{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:03:36Z","timestamp":1788260616326,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T00:00:00Z","timestamp":1682726400000},"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":["Journal of Periodontology"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The purpose of the present study was to prospectively evaluate the 3\u2010year changes in the gingival dimensions following multiple coronally advanced flap (MCAF) with selective use of connective tissue graft (CTG). In addition, the secondary aim was to histologically identify the factors related to phenotype changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty patients treated with MCAF and site\u2010specific application of a CTG were available for the 3\u2010year follow\u2010up. Outcome measures included complete root coverage (CRC), recession reduction, keratinized tissue width (KTW), marginal tissue thickness changes, and primary flap position. Biopsies were harvested at one of the sites treated with the adjunct of CTG. All sections were stained with hematoxylin and eosin, Masson trichrome, Verhoeff\u2010van Gieson, tenascin, and alcian blue stain for semiquantitative evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 3 years, CRC was detected in 86% of sites treated with MCAF alone and 81% of sites treated with MCAF\u00a0+\u00a0CTG. The 47% of sites treated with MCAF\u00a0+\u00a0CTG presented an apical shift of primary flap from its original position. Linear regression showed a significant association between KTW change and the initial KTW in MCAF\u2010treated sites, while both initial KTW and position of primary flap were statistically significantly associated factors with KTW changes in the MCAF\u00a0+\u00a0CTG group. In all the biopsies examined, there is always a marked and clear separation between the connective tissue of the gingival flap and the palatal connective tissue of the graft.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The selective use of CTG is an effective treatment for multiple gingival recessions. Only a limited increase in KTW can be expected in a bilaminar technique if, during the healing phases, the connective tissue is maintained completely covered.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jper.22-0632","type":"journal-article","created":{"date-parts":[[2023,4,10]],"date-time":"2023-04-10T07:38:25Z","timestamp":1681112305000},"page":"1200-1209","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Multiple coronally advanced flap with a selective use of connective tissue graft: A 3\u2010year prospective clinical and histological study"],"prefix":"10.1002","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5956-2161","authenticated-orcid":false,"given":"Giovanna Laura","family":"Di Domenico","sequence":"first","affiliation":[{"name":"Department of Periodontology Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Di Martino","sequence":"additional","affiliation":[{"name":"Department of Periodontology Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluigi","family":"Arrigoni","sequence":"additional","affiliation":[{"name":"Department of Pathology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Aroca","sequence":"additional","affiliation":[{"name":"26K Center for Clinical Research  Paris France"},{"name":"Department of Periodontology Bern University  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"de Sanctis","sequence":"additional","affiliation":[{"name":"Department of Periodontology Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051X.2008.01267.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12172"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2015.130674"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007161.pub3"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2000.71.9.1506"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12590"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051X.2010.01559.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.11607\/prd.3438"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.16\u20100671"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051x.1992.tb01148.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1993.64.8.683"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051x.1996.tb00608.x"},{"key":"e_1_2_9_14_1","first-page":"731","article-title":"Potential of gingival connective tissue to induce keratinization of an alveolar mucosal flap: a long\u2010term histologic and clinical assessment. 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