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Kim SE, Lee G. Treatment of an Infrabony Defect of a Maxillary Canine Tooth Using Enamel Matrix Derivatives with Allogeneic Bone Augmentation in a Dog. J Vet Dent 2024:8987564241246683. [PMID: 38646694 DOI: 10.1177/08987564241246683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
A 5-year-old Miniature Dachshund was presented having an infrabony pocket on the palatal aspect of the right maxillary canine tooth. The bony defect had worsened despite previous closed root planing and administration of a perioceutic agent. A second surgery using an allogeneic cancellous bone augmentation with an enamel matrix derivative was performed in the infrabony defect following open root planing. Eight months after the periodontal surgery, the osseous defect showed healing by improved periodontal probing measurements and increased radiopacity using dental radiography and computed tomography.
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Affiliation(s)
- Se Eun Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Gahyun Lee
- Department of Veterinary Medical Imaging, Haemaru Referral Animal Hospital, Seongnam, Republic of Korea
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Chackartchi T, Bosshardt DD, Imber JC, Stähli A, Sacks H, Nagy K, Sculean A. Histological evaluation following treatment of recession-type defects with coronally advanced flap and a novel human recombinant amelogenin. Clin Oral Investig 2023; 27:5041-5048. [PMID: 37421492 PMCID: PMC10492744 DOI: 10.1007/s00784-023-05123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/14/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing / regeneration in recession-type defects. MATERIALS AND METHODS A total of 17 gingival recession-type defects were surgically created in the maxilla of three minipigs. The defects were randomly treated with a coronally advanced flap (CAF) and either rAmelX (test), or a CAF and placebo (control). At three months following reconstructive surgery, the animals were euthanized, and the healing outcomes histologically evaluated. RESULTS The test group yielded statistically significantly (p = 0.047) greater formation of cementum with inserting collagen fibers compared with the control group (i.e., 4.38 mm ± 0.36 mm vs. 3.48 mm ± 1.13 mm). Bone formation measured 2.15 mm ± 0.8 mm in the test group and 2.24 mm ± 1.23 mm in the control group, respectively, without a statistically significant difference (p = 0.94). CONCLUSIONS The present data have provided for the first-time evidence for the potential of rAmelX to promote regeneration of periodontal ligament and root cementum in recession-type defects, thus warranting further preclinical and clinical testing. CLINICAL RELEVANCE The present results set the basis for the potential clinical application of rAmelX in reconstructive periodontal surgery.
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Affiliation(s)
- Tali Chackartchi
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dieter D Bosshardt
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Robert K. Schenk Laboratory of Oral Histology, Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | | | - Katalin Nagy
- Department of Oral Surgery, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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Zhang T, Zhang L, Li M, Yi F, Li C, Lu Y. Morphological changes in alveolar bone thickness and height after orthodontic proclination or labial movement combined with autogenous soft tissue grafting: a CBCT evaluation. BMC Oral Health 2023; 23:218. [PMID: 37061689 PMCID: PMC10105956 DOI: 10.1186/s12903-023-02944-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/05/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Autogenous soft tissue grafting is indicated in thin gingival biotypes before orthodontic proclination or labial movements to increase the keratinized gingiva and prevent gingival recession. However, its effect on local alveolar bone remodeling is unclear. The aim of this study was to investigate the effects of autogenous soft tissue grafting on local alveolar bone after orthodontic proclination or labial movements. METHODS Sixteen patients with a thin scalloped gingival biotype, narrow keratinized gingiva, or thin cortical bone requiring orthodontic proclination or labial movement of teeth were included. Cone-beam computed tomography (CBCT) images were obtained before grafting and at least 6 months after surgery. Sixty mandibular teeth were included, and the vertical bone level and horizontal labial bone thickness were measured. The results were compared using paired t-tests or Wilcoxon signed-rank test. RESULTS The horizontal labial bone thickness increased, especially at 6 mm below the cementoenamel junction (CEJ) in the mandibular central and lateral incisors (P < 0.05). The total alveolar bone area of the canines, first premolars, and second premolars increased at 3, 6, and 9 mm below the CEJ, respectively, and the differences were statistically significant (P < 0.05). Additionally, vertical bone height increased minimally on the labial side, but the differences were not statistically significant (P > 0.05). CONCLUSIONS New bone regeneration was observed on the labial (pressure) side after autogenous soft tissue grafting, which may represent a mechanism to effectively prevent gingival recession and maintain periodontal health. IRB APPROVAL All the experimental procedures involving humans in this study were approved by the Medical Ethics Committee of Xiangya Stomatological Hospital, Central South University ( No. 20190048).
