Case Series Postoperative Complications Following Gingival Augmentation Procedures Terrence J. Griffin,* Wai S. Cheung,* Athanasios I. Zavras, † and Petros D. Damoulis* Background: Postoperative pain, swelling, and bleeding are the most common complications follow- ing soft tissue grafting procedures; however, detailed documentation is sparse in the literature. The aims of this prospective study were as follows: 1) to com- pare the frequency of complication occurrence after free soft tissue grafting (FSTG) or subepithelial con- nective tissue grafting (SCTG) procedures; 2) to eval- uate the use of an acellular dermal matrix (ADM) as the donor tissue alternative to an FSTG or SCTG; and 3) to identify possible predictors for these compli- cations. Methods: Seventy-five FSTG and 256 SCTG proce- dures were performed in 228 patients by a single operator. In five free soft tissue and 84 bilaminar graft procedures, an ADM was used instead of autog- enous tissue. Variables such as the duration and location of procedures, smoking history, gender, and age were recorded. Patients were asked to fill out a questionnaire 1 week after the surgeries regard- ing postoperative pain, swelling, and bleeding. Data were analyzed using the x 2 test and logistic regression analysis. Odds ratios were calculated for moderate and severe adverse outcomes grouped to- gether. Results: The duration of surgical procedures was highly correlated with pain or swelling post-surgi- cally (P = 0.001). Current smokers were three times more likely to experience post-surgical swelling (P = 0.01). Patients who underwent FSTG procedures were three times more likely to develop post-surgical pain (P = 0.002) or bleeding (P = 0.03) compared to those who received SCTG procedures. When an ADM was applied instead of autogenous tissue, the probability of swelling or bleeding was significantly reduced (odds ratio [OR] = 0.46, P = 0.02 and OR = 0.3, P = 0.001, respectively). Conclusions: Long surgical procedures and smok- ing may increase the severity and frequency of certain post-surgical complications after gingival augmenta- tion procedures. FSTG procedures incur a higher like- lihood for postoperative pain or bleeding than SCTG procedures, whereas the application of an ADM may significantly reduce the probability of swelling and bleeding. J Periodontol 2006;77:2070-2079. KEY WORDS Allograft; connective tissue; postoperative complications; smoking; transplantation, autologous. T he free soft tissue graft (FSTG) and subepi- thelial connective tissue graft (SCTG) are among the most commonly used and widely studied gingival augmentation procedures. 1-12 Both techniques have several applications, including in- creasing keratinized tissue, 1,2 soft tissue thickness, 3,4 and vestibular depth; 5 reducing gingival recession; 6-8 and replacing pigmented and pathological oral mu- cosa. 9,10 The predictability and long-term stability of the surgical outcome for these procedures have also been well established. 11,12 Complications and atypical healing responses after FSTG or SCTG procedures have been reported in the literature, 13-17 albeit in a non-systematic way. Most documented complications are associated with the donor site. Harvesting of a free soft tissue graft can re- sult in excessive hemorrhage, postoperative bone ex- posure, and recurrent herpetic lesions associated with a second surgical procedure leaving a painful, open palatal wound. 13 Cases of a mucocele 14 and an arterio- venous shunt 15 have also been reported. Complica- tions associated with the SCTG include necrosis of graft and palatal tissue, excessive bleeding, prolonged pain/discomfort or infection at the donor and/or recip- ient sites, and graft shrinkage. 18 The main concern for the donor site is tissue necrosis when palatal thickness is inadequate or primary closure is not achieved. 19,20 An association between extensive necrosis and post- operative pain has been suggested, when two SCTG harvesting techniques were evaluated. 21 As a result, several modifications for harvesting donor tissue have been proposed in an effort to preserve blood supply and palatal tissue thickness and achieve pri- mary wound closure. 22-24 Furthermore, a number of * Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA. † Department of Health Policy and Epidemiology, Harvard University School of Dental Medicine, Boston, MA. doi: 10.1902/jop.2006.050296 Volume 77 • Number 12 2070