Patient-centered outcomes after subepithelial connective tissue grafts and coronally advanced flaps

Objective: The use of a coronally advanced flap (CAF) and connective tissue graft (CTG) is a well-established procedure to cover single and multiple recessions and improve soft tissue esthetics. However, until now, there are still limited data evaluating patient morbidity, the fear of imminent tooth loss, and modification of sensitivity in surgical areas. The aim of the present study was to evaluate the patient-centered outcomes associated with CAF + CTG. Method and Materials: Thirty-four patients (mean age, 30.76 ± 6.88 years) with single or multiple Class I and II gingival recessions were treated using a CAF + CTG. The following parameters were evaluated at 14 days and 1, 3, 6, and 12 months after surgery: esthetics, root hypersensitivity, fear of imminent tooth loss, daily activities or nutritional habits, and the levels of postsurgical morbidities. A visual analog scale was used to evaluate patient-centered outcomes. The percentage of patients belonging to each of the severity scales, the mean values associated with each parameter, and the statistical significance of the modification of the monitored parameters were calculated. The parametric F (Fisher) test and the least significant difference post hoc pair-wise comparisons were computed. Results: There were statistically significant differences between baseline and all follow-up time points in root hypersensitivity and in fear of tooth loss. Preoperative prevalence of fear of tooth loss was 99%. Esthetics were statistically significantly improved at the 1-, 3-, 6-, and 12-month visits compared with the evaluation at 14 days. No palatal bleeding was recorded. The pain perception in the donor area was mild: Only 3% of patients reported severe palatal pain, and the mean VAS score for palatal pain was 3.79 ± 1.49. Conclusion: Treatment of single and multiple gingival recessions with CAF + CTG resulted in predictable improvements of soft tissue esthetics and root hypersensitivity but was associated with a slight increase in patient morbidity, mainly related to the harvesting of CTG. This should be considered when treating patients with esthetic demands. Keywords: connective tissue graft, esthetics, gingival recession, patient-centered outcome, quality of life