Connective Tissue Graft Instruments: Harvest, Tunnel and Suture

A connective tissue graft (CTG) takes a strip of subepithelial connective tissue from the palate and places it under a flap or into a tunnel at a recession site to thicken thin gingiva and cover exposed roots. It is the reference soft-tissue graft in periodontal and peri-implant surgery, and its success depends as much on how the tissue is handled as on where it is placed.

This procedure set-up guide walks through the instruments clinicians reach for at each step, drawn from the Helmut Zepf Periodontal Microsurgery Instrument Collection, and matches them to the demands of harvest, tunneling and suturing.

What Instruments Does a Connective Tissue Graft Need?

Three stages, three instrument groups. Harvest: a graduated probe to size the graft, a scalpel for the palatal incisions and atraumatic micro forceps to lift and carry the graft without crushing it. Recipient site: a tunneling instrument matched to the arch (or a periosteal elevator for a flap) to create the pouch that will nourish the graft. Closure: a fine spinlock needle holder and micro scissors for the sling or mattress sutures that hold the graft against the root. The sections below give a specific Helmut Zepf pattern for each.

Harvesting the Donor Graft

Donor-site harvest from the palate, or de-epithelialization of a free gingival graft, demands atraumatic tissue handling above nearly everything else in the procedure. Fine-tipped forceps that grip without crushing the connective tissue bed help preserve graft vascularity during transfer, while a stable, non-slip handle keeps the graft correctly oriented as it moves from the palatal donor site to the recipient bed. A crush injury at this stage can compromise revascularization long before the graft is ever sutured into place.

Best for: the Micro Cooley Forceps, whose ZEPF-Line handle with guide pin keeps the fine tips aligned so delicate donor tissue is held securely without crush injury during harvest and transfer.

Before the incision is made, many clinicians confirm graft dimensions with a graduated periodontometer rather than estimating by eye, particularly when donor tissue availability is limited by palatal vault depth or a prior harvest site.

Best for: the Periodontometer, Kahn Probe, purpose-built for measuring a free gingival graft in 2 mm increments before the incision is made.

Preparing the Recipient Tunnel

Tunnel and pouch techniques for root coverage rely on double-ended tunneling instruments that undermine the tissue through a limited access incision without perforating thin marginal gingiva or the papilla. Upper and lower arch anatomy differ enough that jaw-specific patterns exist. The complete Helmut Zepf tunneling sets, and how the technique developed, are covered in Best Tunneling Instrument Set for 2026 and Tunneling Instruments: Their History; the two individual instruments a CTG tray needs are below.

Best for: the Tunneling Instrument #1 for the Upper Jaw, contoured for supra-periosteal tunnel preparation across the maxillary arch.

Best for: the Tunneling Instrument #2 for the Lower Jaw, angled to maintain control in the more restricted mandibular arch.

Suturing and Stabilizing the Graft

Once the connective tissue graft is positioned within the tunnel or beneath a coronally advanced flap, needle control determines how evenly tension is distributed across the closure. A spinlock needle holder with tungsten carbide jaws grips fine suture material without deforming the needle, which matters most when placing sling or mattress sutures that stabilize the graft against the root surface. Micro scissors with a sharp, micro-serrated blade then let the clinician trim suture ends flush without disturbing the graft or reopening the tunnel entrance. Lock, spring and tungsten carbide Castroviejo variants are compared in Castroviejo Needle Holders by Helmut Zepf.

Best for: the Castroviejo Needle Holder, Straight, whose spinlock design and protected inner spring hold fine suture securely through repeated passes.

Best for: the Micro Spring Castroviejo Scissors, curved and micro-serrated for precise suture trimming close to the tissue surface.

Matching Instruments to Procedure Step

These instruments are drawn from the broader Helmut Zepf Dental Instrument Collection, and the table below summarizes which tool fits which stage of a connective tissue graft procedure.

Instrument	Key Trait	Best For
Micro Cooley Forceps	Guide-pin handle, fine atraumatic tips	Donor graft harvest and transfer
Tunneling Instrument #1 / #2	Double-ended, jaw-specific angulation	Recipient tunnel preparation
Castroviejo Needle Holder	Spinlock, tungsten carbide jaws	Fine suture placement
Micro Spring Castroviejo Scissors	Curved, micro-serrated blade	Suture trimming

FAQs

What instruments are essential for a connective tissue graft procedure?
At minimum, an atraumatic forceps for tissue handling, a tunneling curette matched to the arch being treated, a fine needle holder, and micro scissors for suture management.

Why use jaw-specific tunneling instruments instead of one universal design?
Upper and lower arch anatomy differ in access and curvature, so a single curette angle compromises control in one arch to accommodate the other.

How do tungsten carbide jaws benefit a needle holder used in graft suturing?
Tungsten carbide inserts grip fine monofilament or polypropylene suture securely without deforming the needle shank, reducing slippage during repeated passes.

Is a periodontometer necessary before harvesting a graft?
It is not strictly required, but a graduated probe such as the Kahn design helps confirm available donor tissue dimensions before the incision, reducing the risk of an undersized graft.

Can the same forceps be used for both harvest and graft placement?
Yes, provided the tip design is fine and non-crushing; many clinicians use the same atraumatic forceps throughout harvest, transfer, and stabilization.

How should these microsurgical instruments be reprocessed between cases?
Follow the manufacturer's validated sterilization instructions for each instrument; delicate tips and spinlock mechanisms typically require protected tray placement to avoid damage during cleaning.

Shop the full Periodontal Microsurgery Instrument Collection.

Related resources: Product Library · Helmut Zepf Literature · Busch Catalogs