Mihir Kulkarni

Palatal pedicle grafts have gained popularity for various applications ever since the initial report by Abrams in 1980. The technique saw a series of developments and modifications by various experts such as Scharf and Tarnow (1990), Nemcovsky et al. (1999), Khoury and Happe (2000) and Sclar (2003) among others. Usually, palatal grafts are employed either for soft tissue augmentation in the aesthetic zone or to address the issue of inadequacy of keratinized/attached mucosa. This case series attempts to demonstrate the versatile potential of the palatal connective tissue pedicle graft. The first case demonstrates the utility of the palatal connective tissue pedicle in combination with guided tissue regeneration. The addition of the connective tissue pedicle allowed both hard and soft tissues to be augmented simultaneously, thereby improving the tissue integration and maturation at the time of restoration. The second case demonstrates the use of the palatal connective tissue pedicle for achieving primary closure of the soft tissues over an extraction socket. This precluded the necessity of releasing the buccal flap or the use of adjuncts such as collagen plugs or PRF plugs. The third case represents the application of the connective tissue pedicle in achieving mucosal phenotype improvement as well as allowing passive soft tissue closure over an area of autogenous block grafting. The addition of a pedicle in this situation helped to prevent flap dehiscence or fenestration in the area of a large volume bone augmentation. The palatal pedicle graft can be highly successful due to a partially maintained blood supply. The pedicle helps to prevent graft necrosis as well as reduces the amount of graft shrinkage. Combination of a single incision technique and a pedicle graft, the palatal pedicle can be employed to a great effect in various challenging clinical situations. Apart from the strong evidence supporting the use of palatal grafts, another strong reason for the use of autogenous grafts, especially in developing countries is that the overall financial burden on the patients can be reduced.

Dr. Mihir Kulkarni is a periodontist based in Dharwad, India. He has completed his BDS from the SDM College of Dental Sciences & Hospital, Dharwad in 2010 and his MDS from the Manipal College of Dental Sciences in 2014. He is a Fellow of the ITI and a Fellow of the Indian Society of Oral Implantologists (ISOI). Dr. Mihir Kulkarni is a full time, permanent faculty at the Shri Dharmasthala Manjunatheshwara University, Dharwad and is currently designated as an Associate Professor in the Department of Periodontics and Oral Implantology. He is the recipient of a research grant from the ISOI and has been selected for an education grant by the Osteology Foundation. He is a speaker for the ITI and has also delivered guest lectures for other academic bodies such as the Indian Society of Periodontology, the Indian Society of Restorative Dentistry, Prosthodontics and Periodontics among others. Dr. Mihir Kulkarni has 12 publications listed in SCOPUS and PubMed. His article on the use of Platelet-rich fibrin (PRF) for healing of the palatal free gingival graft donor site is among the first reports of such an application as well as among the first to observe a haemostatic activity of PRF. Dr. Mihir is also a faculty in the ITI Kickstart implantology programme being held at the SDM College of Dental Sciences & Hospital and is also currently pursuing his Ph.D. research in the field of periodontal microbiology.