Comparative Clinical Outcomes of Connective Tissue Graft Procedures Harvested from the Palate, Before and After Recipient Site Preparation: A Randomized Controlled Trial
Objectives: This study aimed to compare the root coverage outcomes of connective tissue grafts (CTG) harvested from the palate before and after recipient site preparation.
Methods: Twenty single gingival recessions type 2 (RT2) at buccal sites of single-rooted teeth, randomized into two groups: graft harvested after (control) and before (test) site preparation. Clinical parameters and patient satisfaction were assessed at baseline and at three months, with follow-ups for complications at 1 week, 2 weeks, 1 month, and 3 months.
Results: At three months, recession reduction was 2.2±1.1 mm (control) and 2.5±0.7 mm (test), with root coverage percentages of 82.0±32.0% and 90.5±30.1%, respectively. No significant differences were observed in clinical outcomes, complications, or patient satisfaction between the two approaches.
Conclusions: These findings indicate that harvesting CTG prior to recipient site preparation can serve as a clinically effective and flexible alternative, especially in situations where anatomical limitations of the palate might complicate the traditional treatment sequence.
1. Fragkioudakis I, Tassou D, Sideri M, Vouros I. Prevalance and clinical characteristics of gingival recession in Greek young adults: a cross-sectional study. Clin Exp Dent Res. 2021;7(5):672-8.
2. Yadav VS, Gumber B, Makker K, Gupta V, Tewari N, Khanduja P, et al. Global prevalence of gingival recession: a systematic review and meta-analysis. Oral Dis. 2022(29):2993-3002.
3. Seong J, Bartlett D, Newcombe R, Claydon N, Hellin N, West N. Prevalence of gingival recession and study of associated related factors in young UK adults. J Dent. 2018;76:58-67.
4. Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003;134(2):220-5.
5. Rajapakse PS, McCracken GI, Gwynnett E, Steen ND, Guentsch A, Heasman PA. Does tooth brushing influence the development and progression of non-inflammatory gingival recession? a systematic review. J Clin Periodontol.
2007;34(12):1046-61.
6. Joss-Vassalli I, Grebenstein C, Topouzelis N, Sculean A, Katsaros C. Orthodontic therapy and gingival recession: a systematic review. Orthod Craniofac Res. 2010;13(3): 127-41.
7. Merijohn GK. Management and prevention of gingival recession. Periodontol 2000. 2016;71(1):228-42.
8. Chambrone L, Botelho J, Machado V, Mascarenhas P, Mendes JJ, Avila-Ortiz G. Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? a systematic review and network meta-analysis. J Periodontol. 2022;93(9):1-17.
9. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol. 1985;56(12): 715-20.
10. Bruno JF. Connective tissue graft technique assuring wide root coverage. Int J Periodontics Restorative Dent. 1994;14(2):126-37.
11. Nelson SW. The subpedicle connective tissue graft: a bilaminar reconstructive procedure for the coverage of denudedroot surfaces. J Periodontol. 1987;58(2):95-102.
12. Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique. Int J Periodontics Restorative Dent. 1994;14(3):302-15.
13. Miller Jr PD. Root coverage with the free gingival graft: factors associated with incomplete coverage. J Periodontol. 1987;58(10):674-81.
14. Harris RJ. The connective tissue with partial thickness double pedicle graft: The results of 100 consecutively-treated defects. J Periodontol. 1994;65(5):448-61.
15. Rebele SF, Zuhr O, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II. volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol. 2014;41(6):593-603.
16. 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.
17. Reiser GM, Bruno JF, Mahan PE, Larkin LH. The subepithelial connective tissue graft palatal donor site: anatomic considerations for surgeons. Int J Periodontics Restorative Dent. 1996;16(2):130-7.
18. Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative complications following gingival augmentation procedures. J Periodontol. 2006;77(12):2070-9.
19. 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 randomizedcontrolled clinical trial. J Clin Periodontol. 2010;37(8): 728-38.
20. Seki M, Miyasaka H, Edamatsu H, Watanabe K. Changes in permeability of strial vessels following vibration given to auditory ossicle by drill. Ann Otol Rhinol Laryngol. 2001;110(2):122-6.
21. Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011;38(7):661-6.
22. Wong DL, Baker CM. Pain in children: Comparison of assessment scales. Pediatr Nurs. 1998;14(1):9-17.
23. Liu S, Yang SD, Fan XW, Yang DL, Ma L, Sun JY, et al. Analyses of effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL: a retrospective cohort study. J Orthop Surg Res. 2019;14(1):1-8.
24. O' Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol. 1972;43(1):38.
25. Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Clin Periodontol. 2018;45(S20):S219-S29.
26. Bernimoulin JP, Lüscher B, Mühlemann HR. Coronally repositioned periodontal flap. J Clin Periodontol. 1975; 2(1):1-13.
27. Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, et al. Treatment of stage I–III periodontitis—the EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(S22):4-60.
28. Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Cincinelli S, et al. Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial. J Clin Periodontol. 2012;39(8):760-8.
29. Cairo F, Cortellini P, Pilloni A, Nieri M, Cincinelli S, Amunni F, et al. Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol. 2016;43(10):849-56.
30. Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. clinical and patient-centred outcomes. J Clin Periodontol. 2014;41(6):582-92.
31. Silva RCD, Joly JC, de Lima AFM, Tatakis DN. Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. J Periodontol. 2004;75(3):413-9.
32. Zuhr O, Akakpo D, Eickholz P, Vach K, Hürzeler MB, Petsos H, et al. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 5 year results of an RCT using 3D digital measurement technology for volumetric comparison of soft tissue changes. J Clin Periodontol. 2021;48(7):949-61.
33. Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinized gingiva. J Clin Periodontol. 1974;1(4):185-96.
34. Orsini M, Orsini G, Benlloch D, Aranda JJ, Lázaro P, Sanz M. Esthetic and dimensional evaluation of free connective tissue grafts in prosthetically treated patients: a 1-year clinical study. J Periodontol. 2004;75(3):470-7.