Histological examination of palatal connective tissue grafts obtained by intraoral deepitelization and extraoral deepitelization methods in the treatment of gingival recessions and clinical comparison of their effectiveness in the recipient area

Gingival recession (GR) is defined as the displacement of the free gingival margin towards the apex. GR can be treated using pedicle flaps, regenerative approaches and free grafts, and combinations of these approaches. Among these techniques, connective tissue graft (CTG) and coronally advanced flap (CAF) is as the gold standard in the treatment method. CTG can be obtained with several techniques including deepitelized gingival graft technique (DGG). There are not adequate number of studies in the literature comparing the methods of obtaining DEG. The aim of the current study is to examine the effectiveness of intraoral deepitelization (iDE) and extraoral deepitelization (eDE) methods in root coverage and donor site healing, clinically and histologically. 35 volunteers (aiDE-16 patients, adDE-19 patients) with GR that met the inclusion criteria participated in the study. Recession depth-width, attachment level, keratinized tissue height-thickness, vestibular depth, and aesthetic, healing and sensitivity scores were recorded from the recipient area. The changes in these values over time were calculated. Bleeding, epithelialization, color match, sensation loss and discomfort measurements were recorded from the donor area. In addition to the numerical values related to the graft during the surgery, slide samples were taken from the CTGs before and after deepitelization, fixed and examined for epithelial remnants. Both methods gave similar root coverage, complete root coverage, keratinized tissue increase, attachment gain, gingival thickness, pocket depth, dentin hypersensitivity and aesthetic results whereas the results were also similar in terms of donor site bleeding, discomfort, analgesic consumption, early wound healing, epithelialization rate and color match. Vestibular depth showed less change with the aiDE method and adDE provided better deepitelization in terms of keratin cells. As a conclusion, both techniques can be recommended in CAF+CTG treatment.