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Affiliation(s)
- Tianyu Zhang
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Lingling Zhang
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Min Li
- Department of Periodontics, Hunan Key Laboratory of Oral Health Research & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Fang Yi
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Chengri Li
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Yanqin Lu
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China.
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Yoshino Y, Miyaji H, Nishida E, Kanemoto Y, Hamamoto A, Kato A, Sugaya T, Akasaka T. Periodontal tissue regeneration by recombinant human collagen peptide granules applied with β-tricalcium phosphate fine particles. J Oral Biosci 2023; 65:62-71. [PMID: 36669699 DOI: 10.1016/j.job.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Recombinant human collagen peptide (RCP) is a recombinantly created xeno-free biomaterial enriched in arginine-glycine-aspartic acid sequences with good processability whose use for regenerative medicine applications is under investigation. The biocompatibility and osteogenic ability of RCP granules combined with β-tricalcium phosphate (TCP) submicron particles (β-TCP/RCP) were recently demonstrated. In the present study, β-TCP/RCP was implanted into experimental periodontal tissue defects created in beagles to investigate its regenerative effects. METHODS An RCP solution was lyophilized, granulated, and thermally cross-linked into particles approximately 1 mm in diameter. β-TCP dispersion (1 wt%; 500 μL) was added to 100 mg of RCP granules to form β-TCP/RCP. A three-walled intrabony defect (5 mm × 3 mm × 4 mm) was created on the mesial side of the mandibular first molar and filled with β-TCP/RCP. RESULTS A micro-computed tomography image analysis performed at 8 weeks postoperative showed a significantly greater amount of new bone after β-TCP/RCP grafting (2.2-fold, P < 0.05) than after no grafting. Histological findings showed that the transplanted β-TCP/RCP induced active bone-like tissue formation including tartaric acid-resistant acid phosphatase- and OCN-positive cells as well as bioabsorbability. Ankylosis did not occur, and periostin-positive periodontal ligament-like tissue formation was observed. Histological measurements performed at 8 weeks postoperative revealed that β-TCP/RCP implantation formed 1.7-fold more bone-like tissue and 2.1-fold more periodontal ligament-like tissue than the control condition and significantly suppressed gingival recession and epithelial downgrowth (P < 0.05). CONCLUSIONS β-TCP/RCP implantation promoted bone-like and periodontal ligament-like tissue formation, suggesting its efficacy as a periodontal tissue regenerative material.
