Abstract
Summary
Tuberosity grafts had a greater percentage of lamina propria and lower percentage of submucosa when compared to lateral palate grafts.
Objective
The study aims to understand the differences in the structural composition of soft tissue autografts harvested from the lateral palate or the tuberosity.
Material and methods
Patients were randomly allocated to receive autografts harvested either from palatal or tuberosity sites to augment horizontal volume deficiencies around single-tooth implants. Tissue biopsies were analyzed for histological and histo-morphometric analysis. Picro-sirius red stain was used to evaluate collagen 1 and 3. Also, immuno-histochemical analysis was performed against MMP1, MMP2, cytokeratin-10, cytokeratin-13, and lysine hydroxylase-2.
Results
Twenty specimens were harvested from 9 subjects in the lateral palate group (PG) and 11 subjects in the tuberosity group (TG). The percentage of lamina propria represented 51.08% in the PG group and 72.79% in the TG group, while the area of submucosa was minimal in the TG group representing 4.89% of the total sample vs 25.75% in the PG. The total area of COL-1 and 3 in the TG was 1.19 ± 0.57 and 0.72 ± 0.44 mm2, respectively, while in the PG, the corresponding values were 1.4 ± 0.7 and 1.04 ± 0.5 mm2. The immuno-histochemical analysis generally showed a higher expression of LLH-2, MMP2, CYT-10, and CYT-13 in the TG when compared with the PG.
Conclusion
Tuberosity grafts had a greater percentage of lamina propria and lower percentage of submucosa. The collagen content in the lamina propria was similar for both groups while the immuno-histochemical profile showed differences in the antibody expression of the epithelial cells.
Clinical relevance
Tuberosity grafts had more lamina propria and less submocusa, which may be beneficial for volume augmentation.
Similar content being viewed by others
References
Chambrone L, Tatakis DN (2015) Periodontal soft tissue root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol 86(2 Suppl):S8–S51
Cairo F (2017) Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontol 2000 75(1):296–316
Sculean A, Gruber R, Bosshardt DD (2014) Soft tissue wound healing around teeth and dental implants. J Clin Periodontol 41(Suppl 15):S6–S22
Thoma DS, Buranawat B, Hammerle CH, Held U, Jung RE (2014) Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol 41(Suppl 15):S77–S91
Muller HP, Heinecke A, Schaller N, Eger T (2000) Masticatory mucosa in subjects with different periodontal phenotypes. J Clin Periodontol 27(9):621–626
Harris RJ (2003) Histologic evaluation of connective tissue grafts in humans. Int J Periodontics Restorative Dent 23(6):575–583
Jung UW, Um YJ, Choi SH (2008) Histologic observation of soft tissue acquired from maxillary tuberosity area for root coverage. J Periodontol 79(5):934–940
Zuhr O, Baumer D, Hurzeler M (2014) The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 41 Suppl 15:S123–S142
Bertl K, Pifl M, Hirtler L, Rendl B, Nurnberger S, Stavropoulos A, Ulm C (2015) Relative composition of fibrous connective and fatty/glandular tissue in connective tissue grafts depends on the harvesting technique but not the donor site of the hard palate. J Periodontol 86(12):1331–1339
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(8):728–738
Zucchelli G, Mazzotti C, Mounssif I, Mele M, Stefanini M, Montebugnoli L (2013) A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant. Clin Oral Implants Res 24(9):957–962
Dellavia C, Ricci G, Pettinari L, Allievi C, Grizzi F, Gagliano N (2014) Human palatal and tuberosity mucosa as donor sites for ridge augmentation. Int J Periodontics Restorative Dent 34(2):179–186
Rojo E, Stroppa G, Sanz-Martin I, Gonzalez-Martin O, Santos Alemany A, Nart J (2018) Soft tissue volume gain around dental implants using autogenous subepithelial connective tissue grafts harvested from the lateral palate or tuberosity area. A randomized controlled clinical study. J Clin Periodontol 45:495–503
