Comparison between two surgical techniques for root coverage with an acellular dermal matrix graft

A modified tunnel technique to treat multiple gingival recessions: Case Series

This case series reports a modified tunnel technique with connective tissue graft for the root coverage of multiple Miller Class I, II, and III gingival recessions. The modified approach presents an innovative suture technique to improve the stability and position of the graft. Ten patients with multiple gingival recessions (n=85 teeth) received surgical root coverage treatment. The gingival recession height and width were measured and presented as median, minimum, and maximum values. The percentage of the root coverage after at least 12 months expressed the treatment effectiveness. The Shapiro-Wilk test evaluated the normality; pared Wilcoxon test determined the exact P-value for the differences in the height of the gingival recession before and after surgical treatment (α = 0.05). An average of 97.9% (± 5.6%, p < 0.0001) root coverage after treatment occurred, and 73 out of 85 recessions presented complete root coverage after 12 months. Treatment of Miller class I and II gingival recessions resulted in root coverage higher than 99 and class III higher than 95% (p < 0.0001). The presented case series report the efficacy of a modified surgical technique promoting more than 95% of root coverage after 12 months in multiple Miller Class I, II, and III gingival recessions. Well-designed blind randomized controlled trials are needed to validate the proposed technique.

Evaluation of PRF Membrane with Coronally Advanced Flap with and without Vertical Releasing Incisions for the Treatment of Gingival Recessions

AIM

The aim of the current study was to compare the esthetic results for subjects with Miller Class I and II gingival recession (GR) abnormalities using platelet-rich fibrin (PRF) membrane with coronal advanced flaps (CAFs) with and without vertical releasing incisions (VRIs; the envelope-type flap and the flap with VRIs).

MATERIALS AND METHODS

Seven defects from each of the test and control groups made up of fourteen defects total. In the test group, PRF + CAF was performed without VRI, while in the control group, VRI was used. Gain in root coverage was the main result, with secondary results including papillary bleeding index (PBI), plaque index (PI), relative gingival margin level, relative attachment level, probing pocket depth, recession depth, width of keratinized gingiva (WKG), and gingival thickness. After 3 months of therapy, a clinical evaluation was conducted.

RESULTS

No significant difference was observed between the two groups in terms of recession reduction (2.08 ± 0.5 vs 1.91 ± 0.66 mm), clinical attachment level (CAL) gain (2.08 ± 0.5 vs 1.91 ± 0.66 mm), and increase in WKG (2.66 ± 0.88 vs 2.58 ± 0.51 mm) for test and control groups, respectively.

CONCLUSION

For the treatment of GR, both groups are efficient. However, the CAF + PRF without VRI group showed higher patient compliance and lower postoperative morbidity.

CLINICAL RELEVANCE

The PRF membrane with CAF with or without VRI provide effective treatment option for GR. CAF + PRF without VRI is easy to perform and has less postoperative complications.

Gingival Thickness and Outcome of Periodontal Plastic Surgery Procedures: A Meta-regression Analysis

OBJECTIVE

To evaluate the impact of soft tissue thickness (STT) on root coverage achieved with different periodontal plastic surgery procedures.

BACKGROUND

Gingival recession has been managed successfully through various surgical approaches, with great variability in outcomes. Anatomic characteristics of the recipient site and selected technique account in part for this variability. Gingival flap thickness is one of the most critical site-related characteristics.

METHODS

An electronic search was conducted on the major databases (PubMed, Embase, Web of Science). Human prospective studies with at least 6 mo of follow-up and with a numeric baseline measurement for gingival thickness were eligible. Only studies including nonsmoking patients were considered. Variables included surgical approach, participant characteristics, local anatomic factors, and follow-up time. Primary outcome was mean percentage root coverage (%RC) achieved, and complete root coverage was a secondary outcome.

RESULTS

A total of 42 studies were included (35 randomized controlled trials, 5 case series, 1 prospective cohort study, and 1 controlled clinical trial). Across studies, the pooled %RC was 81.9% (95% CI, 79.1% to 84.7%). The %RC was not significantly associated (P = 0.267) with baseline soft tissue thickness; however there was a significant (P = 0.031) inverse relationship between STT and %RC after 12-mo follow-up. Subgroup analysis showed that for no graft, there was a significant (P = 0.025) positive relationship between STT and %RC with the exclusion of the single outlier study based on STT.

