title: Root coverage outcome may be affected by heavy smoking: a 2-year follow-up study.
abstract: BACKGROUND
  Although subepithelial connective tissue graft (CTG) has been reported to be a predictable procedure for root coverage, the impact of smoking on the long-term outcome of periodontal plastic surgery is unclear. Hence, the aim of this study was to evaluate the effect of smoking, on a long-term basis, on the stability of gingival tissue following CTG treatment of gingival recession.
  
  
  METHODS
  Twenty-two defects were treated by CTG in canine and premolar Miller Class I and II gingival recessions (11 smokers and 11 non-smokers). The following clinical measurements were obtained at baseline and at 1, 2, 3, 4, 6, 12, 18, and 24 months after surgery: plaque and gingival indexes, extension of gingival recession (GR), probing depth (PD), clinical attachment level (CAL), and gingival thickness. Individuals smoking > or =20 cigarettes/day for > or =5 years were considered smokers.
  
  
  RESULTS
  Data analysis demonstrated that both groups presented similar plaque and gingival indexes (P >0.05), and an intragroup analysis showed that CTG was able to promote root coverage and increase gingival thickness in both groups over time (P <0.05). However, at 24 months postoperatively, statistical analysis showed that smokers presented poorer outcomes with regard to PD, GR, and CAL (P <0.05); in addition, a more satisfactory stabilization of the gingival tissue was found in the non-smoker group.
  
  
  CONCLUSIONS
  Smoking may represent a challenge to root coverage outcome for CTG because smoking significantly affected the stability of gingival tissue over time.
authors.affiliation: Department of Morphology, University of Campinas, Piracicaba, SP, Brazil.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Andia
authors.forename: Angela G
authors.initials: AG
authors.lastname: Martins
authors.forename: Márcio Z
authors.initials: MZ
authors.lastname: Casati
authors.forename: Enilson A
authors.initials: EA
authors.lastname: Sallum
authors.forename: Francisco H
authors.initials: FH
authors.lastname: Nociti
mesh_terms: D000328:Adult; D001641:Bicuspid / Q000473:pathology; D003238:Connective Tissue / Q000637:transplantation; D003481:Cuspid / Q000473:pathology; D003774:Dental Plaque Index; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology / Q000637:transplantation; D005889:Gingival Recession / Q000145:classification / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000145:classification; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D012907:Smoking / Q000009:adverse effects*; D014092:Tooth Root / Q000473:pathology*; D016896:Treatment Outcome