Varghese F, Bukhari AB, Malhotra R, De A (2014) IHC profiler: an open source plugin for the quantitative evaluation and automated scoring of immunohistochemistry images of human tissue samples. PLoS One 9(5):e96801
Yu SK, Lee BH, Lee MH, Cho KH, Kim DK, Kim HJ (2013) Histomorphometric analysis of the palatal mucosa associated with periodontal plastic surgery on cadavers. Surg Radiol Anat 35(6):463–469
Rich L, Wittaker P (2005) Collagen and picrosirius red staining: a polarized light assesment of fibrilar hue and spatial distribution. Braz J Morphol Sci 22(2):97–104
Manjunatha BS, Agrawal A, Shah V (2015) Histopathological evaluation of collagen fibers using picrosirius red stain and polarizing microscopy in oral squamous cell carcinoma. J Cancer Res Ther 11(2):272–276
Arun Gopinathan P, Kokila G, Jyothi M, Ananjan C, Pradeep L, Humaira Nazir S (2015) Study of collagen birefringence in different grades of oral squamous cell carcinoma using Picrosirius red and polarized light microscopy. Scientifica (Cairo) 2015:802980
Kumari K, Ghosh S, Patil S, Augustine D, Samudrala Venkatesiah S, Rao RS (2016) Expression of type III collagen correlates with poor prognosis in oral squamous cell carcinoma. J Investig Clin Dent
Grimm PC, Nickerson P, Gough J, McKenna R, Stern E, Jeffery J, Rush DN (2003) Computerized image analysis of Sirius red-stained renal allograft biopsies as a surrogate marker to predict long-term allograft function. J Am Soc Nephrol 14(6):1662–1668
Diaz Encarnacion MM, Griffin MD, Slezak JM, Bergstralh EJ, Stegall MD, Velosa JA, Grande JP (2004) Correlation of quantitative digital image analysis with the glomerular filtration rate in chronic allograft nephropathy. Am J Transplant 4(2):248–256
Tanriverdi-Akhisaroglu S, Menderes A, Oktay G (2009) Matrix metalloproteinase-2 and -9 activities in human keloids, hypertrophic and atrophic scars: a pilot study. Cell Biochem Funct 27(2):81–87
Ulrich D, Ulrich F, Unglaub F, Piatkowski A, Pallua N (2010) Matrix metalloproteinases and tissue inhibitors of metalloproteinases in patients with different types of scars and keloids. J Plast Reconstr Aesthet Surg 63(6):1015–1021
Sawaf MH, Ouhayoun JP, Forest N (1991) Cytokeratin profiles in oral epithelial: a review and a new classification. J Biol Buccale 19(3):187–198
Feghali-Assaly M, Sawaf MH, Serres G, Forest N, Ouhayoun JP (1994) Cytokeratin profile of the junctional epithelium in partially erupted teeth. J Periodontal Res 29(3):185–195
Pelissier A, Ouhayoun JP, Sawaf MH, Forest N (1992) Changes in cytokeratin expression during the development of the human oral mucosa. J Periodontal Res 27(6):588–598
Sawaf MH, Ouhayoun JP, Shabana AH, Forest N (1992) Cytokeratins, markers of epithelial cell differentiation: expression in normal epithelia. Pathol Biol (Paris) 40(6):655–665
Ouhayoun JP, Gosselin F, Forest N, Winter S, Franke WW (1985) Cytokeratin patterns of human oral epithelia: differences in cytokeratin synthesis in gingival epithelium and the adjacent alveolar mucosa. Differentiation 30(2):123–129
Funding
The study was partially funded by a Young Researcher Grant (14–114) from the Osteology Foundation, Lucerne, Switzerland.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Ethical approval
Ethic approval was obtained from the regional ethical committee (PER-ECL-2011-10-NF). The present investigation was registered in clinicaltrials.gov with the reference NCT03090906.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Sanz-Martín, I., Rojo, E., Maldonado, E. et al. Structural and histological differences between connective tissue grafts harvested from the lateral palatal mucosa or from the tuberosity area. Clin Oral Invest 23, 957–964 (2019). https://doi.org/10.1007/s00784-018-2516-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-018-2516-9