Comparison between connective tissue graft and xenogeneic acellular dermal matrix to treat single gingival recession: A data reanalysis of randomized clinical trials

Changes in creeping attachment for soft tissue augmentation surgery

OBJECTIVES

To investigate creeping attachment after soft tissue augmentation surgery in areas with gingival recession.

MATERIALS AND METHODS

This study observed sites of gingival recession who underwent soft tissue augmentation surgery. Changes in gingival recession depth (RD), keratinized tissue height (KTH) and gingival thickness (GT) were measured at 1, 3, 6, and 12 months post-surgery. The changes in creeping attachment (CA) and mean root coverage (MRC) were calculated, and the relationship between the increase in GT and CA was analyzed.

RESULTS

A total of 58 sites in 24 patients were observed. At 1 month postoperatively, RD, KTH and GT improved in all patients with CA of 0.66 ± 0.40 mm and MRC of 22.9 ± 13.9%. All indicators further improved from 3 to 12 months post-surgery. There was a positive correlation between the increase in GT and CA from 1 to 6 months post-surgery.

CONCLUSION

Significant changes in RD, KTH and GT were observed 1 month after soft tissue augmentation surgery, with all indicators stabilizing by 3 months. The increase of GT was positively correlated with CA, and the phenomenon of creeping attachment was still observed 1 year after the surgery.

CLINICAL RELEVANCE

The study identified changes in creeping attachment after soft tissue augmentation surgery to help clinicians understand this phenomenon better.

Digital workflow to assess gingival recession coverage independently of the cemento-enamel Junction: a prospective clinical study using the modified coronally advanced tunnel technique with porcine dermal matrix

OBJECTIVES

The limited number of studies using digital workflows to measure soft tissue changes depend on the cemento-enamel junction (CEJ), which has been reported to be unreliable. Our primary objective was to apply an advanced digital assessment method, measuring independent from the CEJ to evaluate the modified coronally advanced tunnel technique (MCAT) with a porcine dermal matrix (PDM) for gingival recession coverage.

MATERIALS AND METHODS

Patients with type RT1 and RT2 gingival recessions were treated with the MCAT and a PDM. Plaster casts (preoperative and 6 months postoperative) were digitalized. Subsequent stereolithography (STL)-files were imported and superimposed in the open-source software GOM Inspect for computer-based analysis. Recession depth, mean root and complete root coverage (mRC and cRC), mean recession reduction (mRR) and gingival thickness were evaluated. Statistical analysis was performed using mixed linear models.

RESULTS

A total of 82 teeth (19 patients) were included in the study. Healing was uneventful in all patients. The mean preoperative recession depth was 1.34 ± 0.92 mm. mRC was 65.06 ± 48.26%, cRC was 25.61%, mRR was 0.87 ± 0.83 mm, and gingival thickness gain was 0.33 ± 0.30 mm, with comparable results for RT1 and RT2. Neither tooth type nor type of jaw had any effect on the amount of root coverage.

CONCLUSIONS

The digital evaluation workflow employed offers an approach to evaluate gingival recession coverage outcomes independent of the CEJ. The PDM used in combination with the MCAT shows promising results for root coverage.

Treatment of single gingival recessions using biofunctionalized collagen matrix: A case series

BACKGROUND

Connective tissue graft substitutes have been used widely to overcome autogenous graft limitations. Nevertheless, they do not provide comparable results in the treatment of periodontal and peri-implant soft tissue defects. Based on the principles of tissue-engineered materials, injectable platelet-rich fibrin (i-PRF) has been combined with collagen matrices (CMs) to enhance their clinical efficacy. To the best of our knowledge, this is the first case series demonstrating the use of i-PRF for the biofunctionalization of a volume-stable collagen matrix (VCMX) as an adjunct to coronally advanced flap (CAF) to treat single gingival recession (GR) defects.

