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Ariceta A, Chambrone L, Stuhr S, Couso-Queiruga E. Effect of suturing in root coverage via coronally advanced flaps: A systematic review. Clin Adv Periodontics 2024. [PMID: 39276125 DOI: 10.1002/cap.10312] [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: 06/17/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 09/16/2024]
Abstract
BACKGROUND To analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap. METHODS The protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed. RESULTS A total of 15 randomized clinical trials, including 301 localized GRD in non-molar sites classified as Miller class I-II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5-0. CONCLUSIONS For the treatment of single/localized GRD in non-molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5-0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters. KEY POINTS There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non-molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5-0 material diameter showed the highest percentage of root coverage achieved. PLAIN LANGUAGE SUMMARY This study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5-0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.
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Affiliation(s)
- Alina Ariceta
- Department of Periodontology, School of Dentistry, Catholic University of Uruguay, Montevideo, Uruguay
| | - Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health & Science, Monte de Caparica, Caparica, Portugal
- Unit of Basic Oral Investigations (UIBO), School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Sandra Stuhr
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Emilio Couso-Queiruga
- Department of Oral Surgery and Stomatology, University of Bern School of Dental Medicine, Bern, Switzerland
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Rieder M, Wimmer G, Sokolowski A, Sokolowski A, Payer M, Arefnia B. Treatment of Localized Gingival Recession with an Enamel Matrix Protein-Coated Xenogeneic Dermal Matrix: A Randomized Controlled Trial. MATERIALS (BASEL, SWITZERLAND) 2024; 17:3985. [PMID: 39203163 PMCID: PMC11355834 DOI: 10.3390/ma17163985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024]
Abstract
This study aims to evaluate the influence of the additional use of enamel matrix derivate (EMD) in the treatment of gingival recession defects using a coronally advanced flap (CAF) and a xenogeneic dermal matrix (XDM) by means of digital and clinical assessment methods. In this prospective randomized controlled study, recession height and area, width and thickness of keratinized gingiva, pocket probing depth, and clinical attachment levels were measured at the baseline and followed up for one year. Fifteen patients (n = 15) with 24 gingival recession defects were treated between 2019 and 2021. On average, the digitally assessed root coverage of the control group (CAF + XDM) was not significantly different compared to the test group (CAF + XDM + EMD), with 69 ± 28% and 36 ± 32%, respectively (p = 0.094). One year postoperatively, there were no differences found regarding keratinized tissue width (KTW) between the control group and test group (p = 0.690). However, the control group showed superior results in the thickness of keratinized gingiva (p = 0.044). The present study showed that there were no statistically significant differences in the root coverage results in the CAF + XDM + EMD group compared to the CAF + XDM group. The adjunctive use of EMD to a CAF and XDM in the treatment of gingival recession defects does not appear to have any clinical benefit.
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Affiliation(s)
- Marcus Rieder
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria;
| | - Gernot Wimmer
- Division of Restorative Dentistry, Periodontology and Prosthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria; (G.W.); (A.S.); (A.S.)
| | - Alwin Sokolowski
- Division of Restorative Dentistry, Periodontology and Prosthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria; (G.W.); (A.S.); (A.S.)
| | - Armin Sokolowski
- Division of Restorative Dentistry, Periodontology and Prosthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria; (G.W.); (A.S.); (A.S.)
| | - Michael Payer
- Division of Oral Surgery and Orthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria;
| | - Behrouz Arefnia
- Division of Restorative Dentistry, Periodontology and Prosthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria; (G.W.); (A.S.); (A.S.)
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Kalimeri E, Roccuzzo A, Stähli A, Oikonomou I, Berchtold A, Sculean A, Kloukos D. Adjunctive use of hyaluronic acid in the treatment of gingival recessions: a systematic review and meta-analysis. Clin Oral Investig 2024; 28:329. [PMID: 38771388 PMCID: PMC11108902 DOI: 10.1007/s00784-024-05701-7] [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: 12/17/2022] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES To explore the efficacy of Hyaluronic acid as an adjunctive in treatment of gingival recessions (GR). MATERIALS AND METHODS A systematic literature search was performed in several electronic databases, including Medline/ PubMed, Embase, CENTRAL and LILACS. Recession improvement was evaluated through multiple outcome variables. The Cochrane Risk of Bias tool and the ROBINS-I tool were used to assess the quality of the included trials. Weighted Mean Differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated through meta-analysis using a random-effect model for the amount of Relative Root Coverage (RRC). RESULTS A total of 3 randomised studies were deemed as eligible for inclusion. Their data were also used for pooling the effect estimates. Overall analysis of RRC (3 studies) presented a WMD of 7.49% (p = 0.42; 95% CIs -10.88, 25.86) in favour of adjunctive use of hyaluronic acid during Coronally Advanced Flap (CAF) technique, although statistical significance was not reached. Statistical heterogeneity was found to be high (I2 = 80%). CONCLUSIONS Within their limitations, the present data indicate that the local application of Hyaluronic acid does not lead to additional clinical benefits when used as an adjunctive to the treatment of GR with CAF. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of Hyaluronic acid. CLINICAL RELEVANCE In the frame of the current review, the adjunctive use of Hyaluronic acid does not additionally improve the clinical outcomes obtained during treatment of GR with CAF.
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Affiliation(s)
- Eleni Kalimeri
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ilias Oikonomou
- Department of Periodontology, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Aaron Berchtold
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force & VA General Hospital, Athens, Greece.
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
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Mahajan A, Goyal L, Asi KS, Walhe MS, Chandel N. Clinical effectiveness of periosteal pedicle graft for the management of gingival recession defects-a systematic review and meta-analysis. Evid Based Dent 2023; 24:93-94. [PMID: 37286696 DOI: 10.1038/s41432-023-00898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of periosteal pedicle graft (PPG) in terms of root coverage and patient related outcomes. To the best of our knowledge this is the first systematic review with meta-analysis on PPG. MATERIAL AND METHODS A comprehensive search was performed using electronic and hand searches upto January 2023. Primary outcomes were Recession depth Reduction (Rec Red), mean root coverage (mRC) and complete root coverage (CRC). Secondary outcomes were gain in width of keratinized gingiva (WKG) and patient reported outcome measures (PROMs). Meta-analysis was performed when possible. The risk bias assessment was done using RevMan5.4.1 and Joanna Briggs institute scale for the included RCTs and case series respectively. RESULTS A total of 8 RCTs and 2 case series (538 recession sites) were included based upon the predefined inclusion and exclusion criteria. The follow up period ranged from 6 months to 18 months. Results demonstrated that mRC of PPG + Coronally advanced flap (CAF) was 87.7% for localized gingival recession defects (GRDs) and 84.83% for multiple GRDs. An overall gain in WKG (Weighted Mean =1.49 ± 0.27 mm) was observed among all the included studies in the PPG + CAF group with mean difference (-0.10 (95% CI [-0.52, 0.33], p = 0.66)). Sub-group meta-analysis comparing PPG + CAF with sub-epithelial connective tissue graft (SCTG) + CAF resulted in similar outcomes in terms of Rec Red (0.10 (95% CI [-0.56 to 0.77], p = 0.76)) and gain in WKG (-0.03 (95% CI [-0.25 to 0.18], p = 0.76)). In terms of PROMs systematic review revealed better patient satisfaction with PPG + CAF than SCTG + CAF. CONCLUSION PPG + CAF is a viable treatment modality for management of GRDs. The primary and secondary outcomes achieved utilizing PPG + CAF were found to be comparable to other conventional techniques including the gold standard i.e., SCTG.
