Evaluation of Alteration in Mucogingival Junction Location Following Use of Connective Tissue Graft and Coronally Advanced Flap

Abstract

Statement of Problem: One of the most successful procedures in root coverage is free connective tissue graft combined with coronally advanced flap. The assessment of mucogingival junction (MGJ) changes during healing period is of great importance.Purpose: The aim was to assess the positional changes of MGJ following use of connective tissue graft in combination with coronally advanced flap in 3- 6- and 12- month intervals.Materials and Method: In this cross sectional and interventional study, 19 cases of gingival recession in 10 patients with Miller class I and II defects ≥4 mm were treated with connective tissue graft and coronally advanced flap. After phase I therapy, an acrylic stent was made. Clinical parameters monitored in this study included clinical attachment level (CAL), mucogingival junction (MGJ), keratinized gingival (KG) width and attached gingival (AG) width. Each parameters were measured at baseline, and 3- 6- and 12- month intervals. For comparison, statistical analysis was performed using Paired-T test at p < 0.05.Results: The mean distance from MGJ to acrylic stent at baseline was 5.94± 0.88 mm which during surgery, was moved coronally by 4.39 ± 0.65 mm. Distance from MGJ to CEJ immediately after surgery was 1.55 ± 0.58 mm. This distance during healing periods at 3, 6, and 12 months changed to 3.13± 0.87, 3.34 ± 0.66, and 3.65 ± 0.64 mm, respectively indicating a gradual regression of MGJ to presurgical position. Keratinized gingival width had remarkable changes in 3-, 6- and 12 month intervals in comparison to the baseline. Mean presurgical width of keratinized gingiva was 1.55± 0.76 mm which increased to 3.44 ± 0.49 mm ( p <0.05). Mean presurgical attached gingival was 0.36± 0.62 mm and 12 months after surgery it was increased to 2.18± 0.50 mm 12 month after surgery ( p <0.05). Presurgical clinical attachment level was 5.81± 0.88 mm which was decreased to 1.55 ± 0.57 mm, 12 month after surgery.Conclusion: Based on the findings, it seems that mucogingival junction has a gradual tendency to moved back to its presurgical position after use of free connective tissue graft with coronally advanced flap technique.Key words: Mucous membrane, Gingiva, Connective tissue, Graft, Surgical flap