Efficacy of different gingival graft de-epithelialization methods: A parallel-group randomized clinical trial

The clinical outcomes of either extra-oral (eo) or intra-oral (io) de-epithelialized connective tissue graft (DE-CTG) techniques to the recipient site have not been fully elucidated yet. There is an ongoing debate regarding the possible complications caused by incomplete elimination of the epithelial layer. The aim of this study is to compare clinical effectiveness and de-epithelialization efficacy of ioDE-CTG and eoDE-CTG in recession treatment.

Forty patients, with a single gingival recession, were treated with coronally advanced flap combined with eo- or ioDE-CTG. Data consisted of surgical chair-time, recipient site periodontal and patient-based variables. To evaluate the efficacy of de-epithelialization, histological analyses were also performed via graft imprints.

There was no significant inter-group difference in terms of treatment outcomes. Aesthetic results were also similar for both groups. While chair-time was significantly shorter in the ioDE group, less epithelial remnants were showed with eoDE technique.

Similar clinical outcomes were obtained with eo- and ioDE-CTG. While ioDE is less effective in removing the epithelial layer, no long-term complications due to the epithelial residues were detected. Both techniques can be recommended in recession treatment.

This study demonstrates that extraoral and intraoral de-epithelialized connective tissue grafts in root coverage procedures led to similar clinical results without any further events. The study protocol was registered at ClinicalTrials.gov (NCT05494294).