Subepithelial connective tissue graft for root coverage: clinical case reports and histologic evaluation

Area of Science:

• Periodontology
• Regenerative Medicine
• Oral Surgery

Background:

• Complete root coverage of gingival recessions is a primary goal in periodontal plastic surgery.
• True periodontal regeneration, confirmed by histology, is the microscopic gold standard for evaluating treatment success.
• In vivo human studies examining grafted tissue-root interfaces are lacking.

Observation:

• A novel biopsy technique using a bone marrow needle was developed to obtain tissue samples from grafted sites in humans.
• Two patients with gingival recessions underwent coronally advanced flap surgery with subepithelial connective tissue grafts.
• Clinical assessment showed complete root coverage in both cases, with apparent tissue attachment to the root surface.

Findings:

• Histological examination revealed dense grafted connective tissue, indicating long-term stability.
• No evidence of periodontal ligament or bone formation, characteristic of true regeneration, was observed.
• Healing was characterized by a long connective tissue attachment, distinct from the typical long junctional epithelium.

Implications:

• The developed biopsy method allows for in vivo histological assessment of periodontal plastic surgery outcomes.
• While not achieving true regeneration, the observed connective tissue attachment provides stable root coverage.
• Patient acceptance of biopsy procedures, even when minimally invasive, remains a challenge for post-surgical evaluation.