Modified palatal strip grafting for keratinized tissue augmentation: A technical report

Previously reported techniques on strip grafting have utilized either multiple palatal strips or a single palatal strip in conjunction with a collagen matrix, and have primarily been described for increasing the peri-implant keratinized mucosa width. However, the application of a palatal strip graft for keratinized tissue (KT) augmentation around teeth has not been reported to date. This technical report describes a modified approach to augment KT around teeth using a single palatal strip without adjunctive use of biomaterials.

The modified palatal strip graft (mPSG) technique follows a standardized surgical protocol for recipient bed preparation (three distinct zones), donor site management (harvesting of a 3 mm wide palatal strip and closure with sutures only) and graft stabilization using lateral sutures at extremities of graft and compressive horizontal mattress sutures by engaging the connective tissue zones coronal (zone 1) and apical (zone 3) to the graft placed in zone 2 of recipient site. A representative case, supplemented by additional clinical illustrations, is presented to demonstrate the surgical steps and clinical outcomes.

Clinical observations demonstrated an increase in attached keratinized gingiva and vestibular depth around treated teeth. In addition, limited postoperative pain (severity and duration), absence of delayed bleeding, and faster healing (complete epithelialization achieved within 2 weeks) at the donor site were observed.

The mPSG approach seems to be predictable, cost-effective, and "patient-friendly" for KT augmentation around teeth. Nevertheless, comparative randomized clinical trials are suggested to confirm the observations presented here.

The modified palatal strip graft (mPSG) technique provides a practical approach for simultaneous keratinized tissue augmentation and vestibular deepening around teeth using a single palatal strip graft. The technique eliminates the need for adjunctive biomaterials and may reduce donor-site morbidity and treatment-related costs, though it requires careful case selection, utilizing microsurgical principles and advanced surgical skills for successful outcomes. The mPSG approach may be particularly useful in patients with limited palatal donor tissue, such as adolescents and individuals with a shallow palatal vault, where harvesting a conventional free gingival graft may be challenging.

Some patients have an insufficient amount of firm gum tissue around their teeth, making oral hygiene more difficult and increasing the likelihood of gum inflammation and discomfort during brushing. The most commonly used treatment to increase this tissue is a free gingival graft, which involves harvesting tissue from the palate. Although effective, this procedure can result in postoperative pain, delayed healing, and bleeding at the donor site. This report describes a modified palatal strip graft (mPSG) technique that uses a narrow strip of tissue harvested from the palate to increase the width of attached gum tissue around teeth. Unlike previously described strip graft approaches, the technique does not require additional biomaterials and follows a standardized surgical protocol for different steps of the surgery. The narrow graft design reduces the size of the palatal wound and may improve patient comfort after surgery. Clinical examples demonstrated successful gain of attached gum tissue and an increase in depth of vestibule around teeth. Palatal donor site healing was rapid, and minimal postoperative discomfort was reported. The mPSG technique may provide a practical and cost-effective alternative for patients requiring attached gum tissue augmentation while reducing the morbidity commonly associated with conventional grafting procedures.