Evidence map›Paper›PMID 41744355›Full record

ArticleClinical implant dentistry and related research2026

Clinicians' Stress Levels During Soft Tissue Augmentation Using Autogenous Connective Tissue Grafts: A Pilot Study.

Anina N Zuercher, Franz J Strauss, Rawen Smirani, Ronald E Jung, Reinhard Gruber, Daniel S Thoma

Abstract read
In one paragraph

Article in Clinical implant dentistry and related research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Soft Tissue Volume Augmentation at Single Implant Sites Applying Collagen Matrices or Connective Tissue Grafts: 10-Year Follow-Up of a Randomized Controlled Trial.Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.] · 2026
    Trial
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Anina N ZuercherClinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.ORCID https://orcid.org/0000-0002-9941-3491
Franz J StraussClinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.ORCID https://orcid.org/0000-0002-5832-7327
Rawen SmiraniUniversity of Bordeaux, INSERM U1026 (BioTis), CHU Bordeaux, Université de Bordeaux Collège Sciences de la Santé, Bordeaux, France.ORCID https://orcid.org/0000-0002-5904-1830
Ronald E JungClinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.ORCID https://orcid.org/0000-0003-2055-1320
Reinhard GruberDepartment of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.ORCID https://orcid.org/0000-0001-5400-9009
Daniel S ThomaClinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.ORCID https://orcid.org/0000-0002-1764-7447

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo quantify intraoperative stress responses in clinicians performing mucogingival surgery using subepithelial connective tissue grafts (SCTG) for mucosal thickening by combining physiological and psychological measures and to explore the feasibility of stress monitoring in this surgical context. MATERIALS AND

methodsEleven clinicians performed 14 SCTG procedures. Physiological stress was assessed using heart rate (HR) and salivary cortisol measured at multiple time points from morning baseline through the evening. Psychological stress and workload were evaluated using validated questionnaires, namely the short-form State-Trait Anxiety Inventory (STAI-6) and the Surgery Task Load Index (SURG-TLX). Data were analyzed with linear mixed-effects models to account for repeated measures in this exploratory pilot study.

resultsHeart rate showed a significant overall time effect (p < 0.001), with transient increases during incision, flap preparation and graft harvesting, followed by recovery during suturing. Salivary cortisol levels decreased progressively throughout the day (p < 0.01), consistent with normal diurnal variation and indicating the absence of sustained endocrine stress. Heart rate and cortisol patterns did not differ by clinician experience (< 3 years or ≥ 3 years). STAI-6 scores remained stable over time, whereas SURG-TLX responses identified high mental demand and task complexity as the dominant contributors to perceived workload.

conclusionsSCTG procedures are associated with short-term physiological stress activation without concomitant increases in perceived anxiety, suggesting an adaptive stress and well-regulated responses among clinicians. CLINICAL SIGNIFICANCE: SCTG causes short-term physical stress, but clinicians appear to cope well and do not feel more anxious while performing them. Characterizing stress dynamics during mucogingival surgery may help inform future research on clinician performance, fatigue, and procedural safety in soft tissue augmentation.

Indexed as

connective tissue graftcortisolheart ratepsychological questionnairesoft tissue augmentationstress

Identifiers

PMID41744355
PMCPMC12937924

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.