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

Objective. The goal of periodontal surgery is to cover the exposed root completely or partially in teeth with gingival recession. This correction is important from an aesthetic and a functional point of view. Periodontal regeneration is visible only through histologic analysis. Histologic analysis can reveal the arrangement of the cells embedded in the periodontal-tissue attachment. Micro punch gum technique(2 mm) was used for biopsy.
Method. Three patients with gingival recessions were treated subepithelial connective tissue graft (CTG) and clinical parameters and histological results were recorded.
Results. Complete coverage of the exposed root part was obtained in the three cases, and the histologic analysis revealed a selective settlement with ligament cells that are typical for the formation of connective tissue in periodontal regeneration. Histologic analysis showed keratinized sulcular epithelium with thin and tall extensions into the gingival connective tissue and a junctional epithelium which extended to new cementum. Also increased number of blood vessels and new insertion of the connective tissue was observed. If the clinical goal of periodontal surgery is complete coverage of gingival recessions, then the goal at the microscopic level is to obtain true periodontal regeneration.
Conclusion. CTG is the gold standard in the selection of grafts to resolve recessions. From the choice of gingival flaps, CAF (coronally advanced flap) was and still is number 1, but also the laterally displaced flap gives quite good results in single recessions.
Key words: gingival recession; elastic tissue; collagen; connective tissue.