Human histology of new attachment after root coverage using subepithelial connective tissue graft

Background, aims: Connective tissue grafts are used successfully in periodontal therapy for root coverage. However, reports on the histologic interface between the root surface and the grafted tissue have been few in number. This report describes a case study in which a subepithelial connective tissue graft was placed in a 27-year-old female on the maxillary left side. Methods: The graft (15 mm long, 10 mm wide, 1.5 mm thick) included palatal periosteum and was placed with the periosteal side facing the exposed bone and root surfaces. Results: 15 weeks after grafting, the teeth presented with residual recessions of 1 mm, and buccal probing depths were approximately 1 mm. 14 months postsurgery the 1st maxillary premolars on both sides were extracted for orthodontic therapy. Clinical parameters at the graft site remained as at 15 weeks, Histologic analysis of tooth #24 showed that the sulcular epithelium was keratinized; epithelium lining the dentin exhibited rete ridges projecting Into the gingival connective tissue; and junctional epithelium extended over new cementum. New connective tissue attachment was also observed, including periodontal ligament. Conclusion: Biological width was comparable pre- and post-surgery, indicating a real gain in attachment of 3.9 mm.