Clinical and Patient-Reported Outcomes for Intraoral (Palatal and Tuberosity) Soft Tissue Grafts in Root Coverage Procedures: A Systematic Review.

Background/

Objectives

To systematically compare the clinical and patient-reported outcomes of soft tissue grafts harvested from the palate and tuberosity, in root coverage surgeries. The primary outcomes assessed were graft dimension, tissue thickness, and postoperative discomfort.

Methods

A comprehensive search was conducted in PubMed, Web of Science, OVID Medline, and Scopus databases, covering studies published till December 2023. Eligible studies included clinical studies and clinical trials involving medically fit adults who underwent intraoral soft tissue grafting for mucogingival procedures around teeth. A total of 1209 records were initially identified, with 13 studies meeting the inclusion criteria. Data was extracted and assessed for bias.

Results

Graft dimension in terms of thickness was generally higher for tuberosity grafts (2.9 ± 0.5 mm) compared to palatal grafts (2.3 ± 0.6 mm). Tuberosity grafts demonstrate less volume changes in buccolingual thickness. One study reported decreased postoperative pain for tuberosity compared to palate donor sites. Risk of bias assessment using ROB 2 and ROBINS-I tools showed that most included studies exhibited low risk across key domains. Among randomized trials, two studies raised some concerns due to limitations in blinding and allocation concealment. Non-randomized studies showed a moderate risk primarily in confounding and outcome measurement, consistent with inherent observational design limitations.

Conclusions

The palate remains a well-established and reliable source of soft tissue grafts. Limited evidence from a single short-term comparative clinical study suggests that tuberosity may offer potential advantages, such as greater graft thickness, reduced volume changes, and less postoperative discomfort. However, the comparative evidence between tuberosity and palatal donor sites is derived from a single short-term study and conclusions must therefore be interpreted with caution. Standardized clinical trials with long-term follow-up are needed to confirm these observations. Clinical Relevance: This review provides clinicians with a preliminary evidence-based perspective into the use of tuberosity as a donor site for soft tissue grafting, an area with limited published data, and highlights its potential to enhance patient outcomes and comfort in mucogingival surgery and emphasizing the need for further research in this area.