Soft Tissue Augmentation Using De-Epithelialized Free Gingival Graft Compared to Single-line Incision Subepithelial Connective Tissue Graft in the Management of Miller Class I and II Gingival Recession

Abstract

Aims: The purpose of this randomized controlled clinical trial was to clinically assess soft tissue augmentation and compare patients’ morbidity and root coverage outcomes of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) versus de-epithelialized free gingival graft (DFGG) in the management of Miller Class I and II gingival recession. Materials and Methods: Twenty-eight patients with Miller's Class I or II gingival recession (GR) defects were randomly assigned into two equal parallel groups treated with either CAF + SCTG, harvested using single-line incision technique (control), or CAF + DFGG (test). Gingival thickness (GT), recession depth, recession width, percentage of root coverage, keratinized tissue width, pocket depth, and clinical attachment level were measured at baseline and 3 and 6 months postoperatively. Patient-reported outcomes were assessed postoperatively, including pain, stress, bleeding, and inability to chew. Patients’ overall satisfaction and root coverage esthetic scores were recorded at 6 months. Results: Both groups demonstrated a statistically significant improvement in all clinical outcomes after 3 and 6 months compared to baseline. DFGG showed a statistically significant increase in GT after 6 months. No statistically significant difference was detected in other clinical outcomes between both groups at different time intervals. Both treatments achieved 92.9% complete root coverage. Patients treated with CAF + DFGG reported significantly higher stress and inability to chew scores after 2 weeks than those treated with SCTG. There were no significant differences in patient satisfaction between both groups. Conclusions: CAF + SCTG and CAF + DFGG were both effective and can be applied safely in treating Miller Class I and II GRs.

Comparison of morbidity at the donor site and clinical efficacy at the recipient site between two different connective tissue graft harvesting techniques from the palate: A randomized clinical trial

“…According to the results of this study, the level of pain at the donor site and the consumption of analgesics from the third day to the seventh day were significantly higher in the DGG group, indicating that pain decreased significantly until the third day in the SCTG group, while it persisted in the DGG group. Furthermore, the patients in the DGG group consumed a significantly higher number of analgesics for pain control from the day of surgery to seven days postoperatively (13.25 ± 5.46 versus 6.58 ± 5.63), consistent with the findings of studies by Wessel and Tatakis 8 and Del Pizzo et al 6 Mashaly et al 3 also concluded that the level of chewing disability, stress, and pain on the third day was higher in the DGG method compared to the SCTG method. However, Zucchelli et al 7 found no significant difference in the pain level and analgesic consumption between the two techniques.…”

“…However, this superiority has not been demonstrated in similar studies. 3,7,16 The CRC value for the DGG group in our study was also lower compared to the findings of Zucchelli et al, 7 Mashaly et al, 3 and Bakhishov et al, 16 who reported CRC values of 84%, 93%, and 70%, respectively. It is worth noting that the studies by Zucchelli and Bakhishov assessed CRC at 12 months postoperatively.…”

“…Additionally, regarding clinical efficacy, some studies concluded that the graft obtained using the DGG technique was firmer and capable of creating a greater increase in gingival thickness (GT) compared to the SCTG technique. 3,7 In contrast, a study did not confirm these findings. 16 However, gingival piercing was used to measure the keratinized tissue thickness (GT) in these studies; this method increases the likelihood of errors, possibly due to the displacement of rubber stops, the file entering at different angles, the bending of fine files, and the stopping of thick files before reaching the bone level.…”

“…This tissue is prone to significant shrinkage, resulting in increased graft shrinkage. 3 , 26 In contrast, in the DGG method, due to the presence of more collagen fibers in the lamina propria, the graft is denser and undergoes less shrinkage. 13 , 16 , 27 This study confirmed the findings of previous studies, although the difference between the two groups in terms of graft shrinkage did not reach statistical significance at the 6-month follow-up.…”

“…Studies suggest that since subepithelial connective tissue graft (SCTG) provides better stability of the gingival margin and also creates some creeping attachment over time compared to other surgical methods, this technique, in combination with coronally advanced flap (CAF), is considered the gold standard for treating single or multiple gingival recessions, [1][2][3] especially in cases where the gingiva is thin or there is minimal keratinized tissue around the tooth with recession. 4 The most important complication associated with connective tissue grafts is increased patient morbidity at the donor site.…”