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Affiliation(s)
- Ajay Mahajan
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India.
| | - Lata Goyal
- All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Kanwarjit Singh Asi
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Monika Shekhar Walhe
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Nidhi Chandel
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
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Chambrone L, Boltelho J, Machado V, Mascarenhas P, Mendes JJ, Avila-Ortiz G. Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta-analysis. J Periodontol 2022; 93:1336-1352. [PMID: 35451068 DOI: 10.1002/jper.22-0167] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of this systematic review and network meta-analysis was to assess the efficacy of a bilaminar root coverage technique consisting of the combination of an autogenous subepithelial connective tissue graft (SCTG) and a coronally advanced flap (CAF) compared to the five most indicated alternative approaches for the treatment of single gingival recession defects (GRD). METHODS The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42020221362). Three electronic databases were searched up to September 30th , 2021 to identify randomized controlled trials that involved the treatment of single GRD without interproximal tissue loss via root coverage procedures. A frequentist network meta-analysis was conducted for complete root coverage (CRC), mean root coverage (MRC) and keratinized tissue width (KTW) changes. RESULTS A total of 38 studies reporting on 830 patients and 1,265 GRD were included. SCTG+CAF was ranked as the most efficient treatment approach for MRC, CRC and KTW gain at 6 and 12 months after surgery, except for MRC at the 12-month follow-up where enamel matrix derivative (EMD) plus CAF exhibited superior results. CONCLUSIONS SCTG+CAF can be considered the gold standard for the treatment of single GRD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz -Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Graduate Dentistry Program, School of Dentistry, Ibirapuera University, São Paulo, Brazil; and Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia.,Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - João Boltelho
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz -Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas, Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Vanessa Machado
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz -Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas, Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Paulo Mascarenhas
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz -Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - José João Mendes
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz -Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
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Zhan Y, Wang M, Cao X, Liu F. Effectiveness of acellular dermal matrix graft with a coronally advanced flap for the treatment of Miller Class I/II single gingival recession with thin gingival phenotype: study protocol for a split-mouth randomised controlled trial. BMJ Open 2022; 12:e047703. [PMID: 35078831 PMCID: PMC8796220 DOI: 10.1136/bmjopen-2020-047703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Gingival recession is one of the most common mucogingival deformities requiring surgical correction. The American Academy of Periodontology Regeneration Workshop recommended connective tissue graft (CTG) combined with coronally advanced flap (CAF) for the treatment of Miller Class I and II single-tooth gingival recession. The disadvantages of harvesting autogenous tissue include postoperative bleeding, pain and discomfort at the donor site, restricted tissue supply, increased morbidity and prolonged operative times. Acellular dermal matrix (ADM) contains undamaged collagen and elastin matrices that can be used as a substitute for CTG during root coverage procedures. However, the use of ADM is still controversial. The objective of this split-mouth; randomised, controlled, clinical study is to evaluate the long-term effects of ADM graft (ADMG) combined with CAF on root coverage, aesthetics and patient satisfaction for the treatment of single gingival recession with thin gingival phenotype. METHODS AND ANALYSIS Forty participants with bilateral Miller Class I/II gingival recession will be randomised to receive an ADMG on one side and CTG on the contralateral side, combined with CAF. Gingival recession depth, gingival recession width and keratinised tissue width will be measured at baseline, 2 weeks and 1, 3, 6, 12 and 24 months. Mean root coverage, complete root coverage, root coverage aesthetic score, colour change (∆E) and patient satisfaction will be assessed during follow-up visits. ETHICS AND DISSEMINATION The present study has received approval from the Ethics Committee of Peking University School and Hospital of Stomatology (PKUSSIRB-202054029). Data of this study will be registered with the International Clinical Trials Registry Platform. Additionally, we will disseminate the results through scientific journal. TRIAL REGISTRATION NUMBER ChiCTR2000033230.
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Affiliation(s)
- Yalin Zhan
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, Beijing, PR China
| | - Miaozhen Wang
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, Beijing, PR China
| | - Xiaojing Cao
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, Beijing, PR China
| | - Feng Liu
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, Beijing, PR China
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Panda S, Khijmatgar S, Arbildo-Vega H, Das AC, Kumar M, Das M, Mancini L, Del Fabbro M. Stability of biomaterials used in adjunct to coronally advanced flap: A systematic review and network meta-analysis. Clin Exp Dent Res 2021; 8:421-438. [PMID: 34845864 PMCID: PMC8874057 DOI: 10.1002/cre2.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 12/26/2022] Open
Abstract
AIM The objective of this network meta-analysis was to rank different biomaterials used in adjunct to coronally advanced flap (CAF), based on their performance in root-coverage for Miller's Class I and II gingival recessions. MATERIALS AND METHODS An electronic database search was carried out in PUBMED, CENTRAL, SCOPUS, and EMBASE to identify the eligible articles and compiled into the citation manager to remove the duplicates. The primary outcome was keratinized gingival tissue width (KGW) and percentage of root coverage (%RC). The treatment effect of different biomaterials was estimated using predictive interval plots and ranked based on biomaterials performance, using multidimensional scale ranking. RESULTS CAF + connective tissue graft (CTG), CAF + platelet concentrate matrix (PCM) and acellular dermal matrix (ADM) ranked at the top positions in performance in improving KGW. The highest ranked materials in improving percentage of root coverage in gingival recession were CAF + collagen matrix (CM) + gingival fibroblasts (GF), CAF + ADM + platelet rich plasma (PRP) and CAF + ADM, as compared to CAF alone. CONCLUSION CTG, ADM, platelet concentrates, and CM + GFs, when used in adjunct to CAF, showed improved stability over ≥12 months of follow-up, better percentage of root coverage, and improved keratinized gingival width.
