Long term assessment of root coverage stability using connective tissue graft with or without an epithelial collar for gingival recession treatment. A 12-year follow-up from a randomized clinical trial

Aim To evaluate the long term root coverage outcomes of coronally advanced flap plus a connective tissue graft with (CAF + CTG) or without an epithelial collar (CAF + ECTG), and evaluate the adjacent treated sites included in the flap. Methods Seventeen of the original 20 subjects included in the randomized clinical trial were available at 12 years (43 sites). Mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) on the grafted and adjacent sites were evaluated and compared with baseline and 6 months. Result There was a reduction in the mRC at all sites: 16.52% in the CAF + CTG (p > .05), 19.42% in the CAF + ECTG (p < .05) and 34.12% in the CAF-alone (adjacent treated sites) group (p < .05). No significant differences were observed within the groups for changes in KTW, GT and clinical attachment level (CAL) (p > .05). Keratinized tissue width at baseline and at 6 months was found to be predictors for the stability of the gingival margin in the long term. Conclusions CAF + CTG and CAF + ECTG were found equally efficacious in maintaining the levels of the gingival margin with a small amount of relapse over the period of 12 years while CAF-alone sites showed a greater gingival recession (GR) reoccurrence.