Subperiosteal connective tissue grafts for pocket reduction and preservation of gingival esthetics: a case report

Connective tissue graft as a biological barrier for guided tissue regeneration in intrabony defects: a histological study in dogs

BACKGROUND

The use of the autogenous periosteal graft as biological barrier has been proposed for periodontal regeneration. The aim of this study was to evaluate the histometric findings of the subepithelial connective tissue graft as barrier in intrabony defects compared to a bioabsorbable membrane.

METHODS

Three-walled intrabony defects were created surgically in the mesial aspect of the right and left maxillary canines in five healthy mongrel dogs. The defects were chronified, and two types of barriers were randomly carried out for guided tissue regeneration in a split-mouth design: the test group with a subepithelial connective tissue graft and the control group with a bioabsorbable membrane. The specimens were processed for histometric analyses of the epithelium (E), connective tissue (CT), newly formed cementum (NC), new bone (NB), and total newly formed tissues (NFT).

RESULTS

The test side showed smaller mean of NC (3.6 ± 1.2), NB (2.1 ± 0.7), and NFT (7.7 ± 0.8) than the control group (NC 7.3 ± 0.5; NB 5.3 ± 1.3; NFT 10.1 ± 2.2; P < 0.05). No statistically significant differences were verified for E (test 3.1 ± 2.0; control 2.8 ± 2.1; P > 0.05) and CT (test 2.5 ± 1.1; control 2.0 ± 0.5; P > 0.05) between groups.

CONCLUSION

The bioabsorbable membrane was more effective in maintaining the space for periodontal regeneration than periosteal connective graft when used as barrier.

CLINICAL RELEVANCE

The bioabsorbable membrane showed more favorable regenerative results in intrabony defects in dogs than the subepithelial connective tissue graft as biological barrier.

Effect of connective tissue graft orientation on the root coverage outcomes of coronally advanced flap

The aim of the present study was the evaluation of the effect of connective tissue graft orientation on clinical outcome of root coverage procedure when applied in conjunction with coronally advanced flap. Sixteen similar bilateral recession defects--Miller's class I and II--in eight patients were treated using coronally advanced flap and connective tissue graft harvested from the palate. The defects in each patient were randomly allocated to P-teeth or P-flap groups with the periosteum contacting the tooth surface or the flap, respectively. After initial scaling and root planing, acrylic templates of the treatment sites were generated. Recession depth (RD), recession width (RW), gingival sulcular depth, clinical attachment level, length of keratinized tissue, papilla width, and percentage of root coverage were measured at baseline, 1 and 3 months postoperatively. Wilcoxon and Mann-Whitney U tests were used for analyzing the data. The reduction in RD averaged 3.68 mm in P-teeth and 3.25 mm in P-flap. RW decreased 2.68 and 2.6 mm in P-teeth and P-flap, respectively. Keratinized tissue increased an average of 1.25 mm in P-teeth and 1.31 mm in P-flap. Clinical attachment gain equaled 3.87 mm for P-teeth and 3.32 mm for P-flap. All variables exhibited significant improvement compared to baseline (P < 0.0001), but between-group differences were negligible (P > 0.05). It could be concluded that while the application of connective tissue graft with coronally advanced flap is efficient for coverage of Miller's class I and II gingival recession defects, the short-term clinical outcome of this surgical method is not affected by orientation of connective tissue graft.