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Affiliation(s)
- Sourav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Oral Biology and Genomic Studies, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, India
| | - Heber Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo, Peru
| | - Abhaya Chandra Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Manoj Kumar
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Mohit Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Leonardo Mancini
- Department of life health and environmental sciences, University of L'Aquila, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Porcine Acellular Dermal Matrix: An Alternative to Connective Tissue Graft-A Narrative Review. Int J Dent 2021; 2021:1652032. [PMID: 34527053 PMCID: PMC8437668 DOI: 10.1155/2021/1652032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/04/2021] [Accepted: 08/14/2021] [Indexed: 01/23/2023] Open
Abstract
Porcine acellular dermal matrix has recently been introduced in dentistry as an alternative to the gold standard connective tissue graft especially for the use in gingival recession treatments and soft tissue augmentation in implant surgery. Connective tissue grafts are inconvenient and require a second surgical site leading to greater morbidity, longer surgical procedures, and a more painful postoperative phase for the patient. Other options such as allografts have ethical concerns and are less available in Europe. Thus, dental professionals have sought other techniques and materials. Porcine acellular dermal matrix results in periodontal recession treatment with a gain in recession coverage as well as increased keratinized tissue and soft tissue augmentation. This leads to more keratinized mucosa and greater tissue thickness. Many studies have been published using collagen matrices, but a few strictly use porcine acellular dermal matrix, which have been studied in prospective randomized clinical trials with a large number of patients and longer follow-up periods (more than 5 years). Nevertheless, more data are needed to confirm that the porcine acellular dermal matrix is a suitable alternative although its favourable results to date suggest a positive future.
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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: 11] [Impact Index Per Article: 3.7] [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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Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis. Clin Oral Investig 2021; 25:1613-1626. [PMID: 33474623 DOI: 10.1007/s00784-021-03782-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/06/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth. METHODS Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of p value. RESULTS From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (p ≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (p ≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW. CONCLUSION The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12 months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use. CLINICAL RELEVANCE To know if EMD could improve the results for root coverage.
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11
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A Modified Bilaminar Technique with the Use of a Fibrin-Fibronectin System for a Single Gingival Recession: A Case Report with a Follow-Up of 3 Years. Case Rep Dent 2020; 2020:3892753. [PMID: 33062343 PMCID: PMC7545419 DOI: 10.1155/2020/3892753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022] Open
Abstract
This case report described a modified bilaminar technique for treating a single gingival recession. Patient presented a gingival recession in a maxillary canine. Tooth was in a buccally prominent position and soft keratinized tissue apical to the recession was reduced but still present. A split-full-split thickness trapezoidal flap was designed. Root's surface was prepared with curettes. Epithelial-connective tissue graft was harvested from the palate with reduced dimension. After deepithelialization, the graft was placed with a fibrin-fibronectin system at the maximum root coverage level, and the flap coronally advanced and sutured. At 3-year follow-up control, the free gingival margin was still stable at the postsurgery position, with a thicker biotype corresponding to the grafted area, with no probing and a suitable aesthetic result.
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12
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Moraschini V, Calasans-Maia MD, Dias AT, de Carvalho Formiga M, Sartoretto SC, Sculean A, Shibli JA. Effectiveness of connective tissue graft substitutes for the treatment of gingival recessions compared with coronally advanced flap: a network meta-analysis. Clin Oral Investig 2020; 24:3395-3406. [DOI: 10.1007/s00784-020-03547-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022]
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13
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Zuhr O, Rebele SF, Vach K, Petsos H, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 2‐year results of an RCT using 3D digital measuring for volumetric comparison of gingival dimensions. J Clin Periodontol 2020; 47:1144-1158. [DOI: 10.1111/jcpe.13328] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/07/2020] [Accepted: 05/30/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Otto Zuhr
- Private Practice Hürzeler/Zuhr Munich Germany
- Department of Periodontology Center of Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Germany
| | - Stephan F. Rebele
- Private Practice Rebele Dinkelsbühl Germany
- Department of Periodontics School of Dental Medicine University of Pennsylvania Philadelphia PA USA
| | - Kirstin Vach
- Faculty of Medicine and Medical Center Institute of Medical Biometry and Statistics University of Freiburg Freiburg Germany
| | - Hari Petsos
- Department of Periodontology Center of Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Germany
- Private Practice Dr. Korte Soest Germany
| | - Markus B. Hürzeler
- Private Practice Hürzeler/Zuhr Munich Germany
- Department of Operative Dentistry and Periodontology University School of DentistryAlbert‐Ludwigs‐University Freiburg Germany
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Shaikh MS, Ullah R, Lone MA, Matabdin H, Khan F, Zafar MS. Periodontal regeneration: a bibliometric analysis of the most influential studies. Regen Med 2020; 14:1121-1136. [PMID: 31957597 DOI: 10.2217/rme-2019-0019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: The aim of the present study is to identify the most influential research articles and their main characteristics in the specialty of periodontal regeneration. Materials & methods: The Web of Science database advance search was performed in the subject category of 'Dentistry, Oral surgery and medicine' from January 2004 to October 2018 to retrieve citations data. Results: The majority of the articles were published in journals dedicated to the specialty of periodontology. Among the top-cited articles most emphasized study types were randomized control trials (n = 25) and reviews (n = 20). Conclusion: The present bibliometric analysis provides comprehensive information regarding the contributions made in the advancement of regenerative periodontal research. The authors from developed countries and affiliated with interdisciplinary/multicenter institutions have predominantly contributed.
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Affiliation(s)
- Muhammad S Shaikh
- Department of Oral Biology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University Karachi, Pakistan
| | - Rizwan Ullah
- Department of Oral Biology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University Karachi, Pakistan
| | - Mohid A Lone
- Department of Oral Pathology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University Karachi, Pakistan
| | - Hesham Matabdin
- Department of Periodontics, Eastman Dental Institute, University College London, London, UK
| | - Fahad Khan
- Faculty of Healthcare & Medical Sciences, Anglia Ruskin University Cambridge, UK
| | - Muhammad S Zafar
- Department of Restorative Dentistry, Taibah University, Madina Munawwarra, Saudi Arabia.,Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad, Pakistan
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15
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Tavelli L, McGuire MK, Zucchelli G, Rasperini G, Feinberg SE, Wang HL, Giannobile WV. Biologics-based regenerative technologies for periodontal soft tissue engineering. J Periodontol 2019; 91:147-154. [PMID: 31479158 DOI: 10.1002/jper.19-0352] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/28/2019] [Accepted: 08/10/2019] [Indexed: 01/05/2023]
Abstract
This manuscript provides a state-of-the-art review on the efficacy of biologics in root coverage procedures, including enamel matrix derivative, platelet-derived growth factor, platelet concentrates, and fibroblast-growth factor-2. The mechanism of action and the rationale for using biologics in periodontal plastic surgery, as well as their anticipated benefits when compared with conventional approaches are discussed. Although the clinical significance is still under investigation, preclinical data and histologic evidence demonstrate that biologic-based techniques are able to promote periodontal regeneration coupled with the provision of tooth root coverage.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Michael K McGuire
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Private practice, Houston, TX, USA.,Department of Periodontics, Dental Branch Houston and Health Science Center at San Antonio, University of Texas, San Antonio, TX, USA
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giulio Rasperini
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Policlinic, University of Milan, Milan, Italy
| | - Stephen E Feinberg
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical Engineering & Biointerfaces Institute, College of Engineering, University of Michigan, Ann Arbor, MI, USA
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16
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Chambrone L, Ortega MAS, Sukekava F, Rotundo R, Kalemaj Z, Buti J, Prato GPP. Root coverage procedures for treating single and multiple recession‐type defects: An updated Cochrane systematic review. J Periodontol 2019; 90:1399-1422. [DOI: 10.1002/jper.19-0079] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/18/2019] [Accepted: 04/21/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Leandro Chambrone
