to medial direction 

so that the graft is secured very tightly 

in this position.

The last two sutures are placed right in the center of the 

propeller.

And we might consider these as suspense or sutures 

to hold the graft at the desired 

height.

The number that we place here would depend upon the 

length of your graph.

If we were dealing with just a two tooth graph,

then just one suspension of course would be necessary 

prior to placing our surgical surgical dressing,

then I like to hold this craft in 

position for several minutes,

four or five minutes with a gauze sponge soaked 

in normal sailing so that we get a fibrous 

adhesion between the two connective tissue 

surfaces.

We then can go ahead and place 

the co pack that would use in this particular 

case.

Now,

previously we used to use a dry 

foil and place it between the 

graft and the sutures and the pack.

Uh This was done to keep 

the sutures from becoming impregnated in the pack.

However,

in recent years I've stopped doing this since I found that 

this drive oil also interfered with 

retention of the pack and thereby stabilization of 

the graft,

which is very very important.

We now find that if we remove our pack very,

very carefully starting in this area and 

peeling it back.

If by chance,

one suture does become impregnated in 

this pack,

we can slip the suture scissors between the 

pack and the the tooth and 

cut the suture and then continue to remove 

the pack.

In most cases,

however,

we find that the sutures do not become permanently 

impregnated in this pack,

especially if you use silk and 

cut your ends very short.

And this is the case one week.

Post surgery and immediately 

post pack removal,

you can see the tremendous amount of debris that has 

accumulated under the pack and most of 

this is necrotic epithelial cells 

which have collected 

here.

Now we know from our wound healing studies of this 

particular procedure that the outer 

three layers at least of the epithelium do 

undergo necrosis and sloughing.

And this is what we see here.

We do see though beginning 

recapitalization of the graft in 

this particular area.

We then would go ahead and remove the sutures.

Clean up the area so that 

we have a surgical site which 

looks like this.

If any of this necrotic tissue 

uh is still adhering to the 

graft.

As we see here.

We would leave it there because this will undergo normal stuff 

because of problems in plaque control for the patient.

At this time I'd like to cover the area again for seven 

days.

And this is the graph.

Then at four weeks post surgery we can 

see the increased zone of attached ginger but which we have 

achieved and the fact that we have repositioned the 

friend um at a more typical 

level so that it no longer impinges upon this 

marginal tissue in these two teeth.

And this is the palette.

At four weeks healing is certainly complete 

here we see a little redness yet.

And this will fade out in in another two or three weeks.

So that at eight or nine weeks post surgery 

one would be hard put to be able to tell that a graft was 

secured from this area 

And then the appearance of the surgical site.

At nine weeks post surgery,

the graft is now mature epithelium 

is thick and quite 

normal.

If we were to look at this histological again pointing 

out the wide zone of attached ginger which we have 

achieved in the area deepening of the vestibule 

repositioning of the friend.

Um We can now refer the patient to the prostate 

honest and he can prepare his crowns and so forth.

Feeling secure that the 

marginal tissue is stable here 

and will not undergo further recession.

With that brief introduction,

we can now go to our patient and 

take a look at the surgery that we are going 

to perform this morning.

Her patient is a 17 year old 

um female as you can see who 

has undergone a great deal of dental therapy in the 

last several years.

Specifically she's had full mouth orthodontic 

therapy and coupled 

with this or thematic surgery.

Now back uh when the initial planning 

stages between the orthodontist and oral surgeon took 

place,

it was noted that she had a minimal zone of 

attached ginger in the lower anterior region.

For this reason the oral surgeon made Quota Chrome's 

of the area and we documented the area at that 

time.

This was approximately 18 months ago.

Now,

in the ensuing months we noticed and the patient 

noticed also that the recession was 

continuing in this area.

So let's take a look at this 

And here we can see on tooth 

number 20 for 

a recession area of 

approximately 1.5 millimeters.

On tooth number 25 we see 

approximately two millimeters of recession 

with tangible involvement.

Now we can show that more dramatically 

when we pick up our periodontal probe 

and close just a little bit kim.

Thank you And pull this area 

and we see that we have an inadequate zone of 

attached ginger in this area and 

now we have a friend um which is 

coming into play uh what we 

might call again the positive friend.

Um and if you see the movement the tip of the 

propeller between tooth number 24 and five I'll do 

that once more.

So for this particular problem we 

chose the free mucosal graph 

to stabilize the zone of attached 

ginger and also to eliminate 

this positive friend um problem.

Previous to going on camera here we 

have achieved anesthesia in the area.

And so we'll go right into our surgery again,

if you recall from our previous discussion,

our first step is to d epithelial 

guys the 

remaining a minimal zone of attached ginger 

and then via split thickness to section create 

our recipient bed.