METHODS & RESULTS

The study included 10 patients. Bleeding on probing, probing depth, GR height, clinical attachment level, esthetics, and dentin hypersensitivity were evaluated. After 6 months, a significant GR reduction (RecRed: 2.15 ± 0.7 mm; p = 0.005) and percentage of root coverage (% RC) of 81.13% were observed. Additionally, 40% of the sites showed complete root coverage. Gingival thickness increased 0.64 mm. Patient-centered evaluations demonstrated dentin hypersensitivity and esthetics improvements by the end of follow-up.

CONCLUSION

VCMX biofunctionalized with i-PRF associated with CAF technique showed promising clinical outcomes in the treatment of single RT1 GR defects.

Treatment of Localized Gingival Recession with an Enamel Matrix Protein-Coated Xenogeneic Dermal Matrix: A Randomized Controlled Trial

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.

Multiple gingival recessions associated with non-carious cervical lesions treated by partial restoration and modified coronally advanced flap with either connective tissue graft or xenogeneic acellular dermal matrix: A randomized clinical trial

BACKGROUND

This study aimed to compare a connective tissue graft (CTG) to a (porcine) xenogeneic acellular dermal matrix (XDM), both associated with modified coronally advanced flap (MCAF) and partial resin composite restoration to treat multiple combined defects (CDs).

METHODS

Seventy-eight defects in 38 patients presenting multiple combined defects, that is, gingival recession associated with non-carious cervical lesions, were treated by partial resin composite restoration (apical margin up to 1 mm of the estimated cement-enamel junction) and MCAF along with CTG or XDM. After 6 months, the groups were compared with regard to clinical, patient-centered, and esthetic outcomes.

RESULTS

CD coverage was 72.9% for CTG versus 50.7% for XDM (P < 0.001). Recession reduction was 2.3 mm for CTG versus 1.5 mm for XDM (P < 0.001). CTG resulted in a greater increase in keratinized tissue width (CTG: 0.96 mm vs. XDM: 0.3 mm, P = 0.04) and gingival thickness (CTG: 0.9 mm vs. XDM: 0.3 mm, P < 0.001). Both treatments successfully reduced dentin hypersensitivity and increased esthetics satisfaction, with no statistically significant intergroup differences. Moreover, XDM patients experienced a shorter surgery duration (CTG: 57.2 min vs. XDM: 37.4 min, P < 0.001) and less time to no pain (visual analog scale  =  0; CTG: 6.5 days vs. XDM: 3.5 days, P = 0.04).

CONCLUSION

CTG resulted in significantly greater root coverage and increased keratinized tissue width compared to XDM for treating multiple partially restored CDs. However, increased root coverage at the CTG sites was accounted for by increased probing depth compared to the XDM sites.

Periodontal Phenotype Modification Using Subepithelial Connective Tissue Graft and Bone Graft in the Mandibular Anterior Teeth with Mucogingival Problems Following Orthodontic Treatment

Among the complications of orthodontic treatment, mucogingival problems with gingival recession in the mandibular anterior teeth are challenging for clinicians. Mucogingival problems can lead to esthetic deficits, thermal hypersensitivity, tooth brushing pain, and complicated plaque control. Herein, we present a case of a 16-year-old female with gingival recession in the left mandibular central incisor after orthodontic treatment. The preoperative clinical findings showed a thin soft tissue biotype with root prominence in the mandibular anterior area. The interdental area was relatively depressed. After reflection of the full-thickness flap, root coverage using a bone graft substitute and subepithelial connective tissue graft obtained from the palatal mucosa was performed. The 6-month and 5-year postoperative clinical findings showed improved soft tissue phenotype. The cross-sectional CBCT scans 5 years after surgery showed a well-maintained labial bone plate in the mandibular incisors. Within the limitations of this case report, for patients with gingival recession in the mandibular incisors after orthodontic treatment, a successful biotype modification can be achieved with a combined procedure using subepithelial connective tissue graft with bone graft substitutes.