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Affiliation(s)
- Yuto Yoshino
- Department of Periodontology and Endodontology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hirofumi Miyaji
- Department of Periodontology and Endodontology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
| | - Erika Nishida
- Department of Periodontology and Endodontology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yukimi Kanemoto
- Department of Periodontology and Endodontology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Asako Hamamoto
- Department of Periodontology and Endodontology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Akihito Kato
- Department of Periodontology and Endodontology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tsutomu Sugaya
- Department of Periodontology and Endodontology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tsukasa Akasaka
- Department of Biomedical Materials and Engineering, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Stähli A, Duong HY, Imber JC, Roccuzzo A, Salvi GE, Katsaros C, Ramseier CA, Sculean A. Recession coverage using the modified coronally advanced tunnel and connective tissue graft with or without enamel matrix derivative: 5-year results of a randomised clinical trial. Clin Oral Investig 2023; 27:105-113. [PMID: 36002594 PMCID: PMC9402279 DOI: 10.1007/s00784-022-04691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/15/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To evaluate the 5-year results of single and multiple recession type (RT) 1 and 2 (Miller I to III) recessions treated with the modified coronally advanced tunnel (MCAT) and connective tissue graft (CTG) with or without an enamel matrix derivative (EMD). The main outcome variable was the stability of obtained root coverage from 6 months to 5 years. MATERIALS AND METHODS In 24 patients, both complete and mean root coverage (CRC and MRC) and gain of keratinised tissue (KT) were assessed at 6 months and 5 years after recession coverage by means of MCAT and CTG with or without EMD. Aesthetic outcomes after 5 years were evaluated using the root coverage aesthetic score (RES). RESULTS At 5 years, 24 patients with a total of 43 recessions were evaluated. Eight patients (57.14%) of the test and 6 (60.0%) of the control group showed complete root coverage. MRC revealed no statistically significant differences between the two groups, with 73.87 ± 26.83% (test) and 75.04 ± 22.06% (control), respectively. KT increased from 1.14 ± 0.57 mm to 3.07 ± 2.27 mm in the test group and from 1.24 ± 0.92 mm to 3.02 ± 1.55 mm in the control group, respectively. CONCLUSION Treatment of single and multiple RT 1 and 2 recessions by means of MCAT and CTG with or without EMD yielded comparable clinical improvements which could be maintained over a period of 5 years. The additional use of EMD did not influence the clinical outcomes. CLINICAL RELEVANCE The use of MCAT + CTG yielded successful coverage of single and multiple RT 1 and 2 gingival recessions, while the additional application of EMD did not seem to influence the results.
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Affiliation(s)
- A. Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - H. Y. Duong
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - J. C. Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - A. Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - G. E. Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - C. Katsaros
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - C. A. Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - A. Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
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Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis. Gels 2022; 8:gels8010031. [PMID: 35049566 PMCID: PMC8775041 DOI: 10.3390/gels8010031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/23/2021] [Accepted: 01/02/2022] [Indexed: 01/22/2023] Open
Abstract
To improve treatment efficacy of gingival recessions (GR), chemical preparation of the exposed root surface was advocated. The aim of this study was to compare the additional influence of root biomodifications with 24% ethylenediaminetetraacetic acid (EDTA) alone or with enamel matrix derivative (EMD) on the 12 month outcomes of modified coronally advanced tunnel (MCAT) with subepithelial connective tissue graft in the treatment of multiple GR. Average root coverage (ARC), complete root coverage (CRC), reduction in GR, reduction in recession width (RW), gain in clinical attachment level (CAL), increase in gingival thickness (GT), increase in keratinized tissue width (KTW) and changes in root coverage esthetic score (RES) were evaluated. A total of 60 patients with 215 GR were enrolled. In 70, GR root surfaces were treated with EDTA + EMD, in other 72, with EDTA, while in the remaining 73 saline solution was applied. ARC was 94%, 89%, and 91% in the EDTA + EMD, the EDTA and the saline groups, respectively (p = 0.8871). Gains in clinical attachment level (CAL; 2.1 ± 1.1 mm) and RES values (9.6 ± 0.9) were significantly higher in the EDTA + EMD group, when compared with two other groups. The differences between other preoperative and postoperative parameters showed statistical significance only within but not between groups. MCAT outcomes may benefit from adjunctive use of EDTA + EMD regarding 12 month CAL gain and professionally assessed esthetics using RES following treatment of GR.
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Gomaa M, El Guindy H, Shoukheba M, Metwalli A. Healing of experimental gingival recession defects treated with amnion allograft: histologic and histometric analysis in dogs. J Oral Biosci 2022; 64:93-99. [DOI: 10.1016/j.job.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
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Górski B, Górska R, Szerszeń M, Kaczyński T. Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes. Clin Oral Investig 2021; 26:673-688. [PMID: 34218303 PMCID: PMC8791902 DOI: 10.1007/s00784-021-04045-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022]
Abstract
Objectives To investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls). Materials and methods Twenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT). Results The likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration. Conclusions Based on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES. Clinical relevance Additional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.
