Ctgwt Enhances Keratinized Gingival Width In Teeth And Implants

Conventional regenerative procedures for teeth or implants with infrabony defects accompanied by insufficient buccal keratinized gingiva (<2mm) typically require two-stage surgical approaches. The connective tissue wall technique (CTGWT) utilizes autogenous connective tissue as an alternative to barrier membranes, achieving simultaneous keratinized tissue augmentation through a single surgical intervention and maintaining bone regeneration. This study evaluated four infrabony defects cases (two natural teeth [#31, #24] and two implants [#12, #35]) with inadequate keratinized gingiva. After papilla preservation incisions, a split-thickness flap was elevated, transitioning to full-thickness flap to fully expose the osseous defects. After debridement, bone substitutes were implanted, followed by placement of de-epithelialized autogenous connective tissue grafts over the bone materials. Clinical evaluations over 6-14 months demonstrated reduced probing depths, increased keratinized gingival width and radiographic evidence of reduction in infrabony defect depth in all cases. In gingival recession cases, CTGs serve dual functions as biological barriers and stabilizers between the lateral flap and root surface during early wound healing. Our study applied CTG to enhance tissue vascularization in the defect area while mitigating the risk of membrane exposure associated with excessive tension. This technique therefore enables concurrent bone regeneration and keratinized tissue augmentation in natural teeth and implants with insufficient attached gingiva. The CTGWT demonstrates the capacity to achieve dual therapeutic outcomes - hard tissue regeneration and keratinized gingival augmentation - in single-stage procedures for natural teeth and implants with inadequate keratinized mucosa.