Gingival recession treatment with connective tissue grafts in smokers and non-smokers

Background: Cigarette smoking can adversely affect the results of many periodontal procedures. The purpose of this study was to determine whether cigarette smoking affects wound healing of subepithelial connective tissue grafts. Methods: Seventeen systemically healthy patients with 22 Miller Class I or II mucogingival defects were divided into a non-smoker group or smoker group. Patients were regarded as smokers if they reported smoking 10 to 20 cigarettes per day. The following parameters were documented at the surgery date and 3 and 6 months postoperatively: recession depth (RD), recession width (RW), keratinized gingiva height measured apico-coronally (KG), relative attachment level (RAL), probing depths (PD), bleeding on probing (BOP), and the full-mouth plaque score (FMP). Salivary cotinine samples were taken at the surgery to confirm the smoking history and to quantify cigarette use. Results: Non-smokers (0- to 10-ng/ml cotinine level) healed with statistically more recession coverage than the smokers (> 10-ng/ml cotinine level) (98.3% versus 82.3%, respectively; P = 0.001). Six months postoperatively, the non-smokers healed with a 0.2-mm mean recession depth compared to a 1.0-mm mean recession depth for the smokers. This difference in recession depth was statistically significant (P = 0.014). Conclusions: Root coverage with connective tissue grafts appears to be negatively associated with cigarette smoking. Smokers should consider smoking cessation or reducing the use of cigarettes for optimal results with connective tissue grafts.