Subepithelial connective tissue graft for root coverage in smokers and non-smokers: a clinical and histologic controlled study in humans.
BACKGROUND
The aim of this study was to evaluate root coverage of gingival recessions and to compare graft vascularization in smokers and non-smokers.


METHODS
Thirty subjects, 15 smokers and 15 non-smokers, were selected. Each subject had one Miller Class I or II recession in a non-molar tooth. Clinical measurements of probing depth (PD), relative clinical attachment level (CAL), gingival recession (GR), and width of keratinized tissue (KT) were determined at baseline and 3 and 6 months after surgery. The recessions were treated surgically with a coronally positioned flap associated with a subepithelial connective tissue graft. A small portion of this graft was prepared for immunohistochemistry. Blood vessels were identified and counted by expression of factor VIII-related antigen-stained endothelial cells.


RESULTS
Intragroup analysis showed that after 6 months there a was gain in CAL, a decrease in GR, and an increase in KT for both groups (P <0.05), whereas changes in PD were not statistically significant. Smokers had less root coverage than non-smokers (58.02% +/- 19.75% versus 83.35% +/- 18.53%; P <0.05). Furthermore, the smokers had more GR (1.48 +/- 0.79 mm versus 0.52 +/- 0.60 mm) than the non-smokers (P <0.05). Histomorphometry of the donor tissue revealed a blood vessel density of 49.01 +/- 11.91 vessels/200x field for non-smokers and 36.53 +/- 10.23 vessels/200x field for smokers (P <0.05).


CONCLUSIONS
Root coverage with subepithelial connective tissue graft was negatively affected by smoking, which limited and jeopardized treatment results.
Department of Bucco-Maxillofacial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café s/n, Monte Alegre, Ribeirão Preto, SP, Brazil.
Sérgio L S
SL
Souza
Guilherme O
GO
Macedo
Roberta S
RS
Tunes
Adriana M M
AM
Silveira e Souza
Arthur B
AB
Novaes
Marcio F M
MF
Grisi
Mário
M
Taba
Daniela B
DB
Palioto
Vani M A
VM
Correa
D000328:Adult; D016022:Case-Control Studies; D003238:Connective Tissue / Q000098:blood supply / Q000637:transplantation*; D005260:Female; D005889:Gingival Recession / Q000209:etiology / Q000601:surgery*; D005893:Gingivoplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D012907:Smoking / Q000009:adverse effects*; D018709:Statistics, Nonparametric