Width of keratinized tissue after gingivoplasty of healed subepithelial connective tissue grafts

Background: The subepithelial connective tissue graft has markedly broadene d clinicians' abilities to treat gingival recession. Frequently, however, b ulky soft tissue contours are sequelae of this procedure, and post-healing gingivoplasty is often performed to improve esthetics of the grafted site. As a secondary benefit, it is believed that the zone of keratinized tissue is additionally increased after gingivoplasty. Methods: To further investigate this clinical impression, 16 bilateral pair s of sites with recession in 6 consecutive patients (mean age = 38 +/- 9 ye ars) were studied. At the time of initial grafting, one site in each pair w as randomly assigned to receive either gingivoplasty 2 months later (GP+) o r no further treatment (GP-). Clinical measurement of recession and keratin ized tissue width was standardized using customized acrylic stents and Schi ller iodine solution, which stains epithelia; values were recorded at basel ine (day of graft) and at 2, 3, and 5 months after grafting. Mean clinical gingival widths over time between GP+ and GP- sites, as well as within GPsites, were analyzed by t test. Results: At 5 months, both the GP+ and GP- sites demonstrated a mean root c overage of 87.4% and increased keratinized tissue width (1.2 mm) when compa red to their respective baseline measures. No differences in recession dept h and width of keratinized tissue were seen at 5 months between the GP+ and GP- groups. In addition, no differences in recession or gingival width wer e found between 2- and 5-month observations for either the GP+ or GP- group s. Conclusions: These data suggest that the observed clinical improvements are the outcome of the initial graft surgery and that the gingivoplasty proced ure does not result in additional (or "rebound") increases in keratinized t issue width.