Soft tissue augmentation prior to incisor decompensation in Class III malocclusion – preliminary report

Introduction. Even though the role of orthodontic
treatment in development of gingival recessions is
controversial, teeth movement outside the alveolar
“envelope” has been reported as a risk factor for
dehiscence, and subsequently for gingival recessions.
Aim of the study. To evaluate an increase in thickness
and width of buccal attached gingiva after soft tissue
augmentation preceding incisor decompensation in
Class III malocclusion. Materials and Methods. Eight
individuals (non-smokers) with Class III malocclusion
underwent soft tissue thickening at the buccal aspects
of a total of 30 lower anterior teeth after being
qualified for orthodontic treatment. The autogenous
subepithelial connective tissue graft (sCTG) harvested
from the palate was used and adopted in modified
tunnel flap technique. Clinical measurements were
performed before the surgical procedure and at three
months afterwards, just before commencement of
orthodontic treatment. The significance of changes
of the studied parameters was evaluated by means
of Wilcoxon signed-rank test. Results. Before
augmentation all patients presented thin gingival
biotype with the mean thickness of 0.6±0.17 mm. At
three months postoperatively, the thickness of attached
gingiva, as well as its width, increased significantly
by 0.75±0.18 mm and 1.95±0.9 mm, respectively
(P<0.05). Conclusions. Autogenous sCTG resulted
in significant increase in width and thickness of the
attached gingiva at the buccal aspects of lower anterior
teeth. Transformation of thin gingival biotype into
thick one enabled safe implementation of orthodontic
treatment in the lower arch in patients with Class III
malocclusion. Further research is needed to determine
whether prophylactic grafting provides long-term
protection against recessions during orthodontic
treatment