Evaluation of 2 techniques of epithelial removal in subepithelial connective tissue graft surgery: a comparative histological study

Abstract

Purpose: Subepithelial connective tissue grafts (SCTGs) are commonly performed for the treatment of gingival recession due to their high predictability. This study evaluated and histologically compared connective tissue grafts in terms of the presence of epithelial remnants and composition of the tissue types that were present (epithelium, lamina propria, and submucosa). Methods: Ten patients underwent epithelium removal using 2 different techniques: the use of a blade (group B) and through abrasion (group A). Twenty samples were collected and each tissue type was analyzed histologically in terms of its area, thickness, and proportion of the total area of the graft. Results: In 4 samples (40%) from group B (n=10) and 2 samples (20%) from group A (n=10), the presence of an epithelial remnant was observed, but the difference between the groups was not statistically significant (P>0.05). Likewise, no statistically significant differences were observed between the groups regarding the area, mean thickness, or proportion of the total area for any of the tissue types (P>0.05). Conclusions: Histologically, SCTGs did not show statistically significant differences in terms of their tissue composition depending on whether they were separated from the epithelial tissue by abrasion or by using a blade.

Soft tissue augmentation using de-epithelialized free gingival graft compared to single-line incision subepithelial connective tissue graft in the management of miller class I and II gingival recession: A randomized controlled clinical trial

“…The graft was de-epithelialized with a 15c blade to enable better visualization and ensure complete removal of epithelium, which was consistent with a recent report showing no significant difference between de-epithelialization using blade or abrasion. [ 20 ]…”

Histological and histomorphometric study of human palatal mucosa: Implications for connective tissue graft harvesting

“…This figure is slightly lower than the 0.3 mm reported by Zuhr et al (2014), and values between 0.30 mm (first molar area) and 0.41 mm (canine area) have also been reported (Cho et al, 2013). With respect to percentage, other authors have reported that the epithelial layer represented only 1.04% of the palatal mucosa (Marques de Mattos et al, 2019). This discrepancy with our result (6.45%) could be explained by the fact the abrasion technique used by the aforementioned authors presented epithelial remnants in only 20% of their samples.…”

Late complications after root coverage with two types of subepithelial connective tissue grafts, clinical and histopathological evaluation: A prospective cohort study

“…Previous histological evaluations showed that 80% of PI grafts (24/30) (Harris, 2003) and 100% of DE grafts (5/5) presented epithelial remnants (Azar et al, 2019). Other forms of reducing epithelial remnants are high‐speed diamond burs (abrasion) (Marques de Mattos et al, 2020) or high‐level laser Er: YAG (Grzech‐Leśniak et al, 2018; Gursoy et al, 2019), Er, Cr: YSSG (Lin et al, 2018), Nd: YAG (Keskiner et al, 2016 aluminium, gallium and arsenide diode laser (Ozcelik, Seydaoglu, & Haytac, 2016). Thus, the amount of epithelial tissue remnant in grafts necessary to the development of cysts, epithelial inclusion and/or discharge release (Harris, 2003) remains unknown.…”