Pedicle Tunnel Connective Tissue Graft (PTCTG™)
This case involves a 68 year old gentleman who was referred for replacement of fractured maxillary left cuspid and edentulous first bicuspid tooth (Fig. 1). Clinical evaluation and cone beam CT sagittal section revealed essentially no labial plate (Fig. 2). Also note the apical extent of the free gingival margin of this cuspid root. This case would require both particulate grafting and a connective tissue graft for enhanced vertical soft tissue augmentation. As per my classification this is a severe defect (Fig. 3). Flapless extraction was performed (Fig. 4). A pedicle tunnel connective tissue graft (PTCTG®) was done (Fig. 5, 6, 7, 8, 9) and MinerOss with rh-PDGF (Gem 21) was used for socket grafting (Fig 10, 11). 5-0 Nylon suture was used as a mattress suture for closure of the CTG and 4-0 Vicryl for donor site closure (Fig. 12, 13). At one month edema was still present (Fig. 14). At 5 months total labial plate regeneration was seen with CBCT (Fig. 15). Excellent soft tissue volume was obtained as well, and at 2 years great hard and soft tissue stability was seen (Fig. 16, 17, 18).
I have been performing the PTCTG® since 2007 in private practice and at which time it became of the institute and the Soft Tissue Grafting Course.
Pikos MA. Esthetic zone implant therapy. A sequential protocol for soft and hard tissue regeneration of single tooth extraction sites. Inside Dent 2009:5(2):28-38