Posterior extension of palatal rugae as an anatomical limitation for donor soft tissue grafts in a population of western India

Bhavana A. Thomas; Nilam A. Brahmbhatt; Alfas R. M. P.

doi:10.18203/2394-6040.ijcmph20252858

Authors

Bhavana A. Thomas Department of Periodontology, Government Dental College and Hospital, Ahmedabad, Gujarat, India
Nilam A. Brahmbhatt Department of Periodontology, Government Dental College and Hospital, Ahmedabad, Gujarat, India https://orcid.org/0000-0002-0772-9027
Alfas R. M. P. Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India https://orcid.org/0009-0009-7997-0926

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20252858

Keywords:

Palatal rugae, Periodontal plastic surgery, Soft tissue autograft

Abstract

Background: Palatal soft tissue graft is a common approach for plastic surgery for oral and periodontal soft tissue augmentation procedures. If the palatal rugae are harvested within a soft tissue graft, they could cause a persistent aesthetic issue. The purpose of this study was to investigate the posterior extension of the palatal rugae bilaterally and its proximity towards the tooth among the population of western India.

Methods: 202 Maxillary dental casts from Gujarat with an age range of 20-30 years were examined. The most posterior extension of the bilateral rugae was determined by a standardized periodontal probe. Also, preferred site for soft tissue harvest was subdivided into four regions of interest and the rugae proximity towards tooth was measured.

Results: Total 154 (76.23%) and 147 (72.77%) subjects had their palatal rugae extension beyond the mesial end of the maxillary second premolar on the right and left side, respectively. There was no statistically significant association (p>0.05) between the posterior extension of palatal rugae and other factors such as age, gender and palatal shape. In the four regions examined, the distance from the terminal end of rugae to the gingival margin was greater on the right side compared to the left; however, this difference was not statistically significant.

Conclusions: Despite a greater percentage of palatal rugae extending beyond the mesial end of the maxillary second premolar on the right side, the rugae proximity towards tooth was less compared to the left side.

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References

Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014;41(15):S123-42. DOI: https://doi.org/10.1111/jcpe.12185

Camargo PM, Melnick PR, Kenney EB. The use of free gingival grafts for aesthetic purposes. Periodontology. 2000. 2001;27:72-96. DOI: https://doi.org/10.1034/j.1600-0757.2001.027001072.x

Said KN, Abu Khalid AS, Farook FF. Anatomic factors influencing dimensions of soft tissue graft from the hard palate. A clinical study. Clin Exp Dent Res. 2020;6(4):462-9. DOI: https://doi.org/10.1002/cre2.298

Patil MS, Patil SB, Acharya AB. Palatine rugae and their significance in clinical dentistry: a review of the literature. J Am Dent Assoc. 2008;139(11):1471-8. DOI: https://doi.org/10.14219/jada.archive.2008.0072

Pillai J, Banker A, Bhattacharya A, Gandhi R, Patel N, Parikh S. Quantitative and qualitative analysis of palatal rugae patterns in Gujarati population: a retrospective, cross-sectional study. J Forens Dent Sci. 2016;8(3):126-34. DOI: https://doi.org/10.4103/0975-1475.195110

Rahebi D, Naghavialhosseini A, Pakkhesal M, Rajabi A, Mirzaei F, Salim NA, et al. Palatal rugae patterns in Fars, Turkmen, and Sistani Ethnicities in the eastern part of the Caspian Littoral of Iran. Diagnostics. 2023;13(2):200. DOI: https://doi.org/10.3390/diagnostics13020200

Hosmani J, Gadekar NB, Kotrashetti VS, Nayak R, Babji D, Mishra S. Comparison of palatal rugae pattern among Indian and Tibetan population. J Forens Dent Sci. 2018;10(1):40-4. DOI: https://doi.org/10.4103/jfo.jfds_18_16

Abdul NS, Alzahrani JA, Alharbei SS, Almutib AT, Ibnjuma RA, Almutairi ZH. Palatal rugoscopy: a tool for ethnicity and gender identification among Saudi and Kuwaiti Populations. Cureus. 2024;16(1):e52333. DOI: https://doi.org/10.7759/cureus.52333

Said KN, Abu Khalid AS, Farook FF. Distal extension of palatal rugae as a limitation for donor soft tissue grafts in a Jordanian population: a cross-sectional study. BMC Oral Health. 2021;21(1):203. DOI: https://doi.org/10.1186/s12903-021-01561-9

Alshammari A, Farook FF, Alyahya LA, AlHarbi MN, Alazaz NN, AlKadi L, et al. The posterior extension of the palatal rugae as an anatomical constraint for soft tissue grafts in a Saudi Arabian population. Cureus. 2022;14(12):e32731. DOI: https://doi.org/10.7759/cureus.32731

Kim SJ, Donovan DM, Blanchard SB, Kowolik JE, Eckert GJ. The relationship between acute otitis media and the anatomic form of the hard palate. Pediatr Dent. 2008;30(1):9-14.

Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol. 2010;37(8):728-38. DOI: https://doi.org/10.1111/j.1600-051X.2010.01550.x

Azar EL, Rojas MA, Patricia M, Carranza N. Histologic and histomorphometric analyses of de-epithelialized free gingival graft in humans. Int J Periodont Restor Dent. 2019;39(2):221-6. DOI: https://doi.org/10.11607/prd.3544

Harris RJ. Histologic evaluation of connective tissue grafts in humans. Int J Periodont Restor Dent. 2003;23(6):575-83.

Breault LG, Fowler EB, Billman MA. Retained free gingival graft rugae: a 9-year case report. J Periodontol. 1999;70(4):438-40. DOI: https://doi.org/10.1902/jop.1999.70.4.438

Karring T, Lang NP, Löe H. The role of gingival connective tissue in determining epithelial differentiation. J Periodont Res. 1975;10(1):1-11. DOI: https://doi.org/10.1111/j.1600-0765.1975.tb00001.x

Edel A, Faccini JM. Histologic changes following the grafting of connective tissue into human gingiva. Oral Surg Oral Med Oral Pathol. 1977;43(2):190-5. DOI: https://doi.org/10.1016/0030-4220(77)90155-4

Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with aesthetic demands. J Periodontol. 2000;71(9):1506-14. DOI: https://doi.org/10.1902/jop.2000.71.9.1506

Moura D, Lima E, Lins R, Souza R, Martins A, Gurgel B. The treatment of gummy smile: Integrative review of literature. Rev Clín Periodon Implant Rehabil Oral. 2017;10(1):26-8. DOI: https://doi.org/10.4067/S0719-01072017000100026

FRIEL S. Migration of teeth. Dent Rec. 1949;69(3):74-84.

Reiser GM, Bruno JF, Mahan PE, Larkin LH. The subepithelial connective tissue graft palatal donor site: anatomic considerations for surgeons. Int J Periodont Restor Dent. 1996;16(2):130-7.

Benninger B, Andrews K, Carter W. Clinical measurements of hard palate and implications for subepithelial connective tissue grafts with suggestions for palatal nomenclature. J Oral Maxillofac Surg. 2012;70(1):149-53. DOI: https://doi.org/10.1016/j.joms.2011.03.066

Tavelli L, Barootchi S, Ravidà A, Oh TJ, Wang HL. What is the safety zone for palatal soft tissue graft harvesting based on the locations of the greater palatine artery and foramen? A systematic review. J Oral Maxillofac Surg. 2019;77(2):271.e1-9. DOI: https://doi.org/10.1016/j.joms.2018.10.002

Gargiulo AW, Wentz FM, Orban B: Dimensions and relations of dentogingival junction in humans. J Periodontol. 1961;32:261. DOI: https://doi.org/10.1902/jop.1961.32.3.261

Studer SP, Allen EP, Rees TC, Kouba A. The thickness of masticatory mucosa in the human hard palate and tuberosity as potential donor sites for ridge augmentation procedures. J Periodontol. 1997;68(2):145-51. DOI: https://doi.org/10.1902/jop.1997.68.2.145

Müller HP, Schaller N, Eger T, Heinecke A. Thickness of masticatory mucosa. J Clin Periodontol. 2000;27(6):431-6. DOI: https://doi.org/10.1034/j.1600-051x.2000.027006431.x

Wara-aswapati N, Pitiphat W, Chandrapho N, Rattanayatikul C, Karimbux N. Thickness of palatal masticatory mucosa associated with age. J Periodontol. 2001;72(10):1407-12. DOI: https://doi.org/10.1902/jop.2001.72.10.1407

Stipetić J, Hrala Z, Celebić A. Thickness of masticatory mucosa in the human hard palate and tuberosity dependent on gender and body mass index. Coll Antropol. 2005;29(1):243-7.