**5. Alternative sites for free autogenous graft harvesting-maxillary tuberosity**

Harvesting autogenous free grafts from the tuberosity are linked to different advantages compared to the classical palatal donor sites—the presence of a lower percentage of fatty/glandular tissue within the graft, higher percentage of collagen fibers within the graft, increased thickness of soft tissue in the donor area, and reduced patient morbidity and a lower percentage of other postoperative complications [26, 47, 96].

Soft tissue grafts from the tuberosity undergo minimal shrinkage during healing as a result of a higher quality of harvested soft tissue [47, 97]. A lower level of pain after tuber soft tissue graft harvesting may be explained by the faster rate of donor site healing compared to palatal donor sites. Additionally, the tuberosity donor site is less prone to masticatory friction [47, 96–98].

The presence of the fully erupted or semi-impacted third molar can prevent soft tissue grafting from the tuber region. In seldom clinical cases, hyperplastic response during haling of tuberosity CTG was observed, leading to an esthetic results (**Figures 35–38**) [47, 96].

#### **Figure 35.**

*CTG harvesting from the tuberosity. Autologous graft has been harvested as a free gingival graft. Note the increased thickness and the absence of the fatty tissue inside the CTG.*

**Figure 36.**

*After extraoral de-epithelization: Epithelial layer (left part of the picture) removed from the rest of CTG (right part of the picture).*

**Figure 38.** *Flap adaptation around healing abutments.*
