Western Society of Periodontics

Clinical Studies

Volume Number 4, 1995

The histology of new attachment utilizing a thick autogenous soft tissue graft in an area of deep recession: A case report

This long-awaited histological report of new attachment comes byway of chance and ingenuity on the part of the author. A 40-year-old woman with an area of deep, long-standing recession on a mandibular first premolar was treated for root coverage using a thick (1.5 mm) free autogenous epithelium and connective tissue graft from the palate. The 6.0-mm-deep recession with a 2.0 mm probing depth had complete lack of attached gingiva. The recipient site was instrumented, and after tetracycline conditioning, graft was placed to the CEJ. The tooth was removed in block sections, including the facial soft tissue, ten and one-half months after graft placement when the patient decided to undergo orthodontic therapy that required premolar extractions. At the time of extraction, there had been a gain of 5.0 mm of root coverage, and there was 5.0 mm of keratinized gingiva on the facial aspect. The probing depth was 1 mm. Histological measurement showed 4.4 mm of new attachment and 4.0 mm of new bone growth. The coronal extent of the new attachment and new bone were in an area previously exposed by the recession. The histological findings of this case report indicate that placement of a thick autogenous gingival graft can result in regeneration of connective tissue attachment, cementum, and bone on a root surface with long-standing recession. [J.Y.K.]