Reach across the patient.

This in this manner 

and we'll start the 

epithelial rising and we're going to extend the graft 

from About 

the midpoint and the pillow between tooth number 

22 and 23 to the midpoint 

between tooth number 26 and 27.

And generally I like to start the epithelial rising away 

from me and work towards me.

Could you turn towards me just slightly?

Excellent.

Okay 

this is a 

time consuming phase of this procedure 

in that we want to be very sure that 

we in fact do d epithelial 

eyes if we are going to have a positive 

take from our grant.

And so you can see as we the 

epithelium is following.

So called blending in technique 

working right along here 

keep the blade of the instrument parallel to the 

cortical plate.

If you do this then there's really no danger of 

penetrating the 

remaining connective tissue which is left behind.

Or the perry Ostrum.

Don't let the friend um become a problem.

Just work right across it.

And as you can see as we're working 

the freedom will fall away for us very nicely because we have 

detached the fibers 

of the freedom.

Okay we've done half the area and I see 

that there is a small area of opportunity um 

still left intact.

So we'll go back And work that one out.

Okay well let's just 

continue our progress across 

and you can see the split thickness dissection that 

is developing here and then put the bard 

parker down and take another instrument.

I like to use either the Goldman 

Fox or the Kirkland knife 

again keeping it parallel.

And now very 

carefully 

extending the recipient bed 

to the desired depth.

And we'll do that across the field.

We must be very sure that no 

muscle fibers are going to still 

adhere to the bed below our graph.

If this happens there'll be displacement of the graph 

and a lack of proper take here 

we see some of the epithelium still adhering in the depth of the 

vestibule.

And we would like to trim that margin.

Okay.

And we will bring this down 

just a little more time.

At this point I take a gauze sponge 

soaked in normal saline 

and we'll sponge this area 

off close just a little kim.

And I think we can get a better 

a better view of the recipient bed.

And we take a very close look at it now and make sure 

that there's no epithelium in any areas.

So that then would be our recipient bed 

completed and ready to 

receive the graph.

Now kim has an excellent donor site 

in that she has 

very healthy attached ginger 

on the lingual aspect of 

of our molars and first bicuspid and this will be 

the area that we're going to use.

Now it's important that we 

achieve an 

adequate length in our graft.

And so again we just take our probe,

go to the lower and take a measurement or 

we can make a template out of dry 

foil,

whichever is preferable.

And then transpose this to the palette.

Okay now we can see then that our graft is outlined 

very nicely.

And then we can start from the 

distal aspect 

and again by a split thickness dissection,

secure the graph.

We try to keep these approximately 1 

mm thickness.

And again to reiterate,

we can use the bevel on the bart parker as 

a guide And also you can see the 

instrument shining through the graph.

And clinical experience will tell you when 

you're at the proxy,

approximate thickness that you desire.

I like to keep the under surface of the graft 

very smooth,

just as we like to keep the 

recipient bed very smooth.

So we worked this out very slowly.

Keep the instrument parallel 

to the angle of the palette 

and this works out very nicely.

A separated corn 

suturing forceps is excellent for this.

You picked this up very lightly 

little pressure and we can 

complete the dissection.

Okay,

there we have the graft.

This is the epithelial side and it's very important to 

stay orientated as to which is the epithelial 

side and which is the connective tissue side 

because they can look very similar.

You see a very smooth under surface that we 

have achieved on this graph.

And there we have it.

This is the way I like to carry it to the oral cavity with one corner 

already on the needle 

close just just a little kim.

Thank you.

Now you can see the actual in 

homeostasis that we have 

maintained while working in another area.

We'll start our future.

Then in this area 

placing it into the zone of attached ginger which 

we left behind 

angling slightly 

toward the operator.

And this first night I placed very 

loosely.

Okay.

And before removing that,

that's just tap this in place.

Very good.

All right,

okay.

Could you take them out just a second.

Now,

after I get the graph tacked into place 

with the first suture.

Then we like to again 

sailing soaked,

sponge,

position the graft through the whole field 

in the manner that we would like it to finally 

be.

And hold it there slightly.

And that looks like we've got the position that we would like.

We'll bring it up just slightly.

And now the next step is to place suture in the terminal or 

far side of the graft.

And so here will be our last little suture.

You might think of it as a suspense ary 

suture in the function that it performs 

after placing the sutures.

I again take our normal saline 

soaked gauze and hold finger pressure on the 

graph for just a couple of 

seconds.

And we can achieve some fibers adhesion of the graph 

to the underlying bed 

And there we have everything positioned 

properly at this point.

Then we'll go ahead and put 

two little wire loops on the 

teeth for pack retention.

