{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T16:27:43Z","timestamp":1773073663300,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Oral tissue morphogenesis is innately determined and genetically controlled by underlying connective tissue. The connective tissue graft (CTG) harvested from palatal donor sites originally retains \u201cregional specificity\u201d and is considered to be responsible for epithelial keratinization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This case study presents histological and genomic outcomes of coronally advanced flap (CAF) with CTG for the management of marginal tissue recession (MTR). The tissue samples harvested at 12\u2010month postoperative period, during the debulking procedure of the treated site were subjected to Masson's trichrome staining (MTS) and whole\u2010genome sequencing (WGS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Clinically, the mean root coverage as compared to baseline at 6 months (90%), 12 months (95%), and 24 months (95%) postoperatively was achieved. Overbulking of treated site was evident even after 12 months. Nevertheless, clinically discernible alterations in epithelial keratinization were not present. Although MTS revealed areas of non\u2010keratinization and para\u2010keratinization, WGS revealed a significant expression of keratinization genes, neural crest, and positional marker genes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CAF with CTG is still considered the \u201cgold standard\u201d in treatment of MTR. The keratinization of overlying epithelium at sites hitherto where non\u2010keratinized mucosa is advanced over CTG may not be complete even after 12 months. It is evident from the analysis of the reported case that clinically such sites may appear non\u2010keratinized despite the expression of genes for keratinization. The complex interplay between genomic and phenotypic expressions serves as a foundation of biological concepts. Nevertheless, it is imperative to acknowledge that the phenotype of an organism is not solely determined by genetic expression and is often influenced by a complex interaction between genetic background and environmental factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Summary<\/jats:title><jats:p>The connective tissue serves as a medium for transmitting the genetic code and exerting an influence on the properties of the overlying epithelial tissue.\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Concrete evidence implies connective tissue plays a significant role in influencing the keratinization process of the overlying epithelium.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Epithelial keratinization following a coronally advanced flap with connective tissue graft is also governed by environmental factors in addition to inherent potential within the graft.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Differences in gene expression profiles may vary from individuals, teeth and among sites.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/cap.10273","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T19:07:00Z","timestamp":1700593620000},"page":"192-200","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Histological and whole\u2010genome sequencing analysis of coronally advanced flap with connective tissue graft for the treatment of gingival recession\u2014A case study"],"prefix":"10.1002","volume":"14","author":[{"given":"Saravanan Sampoornam Pape","family":"Reddy","sequence":"first","affiliation":[{"name":"Department of Periodontology Kalinga Institute of Dental Sciences Kalinga Institute of Industrial Technology (Deemed to be University)  Bhubaneswar Odisha India"},{"name":"Department of Periodontology Army Dental Centre (Research &amp; Referral) Army Hospital (Research &amp; Referral)  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Balaji","family":"Manohar","sequence":"additional","affiliation":[{"name":"Department of Periodontology Kalinga Institute of Dental Sciences Kalinga Institute of Industrial Technology (Deemed to be University)  Bhubaneswar Odisha India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,11,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2012.01903.x"},{"issue":"8","key":"e_1_2_9_3_1","first-page":"686","article-title":"Treatment of gingival recessions using coronally advanced flap and connective tissue graft: a long\u2010term retrospective analysis","volume":"52","author":"Iorio\u2010Siciliano V","year":"2021","journal-title":"Quintessence Int"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.11607\/prd.2698"},{"issue":"4","key":"e_1_2_9_5_1","first-page":"373","article-title":"Connective tissue graft: a classification for incision design from the palatal site and clinical case reports","volume":"22","author":"Liu CL","year":"2002","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13532"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nprot.2008.211"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102105\u201010\u201048"},{"key":"e_1_2_9_9_1","first-page":"171","article-title":"Ar en utlakining utan vavnadsforlust otankbar vid kirkurgisk behandling av sk alveolarpyorrea","volume":"19","author":"Norberg O","year":"1926","journal-title":"Sven Tandl\u00e4k Tidskr"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2008.01267.x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0765.1971.tb00619.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1975.46.10.577"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0765.1988.tb01345.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-023-05080-5"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12221"},{"issue":"2","key":"e_1_2_9_16_1","first-page":"82","article-title":"Comparison between subepithelial connective tissue graft and de\u2010epithelialized gingival graft: a systematic review and a meta\u2010analysis","volume":"21","author":"Tavelli L","year":"2019","journal-title":"J Int Acad Periodontol"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0765.1975.tb00001.x"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1985.56.3.132"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.18-0741"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13673"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-014-1299-x"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1984.55.9.531"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrm.2016.24"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/121575"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgen.0020119"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.10273","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T19:55:38Z","timestamp":1760039738000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.10273"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,21]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1002\/cap.10273"],"URL":"https:\/\/doi.org\/10.1002\/cap.10273","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,21]]},"assertion":[{"value":"2023-09-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}