CONCLUSIONS

STT plays a limited role in predicting root coverage across all approaches; when flaps are performed with no graft, the effect of STT is most critical. The length of time following surgery appears to influence outcomes, with 12-mo follow-up offering greater insight.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can suggest to clinicians which periodontal plastic surgery technique to employ when treating challenging cases. In particular, it can be helpful when selecting the treatment approach to treat thin phenotype sites. This study could help clinicians provide a more appropriate treatment decision in such cases.

Root coverage using coronally advanced flap with porcine-derived acellular dermal matrix or subepithelial connective tissue graft: a randomized controlled clinical trial

OBJECTIVE

The aim of this study is to investigate the use of a porcine-derived acellular dermal matrix (MD) in root coverage procedures combined with extended coronally positioned flap (eCAF), in comparison to the subepithelial connective tissue graft (SCTG) associated with the eCAF.

MATERIAL AND METHODS

Eighteen adult patients presenting bilateral type 1 gingival recession were randomly assigned to SCTG or MD groups. Clinical and patient-based outcomes were recorded at 3 and 6 months after the surgical procedure.

RESULTS

Both groups showed a significant reduction in the mean recession height of 3.33 ± 0.89 mm to 1.24 ± 1.10 mm (MD) and 3.21 ± 0.8 mm to 0.83 ± 0.86 mm (SCTG) without difference between groups. Six patients in the test group and eight in the control group obtained complete root coverage. The keratinized tissue height and thickness (KTT) showed a significant increase after 3 and 6 months in both groups. The average KTT gains were 0.39 ± 0.4 mm (MD) and 0.51 ± 0.5 mm (SCTG) (p < 0.05). Performing multivariate analysis suggests that MD addition to coronally advanced flaps may be similar to SCTG.

CONCLUSION

The MD had similar results in comparison to SCTG and in the context of reducing patient morbidity it can be used as an alternative for the treatment of gingival recessions.

CLINICAL RELEVANCE

The SCTG is the gold standard therapy for root coverage. The MD has been widely used in mucogingival surgery as a substitute for SCTG and proposed similar results. A substitute is very important for clinicians and patients. It will give a better postoperative and possibilities to treat multiples recession. (Clinicaltrials.gov Identifier: NCT03675334).

Root coverage stability with acellular dermal matrix in multiple gingival recessions in esthetic zone: A clinical case report with 12-year follow-up

The importance of surgical intervention for the maintenance of long-term results by root coverage of multiple gingival recessions in an esthetic area treated with a tissue substitute (acellular dermal matrix [ADM]-Alloderm^®) is widely required. The present case report highlights the effectiveness of the ADM for the treatment of multiple recession defects in a female patient with Class I and II gingival recession in relation to maxillary anterior associated with esthetics and dentin hypersensitivity demands. The root coverage rate for the anterior area showed greater value with 70% of coverage; at 90 days and 2 and 12 years of follow-up, it showed 70.5%, 79%, and 77%, respectively. Conversely, for the posterior area, these rates were 68.5%, 63%, and 57% for the same follow-up periods. Results regarding gain of keratinized tissue demonstrated superior values for the anterior area, namely 3.92, 3.34 and 3.22 mm at 90 days and 2 and 12 years. These values for the posterior area were 0.54 mm, 2.41, and 1.87 mm, respectively. These findings suggest that the tissue substitute Alloderm^® showed excellent long-term results for areas of multiple recessions, providing root coverage and stability of keratinized tissue gain. After this long period of evaluation, some local factors associated with recurrence of gingival recessions were detected, and a lack of proper periodontal maintenance care was observed. However, esthetic and functional outcomes achieved with surgical procedure were maintained.

Coronally advanced flap and envelope type of flap plus acellular dermal matrix graft for the treatment of thin phenotype multiple recession defects. A randomized clinical trial

INTRODUCTION

The aim of this randomized clinical trial was to assess the aesthetical and clinical outcomes of acellular dermal matrix graft (ADMG) plus coronally advanced flap (CAF) with vertical incisions or the envelope flap in the treatment of thin phenotype, multiple-recession defects.