Okay,

well,

we've placed the wire Loops now 

on the two lateral incisors 

as you can see here,

which will aid us in the retention 

of the periodontal dressing,

which we're now going to place all this 

time.

Of course we were able to keep slight 

pressure on our graft and so we have 

a week to be sure.

But we do have a fiber and adhesion 

between the graft and the underlying 

bed.

Very carefully we would like to remove the 

gauze,

making sure we do not displace the graft,

checking it.

And I placed the co pack over 

the wires that we have placed,

being sure that it is incorporated 

around the the 

little loops.

And then I worked the pack down a typically 

over the graft 

and this again helps in 

immobilization which is extremely important.

And we can muscle trim 

as we see here.

Right and there we have the 

surgical site completely dressed and we can 

feel quite confident that this pack will stay in place for the seven 

days that we wish it to.

Especially since we have the wire loops.

Now we'll place the same type of addressing on the 

palate.

Let's just take a quick look there.

We've again 

remember secured our graph via 

split thickness to section.

Could you open real wide kim and tip your head up just a little bit 

and aspirated please.

And you can see that we really have not had any trouble 

or any problem with undue hemorrhage.

Since this was a very thin section 

as a matter of fact I think we 

can see that the blood clot has already formed 

over the donor site.

Well now place co pack over this area in a similar 

manner as we did on the lower,

give the patient postoperative instructions 

and dismiss her and we'll see her in seven 

days 

kim has now returned for the one week post operative 

treatment.

And before we go into the oral cavity.

I'd like to just say a few words about 

what we should look for today.

Now specifically we're going to remove the 

uh surgical dressing and sutures.

However,

we also want to take a look at the healing up to this 

point.

If you recall during the surgical phase,

we were concerned with creating a 

very smooth recipient bed.

Secondly,

we were concerned with developing a thin 

graph from the palette generally in the range of 

1 to 1.5 millimeters,

which would give us a very thin lamb inappropriate.

And thirdly we were concerned with stabilization of the 

graft.

Now why were we concerned with this?

Well,

the big and critical question during the first three 

days of the healing phase is the 

revascularization of the graft initially 

from 1 to 2 or even three days.

The graft is kept alive by what we call 

osmotic uh 

circulation or diffusion or 

plasma tick circulation.

That is.

Body fluids are bathing the graft and 

keeping it alive until the graft 

can become revascularization which 

takes place around three days and 

onward.

Also we're concerned with the 

graph becoming organically fused with the 

underlying bed which begins to occur around the 6th 

or 7th day and continues on up 

into 20 or 24 days.

So let's now go to the oral cavity 

and take a look at the 

graft site.

You want to place that in at one week 

at one week.

Post up kim tells me that you got along 

very well with the procedure?

Uh The only problem she 

had was in eating and she had to watch her diet 

stay in softer foods and so forth.

Well,

what we're gonna do then today is very gently lift the 

surgical pack away from our 

retaining wires and here we can see one of the wires shining 

through.

Go ahead and get us a 

a little sharper instrument.

And I usually start at the closest 

surface to the operator and very gently 

pick this pack away.

If the suture is incorporated 

in the surgical dressing,

we can reach behind the pack and remove 

it so far.

This has not occurred and were able to tease this off 

very nicely.

Okay,

no problem.

Sutures are free of the pack and 

so then I can reach in and gently 

take this away.

Now let's 

replace this and close just a 

little kim fine.

There we go.

Now we see that certainly there is some 

debris under the pack.

And we normally do see this.

Uh We also see some sloughing epithelial 

cells which are very 

free from the underlying graft which points out 

that epithelial ization in this particular case has 

occurred very well close just a little more if you would and we 

can reflect from 

both sides of our graft.

So this is all re epithelial.

Ized to this point.

Let's go ahead 

and remove our sutures.

Okay,

keep that right in there.

Very good.

Just keep no 

problem.

Okay,

could you close again bit so we can get a closer look.

So now the sutures have been removed and will 

now take a little cotton applicator and 

remove the 

discriminating epithelial cells.

And there we have it.

Now let's just comment a bit about 

the healing.

Close a little bit more 

again,

I want to emphasize that the graft is almost completely 

re epithelial ized here.

So this would mean to me that we were 

fortunate in securing a very thin 

graft,

creating a very smooth bed and getting 

uh excellent stabilization of our graft 

on that bed.

And so then that we had a 

very rapid healing take place 

at this point.

Now we'll go ahead and prepare some 

another mix of co pack and place it over the 

ground.

Now,

the only reason we're doing this is keep 

this in,

the only reason we're gonna do this is that we would like 

to protect the surgical site for a few 

more days since the tissues would 

still be too tender for plaque control.

