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Lip Travel Reduction

Part 3 - Harvesting the connective tissue graft.

Michael Skinner, DDS
In this section of the CE course, Dr. Skinner demonstrates how the connective tissue graft is harvested and then placed using a superperiostal subepithlelial tunner or subconnective tissue tunnel.

I've made a split thickness incision, first incision leaving connective tissue over the bone in the palate, second incision leaving epithelium intact and now I'm gong to harvest a wedge of connective tissue from between those two incisions. And you can see we were efficiently able to harvest a rather sizeable connective tissue graft. And we'll contour kind of vena form the margins of that graft. What's great about the lip travel is that even though it's a fairly technical and fairly tedious procedure, it's still relatively superficial. We're operating in approximately a 1.5 mm of thickness of tissue, we really do not get involved in repositioning muscles and things that cause a great deal of trauma. The lip is very vascular and many times patients can have swelling. So we advise them to be aware of that and schedule the procedure accordingly. Now I'm creating the superperiostial subepithelial tunnel or subconnective tissue tunnel. You're doing great Z. This is where our graft will be inserted. Our connective tissue graft. I'll need that suture Heather. We're going to do a layer closure using horizontal mattress sutures. And we're going to close the connective tissue or approximate the connective tissue so that we have as near passive a flap at our incision line as we possibly can. So we're going to start in the posterior premolar area. Dr. Skinner continues to suture on the other side.These are 4.0 chromic gut sutures and we're going to leave those to dissolve and we'll close our primary margins with a5.0 vicryl suture. When I started perio, it was 90% perio, 10% implants and cosmetic and orthodontic adjunctive procedures and now we're probably 50% implants, another 20% adjunctive procedures associated with implants, cosmetics and then treating periodontal disease. So now we have completed the first layer of closure using resorbable chromic gut sutures,connective tissue to connective tissue, now we're going to suture the margin of the epithelium together using 5.0 vicryl. And this is our epithelial closure. She has minimal amount of attached tissue so we made an effort not to put a suture on the mid-facial of any of the teeth. All of the sutures are in the papilla area. And post-op instructions will be to avoid exaggerated facial expressions for about two weeks, go home stay elevated, hold ice on the lip and at this point we won't even have her try a test smile. All right, I'm going to close the palate with another 5.0. Our thanks to Dr. MichaelSkinner at The Advance Institute for Oral Health. For HDiQDental members, we welcome your comments and questions, you can chat with other professionals about the topic of lip travel reduction and other topics by visiting the chat room and logging in. Dr. Skinner will return occasionally to answer questions directed to him. At HDiQ Dental we are committed to becoming the standard by which the dental training industry is judged. And we can only do that by catering to you our valued members. Please email us your comments, your opinion matters.For HDIQ Dental, I'm Marlene Hilton. We'll see you next time.