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Affiliation(s)
- Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland.
| | - Renata Górska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
| | - Marcin Szerszeń
- Department of Dental Prosthetics, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
| | - Tomasz Kaczyński
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
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Shaikh MS, Lone MA, Matabdin H, Lone MA, Soomro AH, Zafar MS. Regenerative Potential of Enamel Matrix Protein Derivative and Acellular Dermal Matrix for Gingival Recession: A Systematic Review and Meta-Analysis. Proteomes 2021; 9:proteomes9010011. [PMID: 33668721 PMCID: PMC8005981 DOI: 10.3390/proteomes9010011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: The purpose of this study was to assess the clinical effectiveness of using a combination of enamel matrix protein derivative and acellular dermal matrix in comparison to acellular dermal matrix alone for treating gingival recessions. Methods: The Cochrane Library (Wiley), PubMed by Medline (NLM), Medline (EBSCO), and Embase (Ovid) databases were searched for entries up to April 2020. Only clinical trials were included. Primary outcomes were root coverage (%), changes in keratinized tissue width and recession (mm). Meta-analysis was conducted for root coverage, changes in keratinized tissue width, recession, clinical attachment level and probing depth. Results: Four studies were selected for the analysis. In primary outcomes, root coverage, change in keratinized tissue width and recession analysis showed a mean difference of 4.99% (p = 0.11), 0.20 mm (p = 0.14) and 0.13 mm (p = 0.23) respectively between the two groups. Secondary outcomes analysis also exhibited a statistically insignificant difference between the test and control group with mean difference of 0.11 mm (p = 0.32) in clinical attachment level gain and -0.03 mm (p = 0.29) in probing depth reduction analysis. Conclusions: Within the limits of this study, enamel matrix protein derivative combined with acellular dermal matrix used for treating gingival recession defects resulted in no beneficial effect clinically than acellular dermal matrix only.
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Affiliation(s)
- Muhammad Saad Shaikh
- Department of Oral Biology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi 75510, Pakistan;
| | - Mohid Abrar Lone
- Department of Oral Pathology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi 75510, Pakistan;
| | - Hesham Matabdin
- Department of Periodontics, Eastman Dental Institute, University College London, London WC1E 6BT, UK;
| | - Muneeb Ahmed Lone
- Department of Prosthodontics, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Azeem Hussain Soomro
- Department of Oral Pathology, Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
- Correspondence: ; Tel.: +966-507544691
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Shirakata Y, Nakamura T, Kawakami Y, Imafuji T, Shinohara Y, Noguchi K, Sculean A. Healing of buccal gingival recessions following treatment with coronally advanced flap alone or combined with a cross-linked hyaluronic acid gel. An experimental study in dogs. J Clin Periodontol 2021; 48:570-580. [PMID: 33513277 PMCID: PMC8248173 DOI: 10.1111/jcpe.13433] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 01/13/2023]
Abstract
Aim To clinically and histologically evaluate in dogs the healing of gingival recessions treated with coronally advanced flap (CAF) with or without cross‐linked hyaluronic acid (HA). Materials and methods Gingival recession defects were surgically created on the vestibular side of both maxillary canines in 8 dogs. After 8 weeks of plaque accumulation, the 16 chronic defects were randomly treated with either CAF alone or CAF and HA‐gel (CAF/HA). Clinical and histological outcomes were evaluated at 10 weeks post‐surgically. Results Compared to baseline, the clinical measurements at 10 weeks revealed a statistically significant decrease in gingival recession for both CAF (p < 0.01) and CAF/HA (p < 0.001) groups. Statistically significant differences were found in clinical attachment level (p < 0.05) and width of gingival recession (p < 0.01) favouring the CAF/HA group. Bone formation was statistically significantly greater in the CAF/HA group than in the CAF group (1.84 ± 1.16 mm vs., 0.72 ± 0.62 mm, respectively, p < 0.05). Formation of cementum and connective tissue attachment were statistically significantly higher in the CAF/HA group compared with the CAF group (i.e. 4.31 ± 1.78 mm versus 2.40 ± 1.35 mm and 1.69 ± 0.98 mm versus 0.74 ± 0.68 mm, respectively (p < 0.05)). Conclusions The present data have for the first time provided histologic evidence for periodontal regeneration of gingival recession defects following treatment with CAF and HA. Clinical relevance The use of HA in conjunction with CAF may represent a novel modality for treating gingival recession defects.
