{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T08:45:12Z","timestamp":1788511512000,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>In the treatment of gingival recession, different surgical options have been described: free gingival grafts (FGG), connective tissue Grafts (CTG), and a more recent technique, de-epithelialized free gingival graft (DFGG). They are not procedures exempt from the appearance of complications. Most publications refer to postoperative complications, and there is limited literature regarding the development of late complications (weeks or months). Our working group carried out a study to describe the development of late complications associated with the use of DFGG in comparison with CTG, providing an incidence rate and a classification. Sixty-eight patients with mucogingival problems were selected, and divided into two groups: the Test Group, for which we used DFGG + Coronal Advancement Flap (CAF), and the Control Group (CTG + CAF). All patients were treated at the University of Seville\u2019s dental school to solve mucogingival problems for aesthetic and\/or functional reasons. A classification is proposed based on its severity; Major and Minor. Major complications included reepithelialization of the graft, epithelial bands, cul-de-sac, epithelial cysts, and bone exostoses. Minor complications included the graft\u00b4s color changes and superficial revascularization. Late major complications were only associated with the use of the DFGG, and the late minor complications developed with the use of the DFGG were much higher than those associated with CTG. CTG appears to be a safer procedure than DFGG in terms of late complications.<\/jats:p>","DOI":"10.3390\/ijerph18094504","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T12:08:30Z","timestamp":1619179710000},"page":"4504","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Complications in the Use of Deepithelialized Free Gingival Graft vs. Connective Tissue Graft: A One-Year Randomized Clinical Trial"],"prefix":"10.3390","volume":"18","author":[{"given":"Silvestre","family":"Ripoll","sequence":"first","affiliation":[{"name":"Cl\u00ednica Dental Silvestre Ripoll, Marqu\u00e9s de Paradas 40 Local, 41001 Sevilla, Spain"},{"name":"Department of Periodontology, School of Dentistry, Universidad de Sevilla, C\/Avicena S\/N, 41009 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0465-0196","authenticated-orcid":false,"given":"\u00c1ngela","family":"Fern\u00e1ndez de Velasco-Tarilonte","sequence":"additional","affiliation":[{"name":"Department of Periodontology, School of Dentistry, Universidad de Sevilla, C\/Avicena S\/N, 41009 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3996-3280","authenticated-orcid":false,"given":"Beatriz","family":"Bull\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Periodontology, School of Dentistry, Universidad de Sevilla, C\/Avicena S\/N, 41009 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2832-5902","authenticated-orcid":false,"given":"Blanca","family":"R\u00edos-Carrasco","sequence":"additional","affiliation":[{"name":"Department of Periodontology, School of Dentistry, Universidad de Sevilla, C\/Avicena S\/N, 41009 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Fern\u00e1ndez-Palac\u00edn","sequence":"additional","affiliation":[{"name":"Departamento de Ciencias Sociosanitarias, Universidad de Sevilla, 41004 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1902\/jop.1978.49.7.351","article-title":"Treatment of localized gingival recessions. Part I. Lateral sliding flap","volume":"49","author":"Guinard","year":"1978","journal-title":"J. Periodontol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1902\/jop.1981.52.9.569","article-title":"The current status of mucogingival problems and their therapy","volume":"52","author":"Hall","year":"1981","journal-title":"J. Periodontol."},{"key":"ref_3","first-page":"152","article-title":"Free Autogenous Grafts: III. Utilization of Grafts in the Treatment of Gingival Recession","volume":"6","author":"Sullivan","year":"1968","journal-title":"Periodontics"},{"key":"ref_4","first-page":"65","article-title":"Root coverage using free soft tissue autografts following acid application. I. Technique","volume":"2","author":"Miller","year":"1982","journal-title":"Int. J. Periodont. Rest. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1902\/jop.1987.58.10.674","article-title":"Root coverage with the free gingival graft. Factors associated with incomplete coverage","volume":"58","author":"MilIer","year":"1987","journal-title":"J. Periodontol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1902\/jop.1956.27.2.92","article-title":"Repair of gingival defects by a sliding flap operation","volume":"27","author":"Grupe","year":"1956","journal-title":"J. Periodontol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1111\/jcpe.12002","article-title":"Root coverage in molar teeth: A comparative controlled randomized clinical trial","volume":"39","author":"Zucchelli","year":"2012","journal-title":"J. Clin. Periodontol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.jdent.2008.05.007","article-title":"Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller Class I and II recession-type defects?","volume":"36","author":"Chambrone","year":"2008","journal-title":"J. Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1111\/jcpe.12269","article-title":"Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors. A controlled randomized clinical trial","volume":"41","author":"Zucchelli","year":"2014","journal-title":"J. Clin. Periodontol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1111\/jcpe.12112","article-title":"Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: A randomized, controlled clinical trial","volume":"40","author":"Aroca","year":"2013","journal-title":"J. Clin. Periodontol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1902\/jop.2006.060107","article-title":"Flap thickness as a Predictor of Root Coverage: A Systematic Review","volume":"77","author":"Hwang","year":"2006","journal-title":"J. Periodontol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1902\/jop.2008.070325","article-title":"Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures","volume":"79","author":"Wessel","year":"2008","journal-title":"J. Periodontol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1902\/jop.2013.130478","article-title":"Dimensional changes during early healing after a subepithelial connective tissue graft procedure","volume":"85","author":"Rotenberg","year":"2013","journal-title":"J. Periodontol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1902\/jop.1975.46.3.133","article-title":"Complications of free grafts of masticatory mucosa","volume":"46","author":"Brasher","year":"1975","journal-title":"J. Periodontol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1902\/jop.1997.68.4.392","article-title":"Report of a gingival \u201csurgical cyst\u201d developing secondarily to a subepithelial connective tissue graft","volume":"68","author":"Breault","year":"1997","journal-title":"J. Periodontol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1902\/jop.2002.73.3.340","article-title":"Formation of cyst-like area after a connective tissue graft for root coverage","volume":"73","author":"Harris","year":"2002","journal-title":"J Periodontol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Escalante, M.G., and Tatakis, D.N. (2015). Gingival Cyst of the Adult as Early Sequela of Connective Tissue Grafting. Case Rep. Dent., 1\u20136.","DOI":"10.1155\/2015\/473689"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/0030-4220(53)90202-3","article-title":"Cysts of the gingiva","volume":"6","author":"Ritchey","year":"1953","journal-title":"Oral. Surg. Oral. Med. Oral. Pathol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1902\/jop.2003.74.9.1376","article-title":"A gingival cul-de-sac following a root coverage procedure with a subepithelial connective tissue submerged graft","volume":"74","author":"Wei","year":"2003","journal-title":"J. Periodontol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1902\/jop.1996.67.6.611","article-title":"Exostosis associated with autogenous gingival grafts: A report of 9 cases","volume":"67","author":"Singer","year":"1996","journal-title":"J. Periodontol."},{"key":"ref_21","first-page":"38","article-title":"Exostosis following a subepithelial connective tissue graft","volume":"3","author":"Corsair","year":"2001","journal-title":"J. Int. Acad. Periodontol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1902\/jop.2002.73.3.334","article-title":"External Root Resorption Following Partial-Thickness Connective Tissue Graft Placement: A Case Report","volume":"73","author":"Hokett","year":"2002","journal-title":"J. Periodontol."},{"key":"ref_23","first-page":"391","article-title":"Root resorption associated with a subepithelial connective tissue graft for root coverage: Clinical and histologic report of a case","volume":"23","author":"Carnio","year":"2003","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_24","first-page":"619","article-title":"Progressive root resorption associated with the treatment of deep gingival recession. A clinical case","volume":"30","author":"Cizza","year":"2010","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1002\/cap.10047","article-title":"Hyperplastic Response Following Soft Tissue Augmentation in the Esthetic Zone. Clinical Advances in Periodontics","volume":"9","author":"Gluckman","year":"2019","journal-title":"Clin. Adv. Periodontics."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1902\/jop.2007.070099","article-title":"Subepithelial Connective Tissue Graft for Root Coverage: A Case Report of an Unusual Late Complication of Epithelial Origin","volume":"78","author":"Parashis","year":"2007","journal-title":"J. Periodontol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1902\/jop.2009.090041","article-title":"Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: A comparative controlled randomized clinical trial","volume":"80","author":"Zucchelli","year":"2009","journal-title":"J. Periodontol."