MATERIAL AND METHODS

Twenty-two participants with 55 class recession type 1 (RT1) with a depth of ≥3 mm were investigated. Control group was treated with ADMG plus conventional CAF with vertical releasing incisions, whereas test group received the envelope flap with ADMG. Primary outcome variables were complete root coverage (CRC), root coverage aesthetic score and patient satisfaction.

RESULTS

Tooth-based CRC was observed in 23 of the 28 recession defects in mCAF + ADMG group (82.1%), whereas in 19 of the 27 recession defects in CAF + ADMG group (70.37%), with no inter-group difference (p > .05). CRC was observed in 9 of the 11 patients in mCAF + ADMG group (81.8%). On the other hand, in CAF + ADMG group, CRC was achieved in 8 of the 11 patients (72.7%). Results were similar between the groups (p > .05).

CONCLUSIONS

Both techniques were successful in the management of multiple recessions; however, superior results regarding patient's satisfaction were achieved with mCAF + ADMG.

Experimental and clinical studies on regenerative periodontal therapy

The recognition of a periodontal therapy as a regenerative procedure requires the demonstration of new cementum, periodontal ligament, and bone coronal to the base of the defect. A diversity of regenerative strategies has been evaluated, including root surface conditioning, bone grafts and bone substitute materials, guided tissue regeneration, enamel matrix proteins, growth/differentiation factors, combined therapies and, more recently, tissue-engineering approaches. The aim of this chapter of Periodontology 2000 is to review the research carried out in Latin America in the field of periodontal regeneration, focusing mainly on studies using preclinical models (animal models) and randomized controlled clinical trials. This review may help clinicians and researchers to evaluate the current status of the therapies available and to discuss the challenges that must be faced in order to achieve predictable periodontal regeneration in clinical practice.

Experimental and clinical studies on plastic periodontal procedures

We have compiled, in this Periodontology 2000 review, all Latin American literature on experimental and clinical studies of periodontal plastic procedures. The body of literature on this subject has led to a discussion of the features and treatment outcomes of root-coverage procedures. Over time, knowledge on periodontal plastic procedures has become less empirical and more supportive of the clinical management of recession-type defects. Gingival recession etiology, animal studies, free gingival grafts, pedicle flaps (semilunar, laterally positioned, and coronally positioned), and subepithelial connective tissue grafts are extensively reviewed. The use of allografts as an alternative to subepithelial connective tissue grafts, the treatment of multiple gingival recessions, and the rationale for use of guided tissue regeneration and enamel matrix derivative in plastic periodontal procedure is discussed. We also assess how smoking can affect the treatment outcomes in plastic surgery procedures. Minimally invasive procedures are of great value in improving the features of the final tissues. The following aspects identified in this compilation were of great interest: (a) some factors, anatomical in nature, favor the formation of root recessions, but it is the inflammatory process (caused by the presence of biofilm and/or by traumatic toothbrushing) that is responsible for the development of root recessions; and (b) pedicle flap procedures (especially the coronally positioned flap) are extremely versatile and have the most predictable outcome of all root-coverage procedures, especially when combined with subepithelial connective tissue grafting and/or allogeneic grafts. In summary: subepithelial connective tissue grafting is considered as the first option to augment gingival width and thickness, and it may provide better long-term results; the same principles of root-coverage procedures in individual sites appear be used in clinical practice also for multiple-recession type defects; an allograft is an efficient alternative to a subepithelial connective tissue graft and, when it is the treatment option of choice, the use of wide, extended flaps should be considered; because of the superiority of plastic periodontal procedures over guided tissue regeneration and the technical difficulty of the latter, guided tissue regeneration has become obsolete for root-coverage procedures; there is rather a large body of evidence attesting that smoking negatively influences root-coverage procedures, especially subepithelial connective tissue grafts; and minimally invasive techniques may be of great value for improving the results obtained with plastic periodontal procedures, but these techniques need to be better addressed in clinical trials, both in terms of the quality and quantity of the new tissue generated.

