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Halim FC, Sulijaya B. Allogenic Acellular Dermal Matrix and Xenogeneic Dermal Matrix as Connective Tissue Graft Substitutes for Long-Term Stability Gingival Recession Therapy: A Systematic Review and Meta-Analysis. Eur J Dent 2024; 18:430-440. [PMID: 37848072 PMCID: PMC11132762 DOI: 10.1055/s-0043-1772778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Connective tissue graft (CTG) serves as a gold standard for gingival recession therapy. Yet the availability of CTG is limited, and it increases patient morbidity. Allogenic acellular dermal matrix (AADM) and xenogeneic dermal matrix (XDM) have been proven to be effective substitutes of CTG although the long-term stability is unclear. The aim of this study was to analyze the long-term stability outcome of gingival recession therapy using AADM and XDM compared to CTG. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted independently from several online databases (PubMed, Scopus, and Embase). Five of 233 publications were included for final qualitative analysis and meta-analysis focusing on the mean difference of clinical parameters such as recession depth (RD), recession width (RW), probing depth (PD), clinical attachment loss (CAL), tissue thickness (TT), keratinized tissue width (KTW), and mean root coverage (MRC). Meta-analyses of RD, RW, CAL, TT, KTW, and MRC display an overall mean of 0.2 mm (95% confidence interval [CI]: -0.45 to -0.05), 0.29 mm (95% CI: -0.65 to 0.08), 0.2 mm (95% CI: -0.69 to 0.29), 0.25 mm (95% CI: -0.53 to 0.03), 0.26 mm (95% CI: -0.5 to 0.02), and 9.19% (95% CI: -13.95 to -4.43]), respectively, favoring the CTG. PD was the only parameter that favored the AADM or XDM with an overall mean of 0.03 mm (95% CI: -0.05 to 0.11). In all, if the long-term stability is the goal, the CTG is considered superior for gingival recession therapy. However, if it is contraindicated, the AADM and XDM might be considered as alternatives.
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Affiliation(s)
- Felita Clarissa Halim
- Periodontology Specialist Program, Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Benso Sulijaya
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
- Dental Division, Universitas Indonesia Hospital, Depok, West Java, Indonesia
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2
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Azab E, Youssef AR. Biocompatibility Evaluation of Human and Porcine Acellular Dermal Matrix on Human Primary Gingival Fibroblasts: In Vitro Comparative Study. Eur J Dent 2021; 15:563-567. [PMID: 34144630 PMCID: PMC8382466 DOI: 10.1055/s-0041-1727551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective
Allogeneic and xenogeneic acellular dermal matrix (ADM) grafts have been used to treat periodontal soft tissue defects. The purpose of the current study was to compare the effect of human ADM (AlloDerm) and porcine ADM (Derma) on human primary gingival fibroblasts
in vitro
regarding the biocompatibility test.
Materials and Methods
Gingival fibroblasts were obtained from healthy adult gingiva and seeded on AlloDerm or Derma ADM in 96-well plate. The control cells were grown on a surface-treated polystyrene cell-culture plate without matrix. The cells were cultured for 3, 7, and 14 days. The fibroblasts morphology was examined using inverted microscopy, and the cell viability of fibroblasts adherent to the dermal matrix was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell viability assay after 3, 7, and 14 days in culture. The data were statistically evaluated by one-way analysis of variance.
p
-Value of 0.05 was considered significant.
Results
Gingival fibroblasts adjacent to the AlloDerm and Derma matrices were healthy, attached to the well, and did not exhibit any cytopathic changes similar to control. There were no statistically significant differences in the cell viability between the gingival fibroblasts attached to Derma and AlloDerm on day 3 (
p
= 0.841), day 7 (
p
= 0.198), and day 14 (
p
= 0.788).
Conclusion
Considering this
in vitro
study’s limitations, both human and porcine ADM were compatible with the surrounding human primary gingival fibroblasts. No significant differences were observed in the cell viability between the gingival fibroblasts that were attached to Derma and AlloDerm.
