Three- to 4-year follow-up of the reverse palatal pedicle graft for maxillary palatal recessions.

ABSTRACT

BACKGROUND: This study evaluates the long-term stability and clinical outcomes of the reverse palatal pedicle graft (RPPG) technique in treating maxillary molar palatal recessions over a 3 to 4-year follow-up period. METHODS: Three patients with palatal recession defects on maxillary molars were treated using the RPPG technique. Clinical parameters including recession depth, probing depth, and clinical attachment levels (CALs) were recorded at baseline, 2 months, and 3-4 years postoperatively. Healing outcomes, tissue perfusion, and soft tissue thickness were assessed through clinical examination, cone beam computed tomography (CBCT), and ultrasonography. RESULTS: All patients demonstrated significant CAL gain and partial root coverage. The RPPG technique resulted in significant improvements in attachment gain (41%-67%) and root coverage (44%-83%). In addition, a CBCT scan of one grafted site at a 4-year follow-up (Case 1) demonstrates a gain in soft tissue thickness and partial root coverage. Ultrasound imaging of another grafted site at a 4-year follow-up (Case 2) demonstrates a gain in soft tissue thickness and adequate graft perfusion. The outcomes suggest stable graft sites with some evidence of creeping attachment. CONCLUSION: The RPPG technique provides a viable option for treating maxillary molar palatal recessions, demonstrating promising long-term stability and clinical improvements. Further studies with larger sample sizes and frequent follow-ups are needed to better understand the dynamics of creeping attachment and refine clinical guidelines for palatal grafting. KEY POINTS The reverse palatal pedicle graft (RPPG) is a surgical technique providing a viable solution for the treatment of maxillary molar palatal root coverage for a single recession site with 3-4 years of follow-up demonstrating a degree of predictability. Clinical indications for the application of the RPPG technique include severe palatal recession with little to no interproximal attachment loss (RT1 or RT2), palatal root sensitivity, and a sufficient amount of keratinized tissue on the palatal aspect of adjacent teeth. The main limitations of the application of the RPPG technique include its ability to treat only one isolated recession site, the inability for coronal advancement of the flap, and the quality and thickness of the autogenous graft being patient-dependent. PLAIN LANGUAGE SUMMARY: This study explores the reverse palatal pedicle graft (RPPG) technique, a method used to treat gum recession in the palate around the upper posterior teeth. The research followed three patients over a period of 3-4 years after they underwent the RPPG procedure. This technique involves using a piece of tissue from the roof of the mouth and repositioning it to cover the receded gum area. All patients showed significant improvement in gum attachment and coverage of the exposed roots. The grafts remained stable, and there was continued growth of the gum tissue, further covering the exposed roots over time. These promising results suggest that RPPG could be a reliable and effective option for treating severe gum recession on the roof of the mouth. However, further studies with larger patient groups are needed to confirm these findings and refine the technique.