- MSc Dentistry ProgramIbirapuera University São Paulo Brazil
- Unit of Basic Oral Investigation (UIBO)School of DentistryUniversidad El Bosque Bogota Colombia
| | | | | | - Roberto Rotundo
- Unit of PeriodontologyUCL Eastman Dental Institute London UK
| | | | - Jacopo Buti
- Unit of PeriodontologyUCL Eastman Dental Institute London UK
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17
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Dai A, Huang J, Ding P, Chen L. Long‐term stability of root coverage procedures for single gingival recessions: A systematic review and meta‐analysis. J Clin Periodontol 2019; 46:572-585. [PMID: 30980404 DOI: 10.1111/jcpe.13106] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 03/13/2019] [Accepted: 03/26/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Anna Dai
- Department of Periodontology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - Jia‐Ping Huang
- Department of Periodontology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - Pei‐Hui Ding
- Department of Periodontology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - Li‐Li Chen
- Department of Periodontology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
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18
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Chambrone L, Castro Pinto RCN, Chambrone LA. The concepts of evidence‐based periodontal plastic surgery: Application of the principles of evidence‐based dentistry for the treatment of recession‐type defects. Periodontol 2000 2019; 79:81-106. [DOI: 10.1111/prd.12248] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Leandro Chambrone
- M.Sc. Dentistry Program Ibirapuera University Sao Paulo SP Brazil
- Unit of Basic Oral Investigation (UIBO) School of Dentistry El Bosque University Bogota Colombia
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Chambrone L, Salinas Ortega MA, Sukekava F, Rotundo R, Kalemaj Z, Buti J, Pini Prato GP. Root coverage procedures for treating localised and multiple recession-type defects. Cochrane Database Syst Rev 2018; 10:CD007161. [PMID: 30277568 PMCID: PMC6517255 DOI: 10.1002/14651858.cd007161.pub3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable root coverage periodontal plastic surgery (RCPPS) procedures. This review is an update of the original version that was published in 2009. OBJECTIVES To evaluate the efficacy of different root coverage procedures in the treatment of single and multiple recession-type defects. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (searched 15 January 2018), MEDLINE Ovid (1946 to 15 January 2018), and Embase Ovid (1980 to 15 January 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 January 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) only of at least 6 months' duration evaluating recession areas (Miller's Class I or II ≥ 3 mm) and treated by means of RCPPS procedures. DATA COLLECTION AND ANALYSIS Screening of eligible studies, data extraction and risk of bias assessment were conducted independently and in duplicate. Authors were contacted for any missing information. We expressed results as random-effects models using mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes with 95% confidence intervals (CI). We used GRADE methods to assess the quality of the body of evidence of our main comparisons. MAIN RESULTS We included 48 RCTs in the review. Of these, we assessed one as at low risk of bias, 12 as at high risk of bias and 35 as at unclear risk of bias. The results indicated a greater reduction in gingival recession for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (MD -0.37 mm; 95% CI -0.60 to -0.13, P = 0.002; 3 studies; 98 participants; low-quality evidence). There was insufficient evidence of a difference in gingival recession reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix protein (EMP) + CAF and SCTG + CAF. Regarding clinical attachment level changes, GTR rm + CAF promoted additional gains compared to SCTG + CAF (MD 0.35; 95% CI 0.06 to 0.63, P = 0.02; 3 studies; 98 participants; low-quality evidence) but there was insufficient evidence of a difference between ADMG + CAF and SCTG + CAF or between EMP + CAF and SCTG + CAF. Greater gains in the keratinized tissue were found for SCTG + CAF when compared to EMP + CAF (MD -1.06 mm; 95% CI -1.36 to -0.76, P < 0.00001; 2 studies; 62 participants; low-quality evidence), and SCTG + CAF when compared to GTR rm + CAF (MD -1.77 mm; 95% CI -2.66 to -0.89, P < 0.0001; 3 studies; 98 participants; very low-quality evidence). There was insufficient evidence of a difference in keratinized tissue gain between ADMG + CAF and SCTG + CAF. Few data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure. AUTHORS' CONCLUSIONS Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for treating localised or multiple recession-type defects. The available evidence base indicates that in cases where both root coverage and gain in the width of keratinized tissue are expected, the use of subepithelial connective tissue grafts shows a slight improvement in outcome. There is also some weak evidence suggesting that acellular dermal matrix grafts appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by subepithelial connective tissue grafts. RCTs are necessary to identify possible factors associated with the prognosis of each RCPPS procedure. The potential impact of bias on these outcomes is unclear.
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Affiliation(s)
| | | | | | | | | | - Jacopo Buti
- UCL Eastman Dental InstituteUnit of PeriodontologyLondonUK
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20
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Clementini M, Discepoli N, Danesi C, de Sanctis M. Biologically guided flap stability: the role of flap thickness including periosteum retention on the performance of the coronally advanced flap-A double-blind randomized clinical trial. J Clin Periodontol 2018; 45:1238-1246. [DOI: 10.1111/jcpe.12998] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Clementini
- Department of Periodontology; Università Vita-Salute San Raffaele; Milan Italy
| | - Nicola Discepoli
- Department of Medical Biotechnologies; Unit of Periodontics; Università degli Studi di Siena; Siena Italy
| | - Carlotta Danesi
- Department of Periodontology; Università Vita-Salute San Raffaele; Milan Italy
| | - Massimo de Sanctis
- Department of Periodontology; Università Vita-Salute San Raffaele; Milan Italy
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21
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Tavelli L, Barootchi S, Nguyen TV, Tattan M, Ravidà A, Wang H. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta‐analysis. J Periodontol 2018; 89:1075-1090. [DOI: 10.1002/jper.18-0066] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Shayan Barootchi
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Trang V.N. Nguyen
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Mustafa Tattan
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Andrea Ravidà
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Hom‐Lay Wang
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
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22
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Zucchelli G, Tavelli L, Ravidà A, Stefanini M, Suárez-López del Amo F, Wang HL. Influence of tooth location on coronally advanced flap procedures for root coverage. J Periodontol 2018; 89:1428-1441. [DOI: 10.1002/jper.18-0201] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/20/2018] [Accepted: 05/27/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI
| | - Andrea Ravidà
- Department of Periodontics & Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | | | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI
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23
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Does enamel matrix derivative application improve clinical outcomes after semilunar flap surgery? A randomized clinical trial. Clin Oral Investig 2018; 23:879-887. [DOI: 10.1007/s00784-018-2506-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/30/2018] [Indexed: 02/01/2023]
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24
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Laterally positioned flap along with acellular dermal matrix graft in the management of maxillary localized recessions. Clin Oral Investig 2018; 23:595-601. [DOI: 10.1007/s00784-018-2475-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
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25
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Sangiorgio JPM, Neves FLDS, Rocha Dos Santos M, França-Grohmann IL, Casarin RCV, Casati MZ, Santamaria MP, Sallum EA. Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part I: Clinical Outcomes. J Periodontol 2017; 88:1309-1318. [PMID: 28753100 DOI: 10.1902/jop.2017.170126] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Considering xenogeneic collagen matrix (CM) and enamel matrix derivative (EMD) characteristics, it is suggested that their combination could promote superior clinical outcomes in root coverage procedures. Thus, the aim of this parallel, double-masked, dual-center, randomized clinical trial is to evaluate clinical outcomes after treatment of localized gingival recession (GR) by a coronally advanced flap (CAF) combined with CM and/or EMD. METHODS Sixty-eight patients presenting one Miller Class I or II GRs were randomly assigned to receive either CAF (n = 17); CAF + CM (n = 17); CAF + EMD (n = 17), or CAF + CM + EMD (n = 17). Recession height, probing depth, clinical attachment level, and keratinized tissue width and thickness were measured at baseline and 90 days and 6 months after surgery. RESULTS The obtained root coverage was 68.04% ± 24.11% for CAF; 87.20% ± 15.01% for CAF + CM; 88.77% ± 20.66% for CAF + EMD; and 91.59% ± 11.08% for CAF + CM + EMD after 6 months. Groups that received biomaterials showed greater values (P <0.05). Complete root coverage (CRC) for CAF + EMD was 70.59%, significantly superior to CAF alone (23.53%); CAF + CM (52.94%), and CAF + CM + EMD (51.47%) (P <0.05). Keratinized tissue thickness gain was significant only in CM-treated groups (P <0.05). CONCLUSIONS The three approaches are superior to CAF alone for root coverage. EMD provides highest levels of CRC; however, the addition of CM increases gingival thickness. The combination approach does not seem justified.
