A Thirty-Seven-Year Retrospective Assessment of Connective Tissue Grafting: What Have We Learned? A Case Report

This case report presents the 37-year follow-up results of a gingival recession (GR) treatment in the maxillary esthetic zone. In 1987, a healthy 20-year-old woman with a history of orthodontic treatment presented with a chief complaint of GR on the facial area of tooth 21 (FDI numbering system). There was no occlusal trauma, hypersensitivity, or parafunctional habit. Clinically, there was a 4-mm GR on the facial surface, classified as Miller class I (RT1), with a probing depth of 1 mm and no bleeding on probing. A partial-thickness flap was reflected around the teeth to be grafted. The donor site (palate) provided a subepithelial connective tissue graft (SCTG), as per the Langer and Langer protocol. A 2-mm-thick graft was harvested and surgically placed on the recipient site; the flap was then reposi-tioned. The patient was evaluated after 6 months (GR: -0.5 mm), 27 years (GR: 1.0 mm), and 37 years (GR: 1.5 mm). This was a successful long-term result. However, a relapse was noted, possibly exac-erbated by orthodontic treatment associated with the thin overall phenotype in both arches. SCTG is a safe and effective modality for long-term root coverage, demonstrating tissue stability, thickness gain, and complete root coverage within 6 months after the procedure. A relapse of approximately 1.5 mm was noted on the facial surface after 37 years.