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

Abstract

Aim This prospective cohort study evaluated late complications (LC) on recipient sites comparing two types of connective tissue grafts (CTG). Materials and Methods Participants (n: 60) were treated with coronally advanced flap (CAF) plus CTG harvested by de‐epithelialized technique (DE) (n:31) or two‐parallel incision (PI) (n:29). Areas were evaluated to identify white discharge associated or not with gingival cul‐de‐sac. Patients were ordered in groups with (DE+and PI+) or without (DE‐ and PI‐) LC. Biopsies for histopathological analysis in LC areas were proposed. Results Six cases exhibited LC, 5 in DE graft (DE+) and 1 in PI graft (PI+) group; 2 were diagnosed at 3 months postoperatively, 3 at 6 months and one at 12 months. The relative risk for LC was 1.7 times greater for DE graft (p: 0.01; CI: 1.10 to 2.72; RR>1). Differences were not observed for clinical outcomes after both types of CTGs (p > 0.05). Biopsies showed deep invagination of the epithelial lining suggesting cyst‐like area/ cavity with keratin content and consolidated in fibrous connective tissue. After 24 months biopsied areas presented no recurrence of LC, in non‐biopsied patients the clinical condition remained unchanged. Conclusions Considering the limitations of this study, LC on recipient sites demonstrated no statistical difference between two types of CTG.

Complications and treatment errors in peri‐implant soft tissue management

“…The drawback of this technique is the need to completely remove all the epithelium from the free gingival graft. The persistence of epithelial cells can cause the formation of epithelial cysts and/or pseudo pockets 63–65 …”

“…62 For these reasons, the dense connective tissue harvested with the epithelial-connective cysts and/or pseudo pockets. [63][64][65] Besides the intrapatient variability related to the donor site area, different interpatient healing patterns have also been reported. 62,66,67 For reasons that are still unclear, in some patients the connective tissue graft shows an increased tendency to develop hyperplastic/hypertrophic reactions.…”

Early and late complications arising from autologous soft tissue augmentation in dental practice: systematic review

“…It is also important to highlight that despite the possible occurrence of some adverse events related to the treatment with SCTG (i.e., development of cyst-like areas, root resorption, or bone exostosis), these were restricted to a very limited number of cases and cannot per se undermine the safety/success of autogenous grafts. The reduced base of literature suggests that periosteal trauma/fenestration is probably the primary main-causing agent linked with exostosis development in grafted sited by FGG [9,20,21,23,28] also a case with a previously unpublished complication following subepithelial gingival connective tissue graft from the palate as pseudoaneurysm of the greater palatine vessel was explored [27].…”

Comparative histological evaluation of intra‐ and extraorally de‐epithelialized connective tissue graft samples harvested from the posterior palate region

“…22,23 Although rare, the presence of epithelial remnants in CTG may be associated with a variety of complications after soft tissue augmentation interventions. Some authors have linked the use of CTG with external root resorption, 24,25 gingival cul-de-sac with or without keratin discharge, 26,27 epithelial cell discharge, 28 and cyst formation, [29][30][31][32][33] which may result into poor functional and esthetic outcomes. Other authors have reported the appearance of bony exostoses after the use of CTG alone, 34 CTG in conjunction with enamel matrix derivative, 35 autogenous free gingival grafts, 36,37 and skin grafts.…”