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Affiliation(s)
- João Paulo Menck Sangiorgio
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Felipe Lucas da Silva Neves
- Department of Diagnosis and Surgery, Division of Periodontics, State University of São Paulo Campus, São José dos Campos, Brazil
| | - Manuela Rocha Dos Santos
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Isabela Lima França-Grohmann
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Renato Corrêa Viana Casarin
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Márcio Zaffalon Casati
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Mauro Pedrine Santamaria
- Department of Diagnosis and Surgery, Division of Periodontics, State University of São Paulo Campus, São José dos Campos, Brazil
| | - Enilson Antonio Sallum
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
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Geisinger ML, Trammell K, Holmes CM, Kaur M, Geurs NC. Does Adjunctive Use of Growth Factors Improve Clinical Outcomes of Soft Tissue Grafting at Miller Class III Recession Defects? A Review of Current Evidence. Clin Adv Periodontics 2016; 6:99-103. [PMID: 31535488 DOI: 10.1902/cap.2015.150048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/30/2015] [Indexed: 12/17/2022]
Abstract
Focused Clinical Question In patients with gingival recession that is classified as Miller Class III, does adjunctive use of local growth factors with gingival grafting procedures improve clinical outcomes? Clinical Scenario A 31-year-old female presents with a chief complaint of gingival recession (GR) at teeth #4 to #13 (Fig. 1). Interproximal bone loss coronal to the level of the buccal GR is present. She is concerned about esthetics and would like to maximize her chance for complete root coverage. Her medical history is non-contributory, and she has no contraindications to routine dental care. Because of the number of teeth involved and the difficulty in harvesting autogenous tissues, she is treated with acellular dermal matrix§ and enamel matrix derivative‖ with a coronally advanced flap at teeth #4 to #13 (Figs. 2 and 3). Final results reveal significant root coverage on all teeth and complete root coverage on teeth #7 to #10. This results in an esthetically acceptable result (Fig. 4).
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Affiliation(s)
- Maria L Geisinger
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Carolyn M Holmes
- Lister Hill Library of the Health Sciences, University of Alabama at Birmingham
| | - Maninder Kaur
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, AL
| | - Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, AL
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Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 2016; 86:S8-51. [PMID: 25644302 DOI: 10.1902/jop.2015.130674] [Citation(s) in RCA: 258] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This paper aims to create a "bridge" between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice. METHODS This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well. RESULTS Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes. CONCLUSIONS All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT.
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Affiliation(s)
- Leandro Chambrone
- UIBO (Unit of Basic Oral Investigation), Faculty of Dentistry, El Bosque University, Bogotá, Colombia
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Tatakis DN, Chambrone L. The Effect of Suturing Protocols on Coronally Advanced Flap Root-Coverage Outcomes: A Meta-Analysis. J Periodontol 2016; 87:148-55. [DOI: 10.1902/jop.2015.150394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Gupta S, Banthia R, Singh P, Banthia P, Raje S, Aggarwal N. Clinical evaluation and comparison of the efficacy of coronally advanced flap alone and in combination with platelet rich fibrin membrane in the treatment of Miller Class I and II gingival recessions. Contemp Clin Dent 2015; 6:153-60. [PMID: 26097347 PMCID: PMC4456734 DOI: 10.4103/0976-237x.156034] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the clinical efficacy of coronally advanced flap (CAF) alone and in combination with autologous platelet rich fibrin membrane (PRF) in Miller's class I and II gingival recessions. MATERIALS AND METHOD Thirty isolated Miller class I or II sites in 26 subjects were randomly divided into test (15 sites- CAF+PRF) and control (15 sites- CAF alone). Parameters probing pocket depth (PPD), Recession depth (RD), Clinical attachment loss (CAL), Keratinised tissue width (KTW) and Gingival tissue thickness (GTH) were evaluated at baseline, 3 months and 6 months postoperatively. Data was subjected to statistical analysis. P< 0.05 was considered statistically significant. RESULTS Mean percentage root coverage was 91.00±19.98% and 86.60±23.83% for test and control group respectively. Difference between the groups in all parameters at baseline, 3 months and 6 months was non significant. Complete root coverage was obtained in 12 (80%) and 11 (73.3%) subjects in test and control group respectively. The difference was found to be non-significant. Both groups showed significant differences in all parameters at 3 and 6 months respectively except difference in gingival tissue thickness which was non-significant in control group at 3 months. CONCLUSION Combination of PRF to CAF procedure did not provide any added advantage in term of recession coverage in Miller class I and II recessions. Long term trials with more sample size are needed to validate these findings.