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Affiliation(s)
- Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Toshiaki Nakamura
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshiko Kawakami
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takatomo Imafuji
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yukiya Shinohara
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuyuki Noguchi
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Miron RJ, Moraschini V, Del Fabbro M, Piattelli A, Fujioka-Kobayashi M, Zhang Y, Saulacic N, Schaller B, Kawase T, Cosgarea R, Jepsen S, Tuttle D, Bishara M, Canullo L, Eliezer M, Stavropoulos A, Shirakata Y, Stähli A, Gruber R, Lucaciu O, Aroca S, Deppe H, Wang HL, Sculean A. Use of platelet-rich fibrin for the treatment of gingival recessions: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:2543-2557. [PMID: 32591868 DOI: 10.1007/s00784-020-03400-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to compare the use of platelet-rich fibrin (PRF) with other commonly utilized treatment modalities for root coverage procedures. MATERIALS AND METHODS The eligibility criteria comprised randomized controlled trials (RCTs) comparing the performance of PRF with that of other modalities in the treatment of Miller class I or II (Cairo RT I) gingival recessions. Studies were classified into 5 categories as follows: (1) coronally advanced flap (CAF) alone vs CAF/PRF, (2) CAF/connective tissue graft (CAF/CTG) vs CAF/PRF, (3) CAF/enamel matrix derivative (CAF/EMD) vs CAF/PRF, (4) CAF/amnion membrane (CAF/AM) vs CAF/PRF, and (5) CAF/CTG vs CAF/CTG/PRF. Studies were evaluated for percentage of relative root coverage (rRC; primary outcome), clinical attachment level (CAL), keratinized mucosa width (KMW), and probing depth (PD) (secondary outcomes). RESULTS From 976 articles identified, 17 RCTs were included. The use of PRF statistically significantly increased rRC and CAL compared with CAF alone. No change in KMW or reduction in PD was reported. Compared with PRF, CTG resulted in statistically significantly better KMW and RC. No statistically significant differences were reported between the CAF/PRF and CAF/EMD groups or between the CAF/PRF and CAF/AM groups for any of the investigated parameters. CONCLUSIONS The use of CAF/PRF improved rRC and CAL compared with the use of CAF alone. While similar outcomes were observed between CAF/PRF and CAF/CTG for CAL and PD change, the latter group led to statistically significantly better outcomes in terms of rRC and KTW. In summary, the use of PRF in conjunction with CAF may represent a valid treatment modality for gingival recessions exhibiting adequate baseline KMW. CLINICAL RELEVANCE The data indicate that the use of PRF in conjunction with CAF statistically significantly improves rRC when compared with CAF alone but did not improve KMW. Therefore, in cases with limited baseline KMW, the use of CTG may be preferred over PRF.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland.