Okay,

well we've prepared another mix of our 

co pack and we'll re apply this to the surgical 

site 

again,

incorporating it first into our 

retention loops.

Once we have them over the pack over the loop,

then we can work it down again over the 

surgical site.

There we go.

Let's just take the excess off.

Okay.

Okay,

you can take this out now.

We like to muscle trim this market down some 

more now.

We haven't said anything about the donor site as yet.

And so I would like to show you the healing that has 

occurred there.

So the healing on the palate.

And I think we can see that in my look in the little mirror 

and we see that that has re epithelial Ized 

and is no longer uh 

concern.

As far as uh placing another 

surgical dressing over the area,

the patient relates that there's just a slight amount of 

tenderness in the area and she can go ahead and start 

maintaining plaque control the area.

Maybe kIM.

If you could turn towards me a little bit and open 

a little wider we get another view of it.

There we are completely rehab.

A theory Ized.

Okay 

again,

thank you for coming in kim.

And we'll see the patient again in 

approximately seven days to remove 

the retention wires,

the surgical dressing and start her on her plaque control.

We would like to now observe the 14 day 

post op healing phase of our 

free new coastal graph.

Could you close your slightly kim?

Thank you.

If you recall,

the objectives of the procedure was to 

establish a broader zone of attached ginger 

in the area of teeth number 24 and 25 were 

pre operatively.

We had an inadequate zone of attached ginger with 

progressive recession.

We can now see because we've 

used the blending in technique that our graft 

has fallen into place very,

very nicely relative to the pre existing 

papillary attached tissue and the minimal 

zone of attached changer on the teeth in question.

Our graft is at this point in time completely re 

epithelial.

Ized although still quite immature.

And another interesting observation 

is the fact that the previously 

involved friend um has been repositioned at a much 

lower level and it is being retained at this lower 

level by the presence of the free meal coastal graft.

So in sum total then at this point in 

time we can go ahead 

and have the patient begin plaque control 

of the area.

And we should be able to then observe the 

maturation of the surgical site.

At this point,

I like to have the patient go to one of 

our multi tufted,

soft rounded bristle 

toothbrushes and begin to manage this 

area.

In a roll technique brushing from the 

graft to the tooth in a very 

deliberate manner.

Such as we can see here at a 

later time.

We may adjust this relative 

to the results that the patient can achieve with this tooth 

brushing technique,

We would now like to go to the palette 

And observe the 14 

day healing phase.

Here.

Here again we can see the 

complete re epithelial ization of 

the grafted site or the donor site.

Let's take a look at that again,

get this position just right,

okay.

It's very very difficult to pick out the donor 

site as a matter of fact at this point in time 

since recapitalization is 

complete,

there's a very slight red 

undertone to this tissue which will disappear in 

another week to 10 days as maturation 

continues in this area.

We wish to now observe the six week post 

op period for the free mucosal graft which 

was accomplished in tooth number 

23 to 25 area.

Now,

specifically at this period of time,

we feel that the graph should be completely healed.

That is re epithelial Ization has occurred and is now 

mature and that revascularization of the 

graft is also complete.

As a matter of fact,

previous wound healing studies have shown us 

that within 4-4 and a half weeks 

after accomplishing a Freeman coastal graft,

the revascularization of the graph should 

be complete.

We also would like to observe the graph relative to the 

goals that we uh set up for 

ourselves initially to see if they have now 

been fulfilled.

Would you close just a little more?

And I think observing the graph very 

closely,

we can say that these goals have in fact been 

fulfilled.

Number one.

We have increased the zone or width of attached 

ginger from the free ginger margin to the 

depth here.

Now of approximately 4 to 5 

millimeters,

we have established 

a very definite 

vestibular depth in this area 

so that the pull of the mentality muscle in 

this area is now dissipated down here.

Which will I think stabilize 

the position of the free changeable 

margin in this area so that the patient 

no longer needs to be concerned with continued 

recession as was observed after 

her orthodontic therapy.

In addition to that,

I would like to point out that the graft is very stable,

that it is it is completely unmovable 

in this area and then given 

uh reasonable degree of home 

care.

And of course this patient's home care is excellent.

We can predict that the graft will stay 

in this position as long as the patient needs it 

here.

If we could zoom in on this now into my mirror 

and if I turn that you can see that there is no 

residual evidence of 

the donor site.

And this is what we routinely see when accomplishing 

the free mucosal graph that is a 

recapitalization of the donor site is complete 

and certainly by six weeks evidence of 

grass being secured from the area is completely 

gone.

I think then that is 

all we need to see say about this procedure.

It's highly predictable one.

And uh if certain principles that we discussed 

earlier are carried out,

one can predict total success in 

this procedure.

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