Comparison of 2 techniques of subepithelial connective tissue graft in the treatment of gingival recessions

Aim of the study

This retrospective study compares the reduction in recession and gingival augmentation obtained following two types of submerged connective tissue graft ; the envelope technique (E) and the coronally repositioned flap (PC).

Materials and methods

Two groups of ten and eleven patients, treated consecutively, each comprised 31 areas of recession. The first group (E), that included 19 Miller Class 1 recessions and 12 Class 2, was treated by the envelope technique that consists of inserting tissue collected from the palatal aspect of the premolars and molars under a partial thickness flap without making releasing incisions. The other group (PC), that comprised 26 Class 1 and 5 Class 2 recessions, was treated by the coronally repositioned flap technique where the same type of tissue was inserted. Three of the ten patients in group E and eight of the eleven in group PC were smokers.

Results

The percentage coverage at one year in group E was 89.6 ± 15 % and for group PC it was 94.7 ± 11.4 %. Sixty-four percent of the recessions became fully covered in group E against 81 % in group PC. The height of keratinised tissue increased by 35 % in PC and 250 % in E.

Conclusion

Both approaches allowed equivalent amounts of root coverage to occur but the envelope technique had the advantage in terms of tissue keratinisation. The benefit obtained is a function of the initial height of the gingiva and of the amount of graft left exposed.

Commentary

There are many variables that may affect the results in this type of study on multiple recessions. Incisors, canines, premolars and a few molars were included in the limited number of subjects. The statistical analysis was undertaken on the means of sites and not by patients.