The Use of Connective Tissue Graft Wall as an Adjunct to Regenerative Treatment for Deep Intrabony Defects Associated with Gingival Recession: A Retrospective Case Series with 5-Year Follow-up

Background: The adjunctive use of connective tissue grafts (CTGs) in the periodontal regeneration of intrabony defects has been proposed to prevent or limit postoperative gingival recession. However, there is limited evidence regarding the long-term clinical performance of this approach. Methods: This article presents the five-year follow-up outcomes of a combination therapy using CTG, bone substitutes, and biologics for the treatment of deep intrabony defects associated with gingival recession. Twelve healthy, non-smoking patients with 12 deep intrabony defects participated in the study. These patients had a mean clinical attachment loss (CAL) of 9.9 ± 2.1 mm, a mean probing depth (PPD) of 7.8 ± 1.5 mm, and a mean buccal recession (REC) of 2.3 ± 1.8 mm at baseline, before= undergoing the described treatment regimen. Results: After five years, the mean clinical attachment level (CAL) gain was 5.7 ± 3.2 mm (p < 0.001), the mean reduction in probing pocket depth (PPD) was 5.1 ± 1.6 mm (p < 0.001), and the mean reduction in recession (REC) was 1.2 ± 2.1 mm (p = 0.07) Ninety-one percent of sites achieved CAL gain of ≥3 mm and PPD ≤ 4 mm. Compared to baseline, 7 out of 12 sites showed a REC reduction of ≥1 mm, while three sites remained stable, and two sites experienced an increase in gingival recession depth of 1 and 2 mm respectively. Conclusion: Within the limitations of this case series, periodontal regenerative therapy incorporating the adjunctive use of CTG showed to be effective for treating deep non-contained periodontal intrabony defects and respectively stabilize or slightly improve the gingival margin over five years.