| | - Vittorio Moraschini
- Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.,Catholic University of San Antonio de Murcia (UCAM), Murcia, Spain.,Villaserena Foundation for Research, Città Sant'Angelo, PE, Italy
| | | | - Yufeng Zhang
- Department of Oral Implantology, University of Wuhan, Wuhan, China
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland
| | - Benoit Schaller
- Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Institute of Medicine and Dentistry, Niigata University, Niigata, Japan
| | - Raluca Cosgarea
- Department of Prosthetic Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania.,Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Soren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Delia Tuttle
- Canyon Lake Dental Office, Lake Elsinore, CA, USA
| | - Mark Bishara
- West Bowmanville Family Dental, Bowmanville, Ontario, Canada
| | | | - Meizi Eliezer
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Alexandra Stähli
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Reinhard Gruber
- Department of Oral Biology, University of Vienna, Vienna, Austria
| | - Ondine Lucaciu
- Department of Prosthetic Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Sofia Aroca
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der TUM, Munich, Germany
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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Tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: a randomized clinical trial. Clin Oral Investig 2020; 24:4475-4486. [PMID: 32382922 PMCID: PMC7666664 DOI: 10.1007/s00784-020-03312-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/23/2020] [Indexed: 01/04/2023]
Abstract
Objectives The aim of this study was to compare outcomes of the modified coronally advanced tunnel technique (MCAT) combined with subepithelial connective tissue graft (SCTG) with or without enamel matrix derivative (EMD), in the treatment of gingival recession types 1 and 2. Materials and methods A total of 20 patients with 150 multiple gingival recessions (GR) were included in the study. On one side, MCAT was combined with SCTG and EMD (tests), whereas MCAT with SCTG was applied on the contralateral side (controls). Clinical parameters were measured at baseline and 6 months after surgery. Visual analog scales (VAS) and questionnaires were used to assess patient-reported outcomes and the root coverage esthetic score (RES) for professional esthetic evaluation. Results MCAT+SCTG+EMD was not superior with regard to root coverage. At 6 months, average root coverage (ARC) was 87.4% for SCTG+EMD-treated and 90.9% for SCTG-treated defects (p = 0.4170). Complete root coverage (CRC) was observed in 86.7% (tests) and 85.3% (controls) of the cases (p = 0.9872). Significantly less pain was reported using VAS (p = 0.0342) post-operatively in the SCTG+EMD group. Professional assessment of esthetic outcomes using RES showed a significant difference (9.25 versus 8.71, p = 0.0103) in favor of the test group. Conclusions Both treatment modalities were equally effective in treatment of multiple GR and led to similar improvements in clinical parameters. However, the application of EMD as an adjunct resulted in less post-operative pain and better professionally assessed esthetic outcomes. Clinical relevance Patients’ early morbidity and 6-month esthetic outcomes following GR coverage with MCAT might be influenced by means of EMD utilization.
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13
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Effect of enamel matrix derivative on wound healing following gingival recession coverage using the modified coronally advanced tunnel and subepithelial connective tissue graft: a randomised, controlled, clinical study. Clin Oral Investig 2019; 24:1043-1051. [PMID: 31290017 DOI: 10.1007/s00784-019-03008-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/01/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The potential effect of enamel matrix derivative (EMD) on wound healing following recession coverage surgery is still controversially discussed in the literature. The aim of this randomised, controlled, single blinded clinical study was, therefore, to investigate clinically and immunologically the potential effects of EMD on early wound healing and clinical results following treatment of single and multiple gingival recessions by the modified coronally advanced tunnel technique (MCAT) and subepithelial connective tissue graft (sCTG). MATERIALS AND METHODS A total of 40 systemically healthy patients with Miller class I, II or III single or multiple gingival recessions were treated with MCAT + sCTG with or without EMD. Patients were consecutively enrolled and randomly assigned to test or control treatment. Inflammatory markers (interleukin (IL)-1β, IL-8, IL-10 and matrix metalloprotease (MMP)-8) were measured at baseline, 2 days and 1 week postoperatively. The following clinical parameters were assessed at baseline and at 6 months postoperatively: Recession Depth (RD), Recession Width (RW), Width of Keratinized Tissue (KT) and Probing Depth (PD). Patient-reported outcomes were analysed by means of a visual analogue scale. RESULTS No statistically significant differences were detected between the 2 groups in terms of inflammatory markers and patient-reported outcomes during early wound healing. In the test group, RD was reduced from 4.0 ± 1.2 mm at baseline to 0.9 ± 1.3 mm at 6 months (p < 0.001), while the corresponding values in the control group were 4.5 ± 2.0 mm at baseline and 1.0 ± 1.0 mm at 6 months, respectively. At 6 months, mean root coverage measured 78 ± 26% in the test group and 77 ± 18% in the control group, respectively. CONCLUSION Within their limits, the present data have failed to show an influence of EMD on the clinical and immunological parameters related to wound healing following recession coverage surgery using MCAT and sCTG. CLINICAL RELEVANCE Early wound healing following recession coverage by means of MCAT and sCTG does not seem to be influenced by the additional application of EMD.
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