},{"key":"ref_28","first-page":"465","article-title":"Epithelial Inclusion Cyst After. Free Gingival Graft: A Case Report","volume":"27","year":"2007","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1902\/jop.1991.62.4.269","article-title":"Bony exostosis as a sequela to free gingival grafting: Two case reports","volume":"62","author":"Pack","year":"1991","journal-title":"J. Periodontol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1902\/jop.1996.67.3.250","article-title":"Development of an exostosis following a free gingival graft: Case report","volume":"67","author":"Czuszak","year":"1996","journal-title":"J. Periodontol."},{"key":"ref_31","first-page":"20","article-title":"A further report of bony exostosis occurring as a sequela to free gingival grafts","volume":"16","author":"Efeoglu","year":"1994","journal-title":"Periodontal Clin. Investig."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1034\/j.1600-051X.2002.290514.x","article-title":"Exostosis following a free gingival graft","volume":"29","author":"Echeverria","year":"2002","journal-title":"J. Clin. Periodontol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"12","DOI":"10.29252\/wjps.8.1.12","article-title":"Free Gingival Graft as a Single Step Procedure for Treatment of Mandibular Miller Class I and II Recession Defects","volume":"8","author":"Goyal","year":"2019","journal-title":"World J. Plast. Surg."},{"key":"ref_34","first-page":"224","article-title":"Evaluation of color and width of attached gingiva gain in two surgical techniques: Free gingival graft and connective tissue graft covered by thin mucosal flap, a clinical trial","volume":"20","author":"Raoofi","year":"2019","journal-title":"J. Dent. (Shiraz)"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Maia, V.T.G., Kahn, S., De Souza, A.B., and Fernandes, G.V.D.O. (2021). De-Epithelialized Connective Tissue Graft and the Reminiscent Epithelial Content after Harvested by the Harris\u2019 Technique: A Histological and Morphometrical Case Series. Clin. Adv. Periodontics.","DOI":"10.1002\/cap.10151"},{"key":"ref_36","first-page":"8","article-title":"A classification of marginal tissue recession","volume":"5","author":"MilIer","year":"1985","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"540","DOI":"10.3389\/fendo.2019.00540","article-title":"The Role of Oxidative Stress and Hormones in Controlling Obesity","volume":"10","author":"Pinto","year":"2019","journal-title":"Front. Endocrinol."},{"key":"ref_38","first-page":"279","article-title":"A single incision technique to harvest subepithelial connective tissue grafts from palate","volume":"19","author":"Hurzeler","year":"1999","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_39","first-page":"8","article-title":"Complete coverage of the denuded root surface with a one-stage gingival graft","volume":"3","author":"Holbrook","year":"1983","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_40","first-page":"19","article-title":"Postoperative Complications Following Gingival Grafts: A Prospective Cohort Study","volume":"4","author":"Roman","year":"2011","journal-title":"Appl. Med. Inform."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1902\/jop.2006.050296","article-title":"Postoperative Complications Following Gingival Augmentation Procedures","volume":"77","author":"Griffin","year":"2006","journal-title":"J. Periodontol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1089\/photob.2019.4713","article-title":"Ex Vivo Evaluation of Gingival Ablation with Various Laser Systems and Electroscalpel","volume":"38","author":"Kawamura","year":"2020","journal-title":"Photobiomodulation Photomedicin Laser Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"869","DOI":"10.21873\/invivo.11851","article-title":"CO2 Laser De-epithelization Technique for Subepithelial Connective Tissue Graft: A Study of 21 Recessions","volume":"34","author":"Yoshino","year":"2020","journal-title":"In Vivo"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Gursoy, H., Yarimoglu, E., Kuru, B., Ozkan Karaca, E., and Ince Kuka, G. (2019). Evaluation of the Effects of Er:YAG Laser for the De-Epithelialization of the Palatal Graft in the Treatment of Multiple Gingival Recessions: A Randomized Clinical Trial. Photobiomodulation Photomedicine Laser Surg.","DOI":"10.1089\/photob.2019.4681"},{"key":"ref_45","first-page":"501","article-title":"The \u2019All-on-four\u2019 protocol in HIV-positive patients: A prospective, longitudinal 7-year clinical study","volume":"12","author":"Romanos","year":"2019","journal-title":"Int. J. Oral. Implantol. (Berl.)"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1902\/jop.2010.100278","article-title":"Root coverage esthetic score after treatment of gingival recession: An interrater agreement multicenter study","volume":"81","author":"Cairo","year":"2010","journal-title":"J. Periodontol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/9\/4504\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:52:05Z","timestamp":1760161925000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/9\/4504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,23]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["ijerph18094504"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18094504","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,23]]}}}