The coronally advanced flap plus connective tissue graft in the treatment of multiple gingival recessions: a randomized longitudinal study.

Aim: It is to evaluate the clinical significance of thickness and position level of CTG in relation to the clinical outcomes obtained in multiple recessions on three contiguous teeth over 6-month follow up. Materials and Methods: Ten patients were enrolled. At baseline were recorded the FMPS, FMBS, PSR score, PI and BoP in relation to the treated areas. The indexes selected were the PD, keratinized tissue width (KTW-mesial, buccal and distal), recession depth (RD-mesial, buccal and distal) and the recession width (RW). The flap and graft thickness were always recorded and the CTG was randomly placed at the CEJ or 1 mm coronally. The measurements were in duplicate, on the patient and on a plaster model through an acrylic mock-up in a special copolymer mask at baseline and at 6 month. Results: A total of 30 Miller class I, II and III gingival recessions were treated. Four patients were the test group (TG) with regard to the positioning of the CTG while the control group (CG - 6 patients) was assessed in relation to the thickness of the CTG placed at the CEJ. At baseline there was no significant difference between the two groups. At 6 months, buccal RD, RW outcomes appeared to be more favorable in the TG VS CG. In multivariate analysis 1mm increase of CTG thickness, increased 36.3 mm distal RD and 7.5 KTW mm recovery while buccal RD 6-month defect decreased of 3.2%. However, a 1mm increase of baseline thickness defect increased of 0.33mm the 6-month thickness defect. Conclusions: A positive correlation is observed between the CTG thickness and outcomes, independently from the baseline thickness defect that, conversely, worsens the recovery trend. A positive correlation between the baseline thickness defect and the CTG thickness is observed. The coronal positioning of CTG induce better outcomes by CAF+CTG technique.