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Clinicians' Stress Levels During Soft Tissue Augmentation Using Autogenous Connective Tissue Grafts: A Pilot Study
Anina N Zuercher1, Franz J Strauss1,2, Rawen Smirani3
1Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.
Clinical Implant Dentistry and Related Research
|February 26, 2026
Summary
Clinicians performing subepithelial connective tissue graft (SCTG) surgery experience transient physiological stress, but their anxiety levels remain stable. This indicates effective stress management during mucogingival procedures.
Area of Science:
- Periodontology
- Oral Surgery
- Surgical Stress Physiology
Background:
- Mucogingival surgery using subepithelial connective tissue grafts (SCTG) is a common procedure for mucosal thickening.
- Quantifying intraoperative stress in clinicians is crucial for understanding performance and well-being.
- Feasibility of real-time stress monitoring in surgical settings requires investigation.
Purpose of the Study:
- To quantify intraoperative stress responses in clinicians during SCTG procedures.
- To combine physiological and psychological measures for a comprehensive stress assessment.
- To explore the feasibility of stress monitoring in this surgical context.
Main Methods:
- Eleven clinicians performed 14 SCTG procedures.
- Physiological stress was measured via heart rate (HR) and salivary cortisol.
- Psychological stress and workload were assessed using the State-Trait Anxiety Inventory (STAI-6) and Surgery Task Load Index (SURG-TLX).
Main Results:
- Heart rate showed transient increases during critical surgical phases (incision, flap preparation, graft harvesting).
- Salivary cortisol levels exhibited normal diurnal variation, with no sustained endocrine stress.
- Perceived workload was high, primarily driven by mental demand and task complexity, while anxiety scores remained stable.
Conclusions:
- SCTG procedures induce short-term physiological stress responses in clinicians.
- Clinicians demonstrate adaptive stress regulation and well-managed responses during these procedures.
- Characterizing stress dynamics can inform future research on clinician performance, fatigue, and procedural safety.
