I have received many questions related to the indications for each of the above types of grafts. First I should say that there is some overlap for indications related to these types of procedures and that individuals clinicians may assign value to each of the procedures based on the area of the mouth being treated as well as the quality and quantity of the tissue already present in the area.
I was once told by one of my dental school instructors that there is never a reason to do free soft tissue grafts anymore due to the advent of CT grafting. I believed her for three years, however since then have seen increasing valued for free gingival grafts as both an pre-esthetic/prosthetic procedure as well as in some cases definitive treatment. Although they are not as esthetic in nature as CT grafting I do feel that for the desired result they are more predictable and more permanent in nature. I've seen many fgg that are 30+ years old that look brand new. It should be noted that after a CT graft is a year old you may never be able to find it again so I don't have much basis for comparison. Generally speaking you should be more selective of the cases you elect to perform CT grafts on, sometimes it is worthwhile to increase the band of attached gingiva via a FGG before proceeding to a CT graft.
I don't use alloderm routinely, I just haven't been able to duplicate the results of many of the periodontists who use it routinely. I too have excellent outcomes with alloderm, just not on the same consistent basis that I do with native tissue. When palatal stents are properly used I don't feel that using native tissue needs to be significantly more uncomfortable than using an allograft material and if I were having a graft done I would elect for the native autograft as opposed to a foreign material.
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