Introduction

Gingival deficits are usually corrected with autografts from either the palatal mucosa or buccal gingiva.  However, many patients exhibit a minimal band of buccal keratinized tissue with several areas of recession which limits the availability of suitable tissue to transplant.  This limitation can be further complicated by the presence of a small, flat palate which also impedes the therapist's ability to obtain an adequate amount of tissue to transplant.  In these situations, a gingival allograft material that is easily obtained, safely used, and provides predictable results benefits both the patient and the surgeon.

An inadequate band of keratinized tissue has been associated with chronic inflammation¹ and progressive recession when associated with poor oral hygiene.^2,3  Orthodontic appliances, which can impede effective hygiene, can also lead to increased gingival recession in areas with minimal keratinized tissue.^4,5  Other factors that are associated with gingival recession include underlying bony dehiscences, toothbrush abrasion, trauma, factitious injuries, and iatrogenic dentistry.  Various methods of surgical correction for a lack of keratinized tissue range from periosteal separation⁶, sliding or pedicle flaps⁷, the double papilla technique⁸, the coronally positioned flap procedure⁹, free gingival grafts^10,11,12 and subepithelial connective tissue grafts.¹³

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