Gingival recession and mucogingival defects have always been problematic conditions for the dental patient, whether it be dentinal sensitivity, worries about tooth retention, and even esthetics.
Classically, mucogingival surgery has consisted of transplantation of oral autografts, which involves a second surgical site often in the hard palate. While this can result in increased post-operative discomfort, the major drawback is the limited supply of palatal tissue, forcing the patient to undergo multiple corrective procedures when three or more teeth are in need of soft tissue grafting.
A new age of mucogingival surgery was born with the advent of the connective tissue allograft, or acellular dermal matrix, which is human cadaver tissue that has undergone extensive processing to remove all cellular elements, leaving a collagen scaffold that autogenous fibroblasts can attach to and eventually remodel into host periodontal tissues.
Any person who is in need of mucogingival surgery is a candidate for use of a soft tissue allograft. There is no risk of graft rejection based on antigenicity, because all cellular elements have been removed from the tissue during processing.
While an allograft can be used to treat one or two teeth, the ideal use of the allograft is in treating multiple teeth at once, for patients who have recession on four or more contiguous teeth or are involving both arches.
The use of a soft tissue allograft for mucogingval surgery can be accomplished using traditional methods depending on local anatomical factors such as frenum pull, vestibular height and tooth malposition. I prefer to employ a technique called "tunnelling", used by Dr. EP Allen - periodontist in Dallas, where the gingival tissues at the papillae are undermined by blunt dissection rather than traditional scalpel incisions; this preserves anastomosing vasculature in the papillary capillaries, which protects the graft by increasing blood supply to the tissue as well as preventing flap retraction and subsequent exposure of the underlying graft.