Subepithelial Connective Tissue Grafts in the Treatment of Gingival Recessions. A Comparative Study of 2 Procedures

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Abstract
Thirty (30) Class I and Class II recessions in 30 subjects were treated with a subepithelial connective tissue graft procedure. In one group (15 sites), the surgery was carried out in a traditional fashion: the epithelial collar of the graft was preserved and left exposed (CTG group). In the second group (15 sites), the epithelial collar of the graft was removed and the recession areas were conditioned with citric acid. The graft was then sutured and completely immersed under the facial flap which was coronally repositioned (CR group). Clinical assessments included probing depth, probing attachment level, surface area of the recession, and gingival width. These measurements were taken at baseline and at 6 months. In addition, an esthetic evaluation was done. The differences between treatments were not statistically significant except for the augmentation of gingiva (P ≤0.05). Based on the midfacial measurements taken in the central area of the recession, the mean percentage of root coverage was 69.2%. In the CR group, 3 of the 15 recessions exhibited complete root coverage; the gingival augmentation was 65.5%. In the CTG group, 5 of the 15 recessions exhibited complete root coverage; the gingival augmentation was 94.4%. The mean surface area of root exposure was reduced from 13.82 mm2 and 13.67 mm2 to 2.15 mm2 and 2.34 mm2 for the CR group and the CTG group, respectively. One‐hundred percent (100%) of good‐to‐moderate esthetic results were found by a panel of independent examiners; there was tendency toward better results in the CR group. The results of this study indicate that partial success could be expected with subepithelial connective tissue grafting in Class I or Class II recession therapy. It is suggested that the CR group procedure gives better esthetic results than the CTG group procedure. However, when larger augmentation with keratinized tissue is needed, the CTG group procedure is preferred. J Periodontol 1994;65:929–936.