BACKGROUND The subepithelial connective tissue graft has markedly broadened clinicians' abilities to treat gingival recession. Frequently, however, bulky soft tissue contours are sequelae of this procedure, and post-healing gingivoplasty is often performed to improve esthetics of the grafted site. As a secondary benefit, it is believed that the zone of keratinized tissue is additionally increased after gingivoplasty. METHODS To further investigate this clinical impression, 16 bilateral pairs of sites with recession in 6 consecutive patients (mean age = 38 +/- 9 years) were studied. At the time of initial grafting, one site in each pair was randomly assigned to receive either gingivoplasty 2 months later (GP+) or no further treatment (GP-). Clinical measurement of recession and keratinized tissue width was standardized using customized acrylic stents and Schiller iodine solution, which stains epithelia; values were recorded at baseline (day of graft) and at 2, 3, and 5 months after grafting. Mean clinical gingival widths over time between GP+ and GP- sites, as well as within GP+ sites, were analyzed by t test. RESULTS At 5 months, both the GP+ and GP- sites demonstrated a mean root coverage of 87.4% and increased keratinized tissue width (1.2 mm) when compared to their respective baseline measures. No differences in recession depth and width of keratinized tissue were seen at 5 months between the GP+ and GP- groups. In addition, no differences in recession or gingival width were found between 2- and 5-month observations for either the GP+ or GP- groups. CONCLUSIONS These data suggest that the observed clinical improvements are the outcome of the initial graft surgery and that the gingivoplasty procedure does not result in additional (or "rebound") increases in keratinized tissue width.