Correction of Microstomia Reconstruction With the Use of Acellular Dermal Matrix for Buccal Reconstruction

Correction of microstomia is challenging with a high rate of recurrence. We report the successful treatment of microstomia using acellular dermal matrix (ADM) as an adjunct for intraoral lining with >1 year of follow-up.A 9-year-old international patient with severe immunodeficiency presented with severe microstomia because of recurrent oral infections. She had undergone 3 previous failed attempts to re-establish an adequate oral opening and was dependent on enteral nutrition via gastrostomy tube. She underwent release of the oral commissure scar contracture and orbicularis oris and the resultant mucosal defect was lined with ADM. A postoperative splint was used for 8 weeks. One-year follow-up demonstrated maintenance of the oral aperture with complete mucosalization of the ADM; the patient was able to resume oral diet and regular dental hygiene.Mucosal reconstruction with ADM is a viable alternative to local flaps and in this case exhibited minimal soft tissue contraction.

Root coverage procedures for treating localised and multiple recession-type defects

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.

Acellular dermal matrix and subepithelial connective tissue grafts for root coverage: A systematic review

BACKGROUND

The aim of this systematic review was to evaluate whether patients with gingival recession would benefit from an acellular dermal matrix graft (ADMG) in ways that are comparable to the gold standard of the subepithelial connective tissue graft (SCTG).

MATERIALS AND METHODS

A systematic review and meta-analysis comparing ADMG to SCTG for the treatment of Miller Class I and II recession defects was conducted according to PRISMA guidelines. PubMed, Excerpta Medica Database, and Cochrane Central Register of Controlled Trials databases were searched up to March 2016 for controlled trials with minimum 6 months duration. The primary outcome was root coverage; secondary outcomes included attachment level change, keratinized tissue (KT) change, and patient-based outcomes. Both authors independently assessed the quality of each included trial and extracted the relevant data.

RESULTS

From 158 potential titles, 17 controlled trials were included in the meta-analysis. There were no differences between ADMG and SCTG for mean root coverage, percent root coverage, and clinical attachment level gain. ADMG was statistically better than SCTG for gain in width of KT (-0.43 mm; 95% confidence interval: -0.72, -0.15). Only one study compared patient-based outcomes.

CONCLUSION

This review found that an ADMG would be a suitable root coverage substitute for an SCTG when avoidance of the second surgical site is preferred.

A modified surgical technique for root coverage with an allograft: a 12-month randomized clinical trial

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.

Application of acellular dermal matrix in reconstruction of oral mucosal defects in 36 cases

PURPOSE

Artificial grafts have been investigated for use in the repair of oral mucosal defects. The aim of this retrospective study was to present the outcomes of the use of acellular dermal matrix (ADM) grafts to repair oral mucosal defects.

MATERIALS AND METHODS

Data from 36 patients with oral mucosal defects reconstructed with ADM grafts from 2003 through 2009 were reviewed. All patients were followed-up for at least 6 months to observe the graft repair, wound-healing time, contracture, color, infection, pain, immunologic reaction, texture of the graft, and clinical course. Graft success was defined as the ADM graft being replaced by new mucosa-like tissue and the oral mucosal defect being covered with the new mucosa-like tissue. Any evidence of incomplete graft re-epithelialization or graft sloughing was considered a graft failure (complete or incomplete).

RESULTS

Of the 36 cases, 34 grafts (94.4%) were successfully replaced with new mucosa-like tissues and only 2 grafts (5.6%) failed. No complaints such as pain, immunologic reaction, or infection were observed during the follow-up. Mild graft contraction occurred in 7 patients with lip or buccal defects, especially at approximately 3 to 5 weeks after the reconstructive surgery.

CONCLUSIONS

The ADM grafts for oral mucosal defects were safe and effective. The present data support the clinical application of ADM grafts in reconstructing oral mucosal defects caused by various oral diseases.

A Randomized comparative clinical study of two surgical procedures to improve root coverage with the acellular dermal matrix graft

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).

Clinical efficacy of a xenogeneic collagen matrix in augmenting keratinized mucosa around implants: a randomized controlled prospective clinical trial

AIM

The aim of this controlled randomized clinical trial was to evaluate the efficacy of a xenogeneic collagen matrix (CM) to augment the keratinized tissue around implants supporting prosthetic restorations at 6 months when compared with the standard treatment, the connective tissue autograft, CTG).

