Charlie Chen - (3/29/2013 5:05 PM)

Dr.Wong, I also have the same question as Hector. I notice you did not suture the bottom portion of the graft to the periosteum. I would think it would lead to increase in mobility of the graft, especially if the patient move his/her lip. Wouldn't suture the bottom portion of the graft to the periosteum be more secure?

saadou khalaf - (12/26/2012 3:46 PM)

thank u very much dr wong, my question , is it important to cover the site with a perio pack

david wong - (11/4/2012 12:44 AM)

Thanks, Ryan! And yes, we are assuming that with orthodontic treatment the gingival levels will become equal. In regards to this procedure, the graft ended up covering the root up to the CEJ. The CEJ is the coronal/incisal limitation of the tissue height, as grafts will not attach to the enamel. This is why the graft was placed in the position that it was placed. Alternately, lengthening #25 would not be an option because the root would become exposed. Hope that helps... thanks for watching!

Ryan Hanks - (10/26/2012 1:22 PM)

Are we assuming that with the ortho the gingival levels will become equal? If not why weren't the levels made equal at the time of surgery?

thanks!

david wong - (10/23/2012 11:44 PM)

@ Ali... the palatal stent used in this video is made on a cast made from an alginate impression. "JET" acrylic is then "salt & peppered" over the palate to the distal of the first molars usually. Once set, the stent is trimmed by scalloping the material around the gingival margins and embrasure spaces. Hope that helps! Thanks for watching!

david wong - (10/23/2012 11:39 PM)

Hi everyone! Thank you for your questions, and I hope I can clarify a few points. First of all, yes, there is literature supporting the technique performed in this manner. J. Perio, October '76... Dordick, Coslet, and Seibert reported a similar technique utilizing only sutures at the coronal aspect as demonstrated in this video. They performed both a clinical and histological study that showed results similar to free gingival grafts placed on periosteum. In fact, histologically, both this group as well as Raul Caffesse's group in a separate study reported that the two techniques are impossible to discern. The only difference between the way I've demostrated the technique here is that they utilized a periodontal dressing, whereas I did not. Neither one of us etched the root surfaces, and I still do not (not there's anything wrong with that). Most will find that placing the graft on denuded bone is much less technique sensitive and of course bleeding in the recipient site is much less. There is also no increase in morbidity with this technique versus placing the graft on periosteum. As far as utilizing this technique around implants, this is very common; in fact, it's one of the reasons that free gingival grafts are making a comeback of sorts. They can be placed either before or after placement.

Mohamed Ghanem - (10/21/2012 7:10 AM)

Thank you for your presentation, I would like to add my voice to my colleagues and ask why did you do a full-thickness flap in the recipient site, does it make any significance if you have done in in a partial thickness fashion, if you please can supply us with any evidence supporting you technique. also, I wanted to ask if you have tried to use this technique to increase the width of attached mucosa aroud implants before of after their placement. thank you again.

ali momen - (10/20/2012 4:11 PM)

thanks dr wong for your nice presentation.would you please describe about your stent that you used on the donor site?

Haitham Alaa - (10/19/2012 10:58 AM)

why you did full thickness flap