Advertisement

Clinical Oral Investigations

, Volume 18, Issue 9, pp 2213–2219 | Cite as

Early wound healing and patient morbidity after single-incision vs. trap-door graft harvesting from the palate—a clinical study

  • Stefan FicklEmail author
  • Kai R. Fischer
  • Yvonne Jockel-Schneider
  • Christian F. J. Stappert
  • Ulrich Schlagenhauf
  • Moritz Kebschull
Original Article

Abstract

Objectives

The aim of this study is to compare wound healing and patient pain perception of single-incision (single-incision, modified single-incision) and trap-door surgical techniques to harvest subepithelial connective tissue grafts from the palate.

Material and methods

Thirty-six patients were selected for root coverage procedures with subepithelial connective tissue grafts and randomly assigned to two single-incision groups or a trap-door group (n = 12/group). One week after surgery, a modified early-wound healing index (EHI), patient pain and painkiller intake were recorded. Follow-up was performed until complete epithelialization was achieved.

Results

Single-incision techniques showed significantly improved early healing over trap-door approaches. Specifically, the mean EHI was 2.50 ± 1.14 for single-incision techniques, as compared to 3.33 ± 1.30 for trap door. The incidence of secondary healing was significantly lower in the single-incision groups. Concomitantly, the cumulative dosage and duration of painkiller intake were significantly reduced, as compared to the trap-door group.

Conclusion

Within the limits of this trial, single-incision techniques can lead to improved early healing and reduced patient pain after subepithelial connective tissue graft harvesting than trap-door techniques.

Clinical relevance

Avoiding trap-door incisions for harvesting of connective tissue grafts may reduce patient morbidity.

Keywords

Connective tissue graft Wound healing Palate Single incision Trap door 

Notes

Acknowledgments

The authors acknowledge the help of Mr. Benedikt Schumann in the field of patient management and coordination.

Source of funding

This study was funded solely by the authors’ institutions.

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Roccuzzo M, Bunino M, Needleman I, Sanz M (2002) Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 29(Suppl 3):178–194, discussion 195–6PubMedCrossRefGoogle Scholar
  2. 2.
    Chambrone L, Sukekava F, Araujo MG, Pustiglioni FE, Chambrone LA and Lima LA (2009) Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev:CD007161Google Scholar
  3. 3.
    Santamaria MP, Casati MZ, Nociti FH Jr, Sallum AW, Sallum EA, Aukhil I, Wallet SM, Shaddox LM (2013) Connective tissue graft plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesions: microbiological and immunological results. Clin Oral Investig 17:67–77. doi: 10.1007/s00784-012-0690-8 PubMedCrossRefGoogle Scholar
  4. 4.
    Edel A (1974) Clinical evaluation of free connective tissue grafts used to increase the width of keratinized gingiva. J Clin Periodontol 4:185–196CrossRefGoogle Scholar
  5. 5.
    Langer B, Langer L (1985) Subepithelial connective tissue graft technique for root coverage. J Periodontol 56:715–720PubMedCrossRefGoogle Scholar
  6. 6.
    Raetzke P (1985) Covering localized areas of root exposure employing the “envelope” technique. J Periodontol 56:397–402PubMedCrossRefGoogle Scholar
  7. 7.
    Harris RJ (1997) A comparison of two techniques for obtaining a connective tissue graft from the palate. Int J Periodont Restor Dent 17:260–271Google Scholar
  8. 8.
    Hürzeler M, Weng D (1999) A single incision technique to harvest subepithelial connective tissue graft from the palate. Int J Periodont Restor Dent 19:279–287Google Scholar
  9. 9.
    Thalmair T, Fickl S, Hinze M, Bolz W, Wachtel H (2010) Modifizierte Technik zur Entnahme eines subepithelialen Bindegewebstransplantates. Parodontologie 21:100–105Google Scholar
  10. 10.
    Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R (2002) The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site. A preliminary study. J Clin Periodontol 29:848–854PubMedCrossRefGoogle Scholar
  11. 11.
    Wessels J, Tatakis D (2008) Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Clin Periodontol 79:425–430CrossRefGoogle Scholar
  12. 12.
    Griffin TJ, Cheung WS, Zavras AI, Damoulis PD (2006) Postoperative complications following gingival augmentation procedures. J Periodontol 77:2070–2079PubMedCrossRefGoogle Scholar
  13. 13.
    Zucchelli G, Amore C, Sforzal NM, Montebugnoli L, De Sanctis M (2003) Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study. J Clin Periodontol 30:862–870PubMedCrossRefGoogle Scholar
  14. 14.
    Zuhr O, Fickl S, Wachtel H, Bolz W, Hurzeler MB (2007) Covering of gingival recessions with a modified microsurgical tunnel technique: case report. Int J Periodont Restor Dent 27:457–463Google Scholar
  15. 15.
    Wachtel H, Schenk G, Böhm S, Weng D, Zuhr O, Hürzeler M (2003) Microsurgical access flap and enamel matrix derivate for the treatment of periodontal intrabony defects: a controlled clinical study. J Clin Periodontol 30:496–504PubMedCrossRefGoogle Scholar
  16. 16.
    Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 35:136–162. doi: 10.1111/j.1600-051X.2008.01267.x PubMedCrossRefGoogle Scholar
  17. 17.
    Edel A (1998) Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. 1974. Periodontal Clin Investig 20:12–20PubMedGoogle Scholar
  18. 18.
    Jahnke PV, Sandifer JB, Gher ME, Gray JL, Richardson AC (1993) Thick free gingival and connective tissue autografts for root coverage. J Periodontol 64:315–322PubMedCrossRefGoogle Scholar
  19. 19.
    Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M (2010) Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 37:728–738. doi: 10.1111/j.1600-051X.2010.01550.x PubMedGoogle Scholar
  20. 20.
    Lorenzana ER, Allen EP (2000) The single-incision palatal harvest technique: a strategy for esthetics and patient comfort. Int J Periodont Restor Dent 20:297–305Google Scholar
  21. 21.
    Lafzi A, Mostofi Zadeh Farahani R, Abolfazli N, Amid R, Safaiyan A (2007) Effect of connective tissue graft orientation on the root coverage outcomes of coronally advanced flap. Clin Oral Investig 11:401–408. doi: 10.1007/s00784-007-0143-y PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Stefan Fickl
    • 1
    Email author
  • Kai R. Fischer
    • 1
  • Yvonne Jockel-Schneider
    • 1
  • Christian F. J. Stappert
    • 2
    • 3
  • Ulrich Schlagenhauf
    • 1
  • Moritz Kebschull
    • 4
  1. 1.Department of PeriodontologyJulius-Maximilians-University WürzburgWürzburgGermany
  2. 2.Department of PeriodonticsUniversity of Maryland School of DentistryBaltimoreUSA
  3. 3.Department of ProsthodonticsAlbert-Ludwigs-UniversityFreiburgGermany
  4. 4.Department of Periodontology, Operative and Preventive DentistryUniversity of BonnBonnGermany

Personalised recommendations