MATERIALS AND METHODS

This randomized longitudinal parallel controlled clinical trial studied 24 patients with at least one location with minimal keratinized tissue (≤1 mm).

MAIN OUTCOME MEASURE

The 6-month width of keratinized tissue. As secondary outcomes the esthetic outlook, the maintenance of peri-implant mucosal health and the patient morbidity were assessed pre-operatively and 1, 3, and 6 months post-operatively.

RESULTS

At 6 months, Group CTG attained a mean width of keratinized tissue of 2.75 (1.5) mm, while the corresponding figure in Group CM was 2.8 (0.4) mm, the inter-group differences not being statistically significant. The surgical procedure in both groups did not alter significantly the mucosal health in the affected abutments. There was a similar esthetic result and significant increase in the vestibular depth in both groups as a result of the surgery. In the CM group it changed from 2.2 (3.3) to 5.1 (2.5) mm at 6 months. The patients treated with the CM referred less pain, needed less pain medication, and the surgical time was shorter, although these differences were not statistically significant when compared with the CTG group.

CONCLUSIONS

These results prove that this new CM was as effective and predictable as the CTG for attaining a band of keratinized tissue.

Mucogingival surgery: where we stand today

Mucogingival problems are developmental and acquired aberrations in the morphology, position, and/or the amount of gingiva surrounding teeth. According to an academic report by American Academy of Periodontology, mucogingival therapy should be advocated for gingival augmentation and to create adequate vestibular depth in areas with insufficient attached gingiva. This paper provides an overview on mucogingival surgical procedures from its inception to the current time.

Soft tissue volume augmentation by the use of collagen-based matrices: a volumetric analysis

OBJECTIVES

The aim was to test whether or not soft tissue augmentation with a newly developed collagen matrix (CM) leads to volume gain in chronic ridge defects similar to those obtained by an autogenous subepithelial connective tissue graft (SCTG).

MATERIAL AND METHODS

In six dogs, soft tissue volume augmentation was performed by randomly allocating three treatment modalities to chronic ridge defects (CM, SCTG, sham-operated control). Impressions were taken before augmentation (baseline), at 28, and 84 days. The obtained casts were optically scanned and the images were digitally analysed. A defined region of interest was measured in all sites and the volume differences between the time points were calculated.

RESULTS

The mean volume differences per area between baseline and 28 days amounted to a gain of 1.6 mm (CM; SD+/-0.9), 1.5 mm (SCTG; +/-0.1), and a loss of 0.003 mm (control; +/-0.3). At 84 days, the mean volume differences per area to baseline measured a gain of 1.4 mm (CM; +/-1.1), 1.4 mm (SCTG; +/-0.4), and a loss of 0.3 mm (control; +/-0.3). The differences between CM and SCTG were statistically significant compared with control at 28 and 84 days (p<0.001).

CONCLUSION

Within the limits of this animal study, the CM may serve as a replacement for autogenous connective tissue.

Clinical and histological evaluation of an acellular dermal matrix allograft in combination with the coronally advanced flap in the treatment of Miller class I recession defects: an experimental study in the mini-pig

OBJECTIVES

To study the wound healing of acellular dermal matrix (ADM) allografts when used together with coronally advanced flaps (CAF) in the treatment of localized gingival recessions in the mini-pig experimental model.

MATERIAL AND METHODS

Dehiscence defects 4 x 5 mm were surgically created in one buccal root surface in each quadrant of PI, II, or III in three mini-pigs. They were then treated with CAF and the interposition of either a connective tissue graft (CTG) or ADM. As the primary outcome, the histological interface between the ADM and the root surface was studied and was compared with CTG. As secondary outcomes, we assessed the amount and quality of the keratinized tissue and clinical outcomes in terms of root coverage and recession reduction.

RESULTS

At 3 months, the CTG group attained a mean 76% root coverage, versus 62% in the ADM group. The histological interface with the root surface was similar in both groups. The apical migration of the epithelium was 1.79+/-0.46 mm for the CTG and 1.21+/-0.35 mm for ADM. Newly formed cementum was observed with both treatments. New bone and a newly formed periodontal ligament were shown in five specimens in the ADM group and in three in the CTG group.

CONCLUSION

Both materials showed similar clinical and histological outcomes.