Connective tissue versus free gingival grafts for deep mandibular anterior recessions. A 2- to 5-year cross-sectional study.

Aim: Mandibular anterior deep gingival recessions are complex to manage in individuals who lack sufficient keratinized tissue. The aim of the present study was to evaluate the clinical and esthetic outcomes and tissue stability of mucogingival procedures performed by means of a free gingival graft (FGG) or subepithelial connective tissue graft (SCTG) 2- to 5-years post-operatively and to identify the esthetic outcome perception of the patients at follow-up.

Materials and methods: Individuals presenting RT1 and RT2 gingival recessions treated with an FGG or SCTG in the mandibular anterior sextant were recalled to evaluate clinical outcomes and patient satisfaction postoperatively. A visual analog scale (VAS) and recession esthetic score (RES) were used for the evaluation.

Results: A total of 32 consecutive individuals, 16 in each group (FGG/SCTG), responding to the follow-up appointment, entered this study. RT2 recessions were prevalent (87.5% FGG; 68.8% SCTG). Mean recession depth (RD) at baseline was 4.68 ± 0.76 (range: 4 to 6 mm) and 5.31 ± 1.35 (range: 4 to 10 mm) for the SCTG and FGG groups, respectively, and 0.18 ± 0.34 and 0.43 ± 0.49, respectively, at follow-up. Keratinized tissue width (KTW) was significantly greater in FGG individuals at follow-up: 5.25 ± 0.84 vs 2.84 ± 1.12 (P 0.0001; confidence interval [CI]: 1.70 to 3.12). The SCTG group showed a higher RES than the FGG group, but the difference was not significant (P = 0.067, CI: 0.007 to 1.94). The patients' perception (VAS) of satisfactory esthetics was statistically significantly higher than the professional RES assessment for FGG individuals (P = 0.007, CI: 0.36 to 2.01), but the difference between the VAS and RES values was not statistically significant for the SCTG group.

Conclusions: Both SCTGs and FGGs provide satisfactory esthetics and tissue stability. Patients' esthetic perception of FGGs is significantly higher than the professional evaluation.

Clinical relevance: When 100% root coverage is not achieved using an FGG, satisfactory esthetic outcomes with minimal residual recessions of ≤ 1 mm can be accomplished on the more challenging RT2 defects.