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Gingival phenotype changes after different periodontal plastic surgical techniques: a single-masked randomized controlled clinical trial

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Abstract

Objectives

Aim of this clinical study was to evaluate the effects on gingival thickness of three surgical techniques for root coverage: the coronally advanced flap (CAF) alone, with a sub-epithelial connective tissue graft (SCTG) or with leukocyte- and platelet-rich fibrin (L-PRF) membranes.

Methods

Sixty patients with RT1 single maxillary gingival recession were treated with CAF + L-PRF (20 patients), CAF + SCTG (20 patients) or CAF alone (20 patients). At baseline and 6-month after treatment, gingival thickness (GT), keratinized tissue width (KT), gingival recession (GR), clinical attachment level (CAL), probing depth (PD), PROMs, and the aesthetic outcome were recorded.

Results

CAF + SCTG and CAF + L-PRF groups showed a significantly greater mean GT increase than CAF alone (0.31 ± 0.10 mm) with no significant differences between CAF + SCTG (0.99 ± 0.02 mm) and CAF + L-PRF (0.92 ± 0.52 mm) groups (p = 0.55). CAF + SCTG was associated with a significantly greater KT gain (3.85 ± 1.04 mm), while in CAF + L-PRF (2.03 ± 0.53 mm) and CAF (1.50 ± 0.69 mm) groups, KT was not significantly increased. Both GR and CAL showed a significant within groups’ improvement, without among-groups differences. No significant among-groups difference for the aesthetic outcome but greater discomfort and pain-killer consumption in CAF + SCTG group was detected.

Conclusion

All investigated surgical techniques produced significant GR reduction and CAL gain. GT was similarly augmented by CAF + L-PRF and CAF + SCTG techniques; however, the CAF + SCTG technique produced a more predictable KT and GT increase.

Clinical relevance

The results of our study suggest that the CAF + SCTG technique represents the most predictable method for the clinician to improve the gingival phenotype, an important factor for long term gingival margin stability.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article, its supplementary materials, and from the corresponding author [author MP] on request.

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Acknowledgements

Authors report no conflicts of interest related to this study. The trial director was Michele Paolantonio, Department of Innovative Technologies in Medicine & Dentistry, “G. D’Annunzio” University, Chieti-Pescara, Italy.

Author information

Authors and Affiliations

  1. Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK

    Pasquale Santamaria

  2. Department of Innovative Technologies in Medicine & Dentistry, “G. D’Annunzio” University, Chieti-Pescara, Italy

    Pasquale Santamaria, Michele Paolantonio, Luigi Romano, Matteo Serroni, Imena Rexhepi, Giulia Paolantonio, Bruna Sinjari & Beatrice Femminella

  3. Department of Surgical Science, Plastic and Reconstructive Surgery, Tor Vergata University, Rome, Italy

    Lorenzo Secondi

  4. “Luisa D’Annunzio” Institute for High Culture, Pescara, Italy

    Paolo De Ninis

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Contributions

PS, PdN, MP and BF are co-first Authors having designed, written, revised and edited the work; LS and GP collaborated in designing, writing and editing the study; MS and IR cooperated in the study design, article editing and revising; LR collaborated in interpretation of data, article editing, and data collection with IR and BF. PdN did the statistical analysis.

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The study protocol was registered at ClinicalTrials.gov as NCT03712852 after the approval obtained by the G. D’Annunzio University ethic committee. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Santamaria, P., Paolantonio, M., Romano, L. et al. Gingival phenotype changes after different periodontal plastic surgical techniques: a single-masked randomized controlled clinical trial. Clin Oral Invest 27, 3423–3435 (2023). https://doi.org/10.1007/s00784-023-04944-0

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