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Affiliation(s)
- Santosh Gupta
- Department of Periodontics, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India
| | - Ruchi Banthia
- Department of Periodontics, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India
| | - Pallavi Singh
- Department of Periodontics, Index Institute of Dental Sciences, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Priyank Banthia
- Department of Periodontics, Index Institute of Dental Sciences, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sapna Raje
- Department of Periodontics, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India
| | - Neha Aggarwal
- Department of Community Dentistry, Dr. Z.A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000 2015; 68:333-68. [DOI: 10.1111/prd.12059] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/29/2022]
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Cheng GL, Fu E, Tu YK, Shen EC, Chiu HC, Huang RY, Yuh DY, Chiang CY. Root coverage by coronally advanced flap with connective tissue graft and/or enamel matrix derivative: a meta-analysis. J Periodontal Res 2014; 50:220-30. [DOI: 10.1111/jre.12199] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 01/04/2023]
Affiliation(s)
- G.-L. Cheng
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - E. Fu
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - Y.-K. Tu
- Institute of Epidemiology & Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | - E.-C. Shen
- Department of Dentistry; Buddhist Tzu Chi General Hospital, Taipei Branch; Taipei Taiwan
| | - H.-C. Chiu
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - R.-Y. Huang
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - D.-Y. Yuh
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - C.-Y. Chiang
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
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Ayub LG, Ramos UD, Reino DM, Grisi MFM, Taba M, Souza SLS, Palioto DB, Novaes AB. A modified surgical technique for root coverage with an allograft: a 12-month randomized clinical trial. J Periodontol 2014; 85:1529-36. [PMID: 24878327 DOI: 10.1902/jop.2014.140111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this randomized controlled clinical study is to investigate whether a modified surgical technique could provide better results for root coverage and greater amounts of keratinized tissue (KT) with the acellular dermal matrix graft (ADMG). METHODS Fifteen bilateral Miller Class I or II gingival recessions (GRs) were selected. The recessions were treated and assigned randomly to the test group (TG), and the contralateral recessions were assigned to the control group (CG). The ADMG was used in both groups with differences in the graft positioning between them. The following clinical parameters were measured before the surgeries and after 12 months: 1) probing depth; 2) relative clinical attachment level; 3) GR; 4) thickness of KT (TKT); and 5) KT width. A new parameter, the GR area (GRA), was measured in standardized photographs using a special device and software. RESULTS There was no significant difference between groups in KT width and TKT parameters at the 12-month postoperative period. However, there was a significant difference between the gains in GR (ΔGR) and GRA (ΔGRA), favoring the TG after 12 months. The TG presented ΔGR = 3.04 ± 0.29 mm and ΔGRA= 38,919 ± 9,238 pixel square values (pix(2)), and the CG presented ΔGR= 2.61 ± 0.41 mm and ΔGRA= 22,245 ± 9,334 pix(2) (P <0.05 and <0.001, respectively). CONCLUSIONS Both techniques were successful. The TG treatment was more effective in reducing GR and GRA. The flap and graft position may be of importance in root coverage procedures outcome.
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Affiliation(s)
- Lauro G Ayub
- Department of Periodontology, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 2014; 41 Suppl 15:S44-62. [DOI: 10.1111/jcpe.12182] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/06/2013] [Accepted: 10/13/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Francesco Cairo
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Florence; Florence Italy
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Siena; Siena Italy
| | - Michele Nieri
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Florence; Florence Italy
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Siena; Siena Italy
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Salhi L, Lecloux G, Seidel L, Rompen E, Lambert F. Coronally advanced flap versus the pouch technique combined with a connective tissuegraft to treat Miller's class I gingival recession: a randomized controlled trial. J Clin Periodontol 2014; 41:387- 95. [DOI: 10.1111/jcpe.12207] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Leila Salhi
- Faculty of Medicine; Department of Periodontology and Oral Surgery; University of Liege; Liege Belgium
| | - Geoffrey Lecloux
- Faculty of Medicine; Department of Periodontology and Oral Surgery; University of Liege; Liege Belgium
| | - Laurence Seidel
- Faculty of Medicine; Department of Biostatistics; University of Liege; Liege Belgium
| | - Eric Rompen
- Faculty of Medicine; Head of the Department of Periodontology and Oral Surgery; University of Liege; Liege Belgium
| | - France Lambert
- Faculty of Medicine; Department of Periodontology and Oral Surgery; University of Liege; Liege Belgium
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Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L. Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: a comparative short- and long-term controlled randomized clinical trial. J Clin Periodontol 2014; 41:396-403. [DOI: 10.1111/jcpe.12224] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Ilham Mounssif
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Claudio Mazzotti
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Matteo Marzadori
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | | | - Lucio Montebugnoli
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
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Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus
coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. J Clin Periodontol 2013; 41:582-92. [DOI: 10.1111/jcpe.12178] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Otto Zuhr
- Private Office Huerzeler/Zuhr; Munich Germany
- Department of Periodontology; Center for Dental, Oral and Maxillofacial Medicine (Carolinum); Johann Wolfgang Goethe-University; Frankfurt/Main Germany
| | - Stephan F. Rebele
- Private Office Huerzeler/Zuhr; Munich Germany
- Department of Operative Dentistry and Periodontology; University School of Dentistry; Albert-Ludwigs-University; Freiburg Germany
| | - David Schneider
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Rony E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Markus B. Hürzeler
- Private Office Huerzeler/Zuhr; Munich Germany
- Department of Operative Dentistry and Periodontology; University School of Dentistry; Albert-Ludwigs-University; Freiburg Germany
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Sayar F, Akhundi N, Gholami S. Connective tissue graft vs. emdogain: A new approach to compare the outcomes. Dent Res J (Isfahan) 2013; 10:38-45. [PMID: 23878562 PMCID: PMC3714822 DOI: 10.4103/1735-3327.111768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The aim of this clinical trial study was to clinically evaluate the use of enamel matrix protein derivative combined with the coronally positioned flap to treat gingival recession compared to the subepithelial connective tissue graft by a new method to obtain denuded root surface area. Materials and Methods: Thirteen patients, each with two or more similar bilateral Miller class I or II gingival recession (40 recessions) were randomly assigned to the test (enamel matrix protein derivative + coronally positioned flap) or control group (subepithelial connective tissue graft). Recession depth, width, probing depth, keratinized gingival, and plaque index were recorded at baseline and at one, three, and six months after treatment. A stent was used to measure the denuded root surface area at each examination session. Results were analyzed using Kolmogorov-Smirnov, Wilcoxon, Friedman, paired-sample t test. Results: The average percentages of root coverage for control and test groups were 63.3% and 55%, respectively. Both groups showed significant keratinized gingival increase (P < 0.05). Recession depth decreased significantly in both groups. Root surface area was improved significantly from baseline with no significant difference between the two study groups (P > 0.05). The results of Friedman test were significant for clinical indices (P < 0.05), except for probing depth in control group (P = 0.166). Conclusion: Enamel matrix protein derivative showed the same results as subepithelial connective tissue graft with relatively easy procedure to perform and low patient morbidity.
