Histological evaluation of 4 cases of root coverage following a connective tissue graft combined with an enamel matrix derivative preparation

Background: The purpose of this report was to evaluate the histological characteristics of 4 clinically successful root coverage procedures performed with a combination of a connective tissue (CT) graft and an enamel matrix derivative (EMD) preparation. Methods: Four maxillary teeth (3 canines and I first premolar) that presented with mucogingival problems and Miller's Class 11 and III gingival recession were evaluated in the study. Surgical therapy for root coverage consisted of autogenous CT grafts combined with the topical application of EMD. Following healing, treated teeth were extracted with a portion of their buccal attachment apparatus. Two teeth were extracted at 6 months and 2 teeth at I year postoperatively. Specimens were prepared for histology and analyzed by light microscopy. Results: All treated teeth presented with clinical signs of successful root coverage. Histological observations of the 4 specimens revealed similar findings. The junctional epithelium was less than or equal to2 mm long. Apical to the junctional epithelium, dense CT fibers were found in close proximity to the root surface, but in general, no insertion of these fibers into the root was observed. In one 6-month specimen, formation of new cementum and new bone was observed in the most apical end of the grafted area. Conclusions: The results of this study suggest that a combination of CT grafts and EMD results mainly in an adhesion between the CT and root surface. Some periodontal regeneration may occur in some regions. The development of a long junctional epithelium was not observed with this combined therapy for the treatment of gingival recession.