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.
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References
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 195–6
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:CD007161
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
Edel A (1974) Clinical evaluation of free connective tissue grafts used to increase the width of keratinized gingiva. J Clin Periodontol 4:185–196
Langer B, Langer L (1985) Subepithelial connective tissue graft technique for root coverage. J Periodontol 56:715–720
Raetzke P (1985) Covering localized areas of root exposure employing the “envelope” technique. J Periodontol 56:397–402
Harris RJ (1997) A comparison of two techniques for obtaining a connective tissue graft from the palate. Int J Periodont Restor Dent 17:260–271
Hürzeler M, Weng D (1999) A single incision technique to harvest subepithelial connective tissue graft from the palate. Int J Periodont Restor Dent 19:279–287
Thalmair T, Fickl S, Hinze M, Bolz W, Wachtel H (2010) Modifizierte Technik zur Entnahme eines subepithelialen Bindegewebstransplantates. Parodontologie 21:100–105
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 29:848–854
Wessels J, Tatakis D (2008) Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Clin Periodontol 79:425–430
Griffin TJ, Cheung WS, Zavras AI, Damoulis PD (2006) Postoperative complications following gingival augmentation procedures. J Periodontol 77:2070–2079
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 30:862–870
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 27:457–463
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 30:496–504
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
Edel A (1998) Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. 1974. Periodontal Clin Investig 20:12–20
Jahnke PV, Sandifer JB, Gher ME, Gray JL, Richardson AC (1993) Thick free gingival and connective tissue autografts for root coverage. J Periodontol 64:315–322
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
Lorenzana ER, Allen EP (2000) The single-incision palatal harvest technique: a strategy for esthetics and patient comfort. Int J Periodont Restor Dent 20:297–305
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
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.
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Fickl, S., Fischer, K.R., Jockel-Schneider, Y. et al. Early wound healing and patient morbidity after single-incision vs. trap-door graft harvesting from the palate—a clinical study. Clin Oral Invest 18, 2213–2219 (2014). https://doi.org/10.1007/s00784-014-1204-7
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DOI: https://doi.org/10.1007/s00784-014-1204-7