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Affiliation(s)
- Ferena Sayar
- Department of Periodontology, Islamic Azad University, Dental Branch, Tehran, Iran
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Kuis D, Sciran I, Lajnert V, Snjaric D, Prpic J, Pezelj-Ribaric S, Bosnjak A. Coronally advanced flap alone or with connective tissue graft in the treatment of single gingival recession defects: a long-term randomized clinical trial. J Periodontol 2013; 84:1576-85. [PMID: 23432657 DOI: 10.1902/jop.2013.120451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Numerous surgical approaches for the treatment of single gingival recession (GR) defects are documented in the literature. The aim of this 5-year, split mouth-design, randomized clinical trial was to evaluate the effectiveness of coronally advanced flap (CAF) alone versus CAF with connective tissue graft (CAF+CTG) in the treatment of single Miller Class I and II GR defects. METHODS Thirty-seven patients with 114 bilateral, single Miller Class I and II GR defects were treated with CAF on one side of the mouth and CAF+CTG on the other side. Clinical measurements (GR length [REC], keratinized tissue width [KT], complete root coverage [CRC], and percentage of root coverage [PRC]) were evaluated before surgery and after 6, 12, 24, and 60 months. RESULTS There was a significant reduction of REC and increase of KT after surgery in both groups. CAF+CTG showed significantly better results for all evaluated clinical parameters in all observed follow-up periods. Miller Class I defects showed better results in terms of REC, CRC, and PRC, whereas Miller Class II showed better results in KT, both in favor of CAF+CTG. Miller Class I defects showed better results than Miller Class II GR defects regardless of the surgical procedure used. CONCLUSIONS Both surgical procedures were effective in the treatment of single Miller Class I and II GR defects. The CAF+CTG procedure provided better long-term outcomes (60 months postoperatively) than CAF alone. Long-term stability of the gingival margin is less predictable for Miller Class II GR defects compared to those of Class I.
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Affiliation(s)
- Davor Kuis
- Department of Oral Medicine and Periodontology, School of Dentistry, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Buti J, Baccini M, Nieri M, La Marca M, Pini-Prato GP. Bayesian network meta-analysis of root coverage procedures: ranking efficacy and identification of best treatment. J Clin Periodontol 2013; 40:372-86. [DOI: 10.1111/jcpe.12028] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/13/2012] [Accepted: 09/09/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Jacopo Buti
- Department of Public Health; University of Florence; Florence Italy
| | - Michela Baccini
- Department of Statistics; University of Florence; Florence Italy
- Biostatistics Unit; ISPO Cancer Prevention and Research Institute; Florence Italy
| | - Michele Nieri
- Department of Public Health; University of Florence; Florence Italy
| | - Michele La Marca
- Department of Public Health; University of Florence; Florence Italy
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Cortellini P, Pini Prato G. Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience. Periodontol 2000 2012; 59:158-84. [PMID: 22507065 DOI: 10.1111/j.1600-0757.2011.00434.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
During the past three decades, several surgical techniques have been proposed to treat single and multiple gingival recessions. Evidence indicates that coronally advanced flap-based approaches result in the best clinical results. Among all the different techniques, the use of a graft under a coronally advanced flap results in the best short- and long-term outcomes in terms of root coverage and gain in keratinized tissue. The use of a coronally advanced flap + connective tissue graft would appear to be the best choice for root coverage. However, harvesting a graft from the palate adds morbidity, surgical chair-time and requires increased surgical skills. A potential alternative could be the use of enamel matrix derivatives under a coronally advanced flap, and this achieves similar clinical outcomes and is less invasive, but adds economic costs to the treatment. Evidence shows that a coronally advanced flap alone in many instances results in complete root coverage and is stable over time. A coronally advanced flap is less invasive for the patient, requires less chair-time and probably less surgical skill. It would therefore be desirable to use a coronally advanced flap approach when indicated. It has been hypothesized that a coronally advanced flap approach alone could be successfully applied when the residual gingiva is thick and wide, although existing evidence does not support this hypothesis in full. Accordingly, the adjunctive use of a graft or enamel matrix derivatives could be restricted to sites at which there is thin and narrow residual gingiva.
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Ayub LG, Ramos UD, Reino DM, Grisi MFM, Taba M, Souza SLS, Palioto DB, Novaes AB. A Randomized comparative clinical study of two surgical procedures to improve root coverage with the acellular dermal matrix graft. J Clin Periodontol 2012; 39:871-8. [PMID: 22712624 DOI: 10.1111/j.1600-051x.2012.01915.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2012] [Indexed: 11/27/2022]
Abstract
AIM This randomized, controlled, clinical study compared two surgical techniques for root coverage with the acellular dermal matrix graft (ADMG) to evaluate which procedure could provide better root coverage and greater amounts of keratinized tissue. MATERIALS AND METHODS Fifteen pairs of bilateral Miller Class I or II gingival recessions were treated and assigned randomly to the test group, and the contra-lateral recessions were assigned to the control group. The ADMG was used in both groups. In the control group, the graft and flap were positioned at the level of the cemento-enamel junction (CEJ), and in the test group, the graft was positioned 1 mm apical to the CEJ and the flap 1 mm coronal to the CEJ. The clinical parameters were taken before the surgeries and after 6 months. The gingival recession area, a new parameter, was measured in standardized photographs through a special device and software. RESULTS There were statistically significant differences favouring the proposed technique for all parameters except for the amount of keratinized tissue at 6 months. CONCLUSIONS The proposed test technique is more suitable for root coverage procedures with ADMG, and the new parameter evaluated appears valuable for root coverage analysis. (Clinicaltrials.gov Identifier: NCT01175720).
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Affiliation(s)
- Lauro G Ayub
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Brazil
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B. Alves L, P. Costa P, de Souza SLS, F. de Moraes Grisi M, B. Palioto D, Taba Jr M, B. Novaes Jr A. Acellular dermal matrix graft with or without enamel matrix derivative for root coverage in smokers: a randomized clinical study. J Clin Periodontol 2012; 39:393-9. [DOI: 10.1111/j.1600-051x.2012.01851.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2011] [Indexed: 01/04/2023]
Affiliation(s)
- Luciana B. Alves
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo; São Paulo; Brazil
| | - Priscila P. Costa
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo; São Paulo; Brazil
| | - Sérgio Luís Scombatti de Souza
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo; São Paulo; Brazil
| | - Márcio F. de Moraes Grisi
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo; São Paulo; Brazil
| | - Daniela B. Palioto
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo; São Paulo; Brazil
| | - Mario Taba Jr
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo; São Paulo; Brazil
| | - Arthur B. Novaes Jr
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo; São Paulo; Brazil
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Koop R, Merheb J, Quirynen M. Periodontal regeneration with enamel matrix derivative in reconstructive periodontal therapy: a systematic review. J Periodontol 2011; 83:707-20. [PMID: 22050544 DOI: 10.1902/jop.2011.110266] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Enamel matrix derivative (EMD) is commonly used in periodontal therapy. The aim of this systematic review is to give an updated answer to the question of whether the additional use of EMD in periodontal therapy is more effective compared with a control or other regenerative procedures. METHODS A literature search in MEDLINE (PubMed) for the use of EMD in periodontal treatment was performed up to May 2010. The use of EMD in treatment of intrabony defects, furcations, and recessions was evaluated. Only randomized controlled trials with ≥1 year of follow-up were included. The primary outcome variable for intrabony defects was the change in clinical attachment level (CAL), for furcations the change in horizontal furcation depth, and for recession complete root coverage. RESULTS After screening, 27 studies (20 for intrabony defects, one for furcation, and six for recession) were eligible for the review. A meta-analysis was performed for intrabony defects and recession. The treatment of intrabony defects with EMD showed a significant additional gain in CAL of 1.30 mm compared with open-flap debridement, EDTA, or placebo, but no significant difference compared with resorbable membranes was shown. The use of EMD in combination with a coronally advanced flap compared with a coronally advanced flap alone showed significantly more complete root coverage (odds ratio of 3.5), but compared with a connective tissue graft, the result was not significantly different. The use of EMD in furcations (2.6 ± 1.8 mm) gave significantly more improvement in horizontal defect depth compared with resorbable membranes (1.9 ± 1.4 mm) as shown in one study. CONCLUSIONS In the treatment of intrabony defects, the use of EMD is superior to control treatments but as effective as resorbable membranes. The additional use of EMD with a coronally advanced flap for recession coverage will give superior results compared with a control but is as effective as a connective tissue graft. The use of EMD in furcations will give more reduction in horizontal furcation defect depth compared with resorbable membranes.
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Affiliation(s)
- Richard Koop
- Department of Periodontology, Catholic University Leuven, Leuven, Belgium
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Ozturan S, Durukan SA, Ozcelik O, Seydaoglu G, Cenk Haytac M. Coronally advanced flap adjunct with low intensity laser therapy: a randomized controlled clinical pilot study. J Clin Periodontol 2011; 38:1055-62. [DOI: 10.1111/j.1600-051x.2011.01774.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2011] [Indexed: 01/16/2023]
Affiliation(s)
- Seda Ozturan
- Department of Periodontology; Faculty of Dentistry; Cukurova University; Adana; Turkey
| | - Sulhi Andac Durukan
- Department of Periodontology; Faculty of Dentistry; Cukurova University; Adana; Turkey
| | - Onur Ozcelik
- Department of Periodontology; Faculty of Dentistry; Cukurova University; Adana; Turkey
| | - Gulsah Seydaoglu
- Department of Biostatistics; Faculty of Medicine; Cukurova University; Adana; Turkey
| | - Mehmet Cenk Haytac
- Department of Periodontology; Faculty of Dentistry; Cukurova University; Adana; Turkey
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Chambrone L, Pannuti CM, Tu YK, Chambrone LA. Evidence-based periodontal plastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage. J Periodontol 2011; 83:477-90. [PMID: 21859324 DOI: 10.1902/jop.2011.110382] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this review is to conduct an individual patient data meta-analysis of randomized controlled clinical trials (RCTs) to evaluate whether baseline recession-, patient-, and procedure-related factors can influence the achievement of complete root coverage (CRC). METHODS A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE (for Medical Literature Analysis and Retrieval System Online), EMBASE (for Excerpta Medica Database), CENTRAL (for Cochrane Central Register of Controlled Trials), and the Cochrane Oral Health Group's Specialized Register databases up to and including March 2011. Only RCTs, with a duration of ≥6 months evaluating recession areas (Miller Class I or II) that were treated by means of root coverage procedures were included. Mixed-effects logistic regression analyses were conducted to evaluate associations between five baseline variables and CRC. RESULTS Of the 70 potentially eligible trials, 22 were included in the meta-analyses. In total, the data from 320 patients and 16 procedures were evaluated. None of the RCTs were classified as low risk of bias. Of the 602 recessions treated, 310 (51.5%) achieved CRC. Subepithelial connective tissue grafts (SCTGs), matrix grafts, and enamel matrix derivative protein (EMD) procedures were superior in achieving CRC when compared to coronally advanced flap (CAF) alone. For the adjusted covariates, the greater the baseline recession depth, the smaller the chance of achieving CRC (individual procedure analysis [odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.44, 0.70] and grouped procedure analysis [OR = 0.56; 95% CI = 0.45, 0.71]), as well as studies with conflict of interest were more likely to achieve CRC than those without conflict of interest (individual procedure analysis [OR = 6.78; 95% CI = 1.78, 25.86]). CONCLUSIONS SCTGs, matrix grafts, and EMD were superior to CAF in achieving CRC, but SCTGs showed the best predictability. The impossibility of inclusion of all identified RCTs should be taken into consideration when interpreting the present findings.
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Affiliation(s)
- Leandro Chambrone
- Dental Research Division, Department of Periodontics, Guarulhos University, Guarulhos, SP, Brazil.
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The effect of enamel matrix protein on gingival tissue thickness in vivo. Odontology 2011; 100:61-6. [DOI: 10.1007/s10266-011-0022-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 12/28/2010] [Indexed: 11/30/2022]
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Nazareth CA, Cury PR. Use of Anorganic Bovine-Derived Hydroxyapatite Matrix/Cell-Binding Peptide (P-15) in the Treatment Isolated Class I Gingival Recession of Defects: A Pilot Study. J Periodontol 2011; 82:700-7. [DOI: 10.1902/jop.2010.100434] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Andrade PF, Grisi MF, Marcaccini AM, Fernandes PG, Reino DM, Souza SL, Taba M, Palioto DB, Novaes AB. Comparison Between Micro- and Macrosurgical Techniques for the Treatment of Localized Gingival Recessions Using Coronally Positioned Flaps and Enamel Matrix Derivative. J Periodontol 2010; 81:1572-9. [DOI: 10.1902/jop.2010.100155] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root-Coverage Procedures for the Treatment of Localized Recession-Type Defects: A Cochrane Systematic Review. J Periodontol 2010; 81:452-78. [DOI: 10.1902/jop.2010.090540] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, Etienne D. Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol 2009; 37:88-97. [PMID: 19968743 DOI: 10.1111/j.1600-051x.2009.01492.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this controlled randomized split-mouth study was to evaluate whether a modified tunnel/connective tissue graft (CTG) technique - enamel matrix derivative (EMD) combination will improve the treatment of multiple class III recession when compared with the same technique alone. MATERIALS AND METHODS Twenty healthy subjects with a mean age of 31.7 years, were enrolled for the trial in a university periodontal clinic. Patients with at least three adjacent gingival recessions on both sides of the mouth were treated with a modified tunnel/CTG technique. On the test side, an EMD was used in addition. Clinical parameters were measured at baseline, 28 days, 3, 6 and 12 months after the surgery. Results are presented at the subject level. RESULTS The mean root coverage from baseline to 1 year post-surgery was 82% for the test group and 83% for the control group. Complete root coverage was achieved at 1 year in eight (38%) of the 20 surgeries (experimental and control group). CONCLUSIONS One-year results indicate that the modified tunnel/CTG technique is predictable for the treatment of multiple class III recession-type defects. The addition of EMD does not enhance the mean clinical outcomes.
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Affiliation(s)
- Sofia Aroca
- Department of Periodontology, Faculty of Dentistry, University of Szeged, Szeged, Hungary.
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