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Affiliation(s)
- Ehab Azab
- Department of Basic and Clinical Oral Sciences, Division of Periodontology, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdel-Rahman Youssef
- Department of Basic and Clinical Oral Sciences, Division of Basic Medical Science, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia.,Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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3
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Couto SR, Luan X, Rossmann JA, Stenberg WV, Yen K, Atwi S, Svoboda KK. An in vivo comparison of wound healing characteristics of two commercial acellular dermal matrices. Clin Exp Dent Res 2021; 7:679-691. [PMID: 33939337 PMCID: PMC8543485 DOI: 10.1002/cre2.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 01/09/2021] [Accepted: 01/29/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Many acellular dermal matrices (ADMs) are available for use in periodontal surgical procedures. However, few studies exist evaluating their in vivo healing properties. The objectives of this study were to compare the wound healing and remodeling of two ADMs used for gingival augmentation procedures in the rat model. Materials and methods This was a nonrandomized controlled split‐mouth study. Envelope flaps were surgically created in the maxillary quadrants of 24 Sprague Dawley rats. Each received either (a) AlloDerm Regenerative Tissue Matrix, or (b) OrACELL. Gingival tissue from one mandibular quadrant served as the untreated control. Six male and six female rats were treated for 7 or 21 days. Biopsies were processed for histologic analysis (H&E, Picro‐sirius red, Verhoeff's solution) or RNA analysis (RT‐PCR) to analyze the expression of type I collagen (Col1a1), fibronectin (Fn‐1) and VEGF‐A (Vegf‐A). Results There was a greater density of fibroblasts in OrACELL compared to AlloDerm at both timepoints. There was a greater density of elastin present in AlloDerm compared to OrACELL at 7 days but no differences at 21 days. There were no differences between test groups in the percentage of birefringent collagen or in the expression of Vegf‐A or Fn‐1. At 7 days, there were significantly more fibroblasts for males in the OrACELL group compared to females. At 21 days, there was a significantly greater expression of Col1a1 for males in the OrACELL group compared to females. Conclusions Early wound healing and remodeling of OrACELL appeared to occur more rapidly than AlloDerm and was accelerated in male rats. Whether these results have clinical implications for soft tissue grafting procedures in humans remains to be determined.
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Affiliation(s)
- Sophie R Couto
- Department of Periodontics, Texas A&M University, College of Dentistry, Dallas, Texas, USA
| | - Xianghong Luan
- Department of Periodontics, Texas A&M University, College of Dentistry, Dallas, Texas, USA
| | - Jeffrey A Rossmann
- Department of Periodontics, Texas A&M University, College of Dentistry, Dallas, Texas, USA
| | - William V Stenberg
- Department of Biomedical Sciences, Texas A&M University, College of Dentistry, Dallas, Texas, USA
| | - Karen Yen
- Texas A&M University, College of Dentistry, Dallas, Texas, USA
| | - Sarah Atwi
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Kathy K Svoboda
- Department of Biomedical Sciences, Texas A&M University, College of Dentistry, Dallas, Texas, USA
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4
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Mithradas N, Sudhakar U, Arunachalam LT, Suresh S, Raja M. A novel soft tissue cone-beam computed tomography study in the evaluation of gingival thickness associated with subepithelial connective tissue graft versus acellular dermal matrix in the management of gingival recession: A clinical study. J Indian Soc Periodontol 2020; 24:421-427. [PMID: 33144769 PMCID: PMC7592622 DOI: 10.4103/jisp.jisp_508_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dental esthetic awareness among patients led the clinicians to introduce newer materials and predictable techniques that satisfy the patients' esthetic demands. AIM To evaluate and compare the efficacy of subepithelial connective tissue graft (SECTG) and acellular dermal matrix (ACDM) allograft in the treatment of Millers Class I or Class II recession with the determination of gingival thickness using an impertinent method, soft tissue cone-beam computed tomography (ST-CBCT). MATERIALS AND METHODS A split-mouth study with a total of ten patients with bilateral Millers class I or class II recession is randomly assigned by a coin toss method as Group I (SECTG) and Group II (ACDM) along with coronally advanced flap. Clinical parameters including recession height (RH), recession width (RW), probing depth, clinical attachment level (CAL), and height of keratinized tissue (HKT) were evaluated at baseline, 90th day, and 180th day for both groups. The thickness of keratinized tissue (TKT) was determined by most reliable, predictable and noninvasive method called ST-CBCT. RESULTS Statistically significant reduction in RH and RW, gain in CAL, and increase in HKT and TKT in both Group I and Group II were seen in 90th day and 180th day. However, when both Group I and Group II were compared between 0 and 180th day, the change in RH and RW, gain in CAL, and increase in HKT and TKT did not show any statistically significant change. CONCLUSION The present study suggested that root coverage with both SECTG and ACDM is very predictable procedure and it is stable for 6 months. ST-CBCT is a newer dimension in periodontal imaging and will certainly aid clinicians in the execution of various treatment modalities with increased predictability.
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Affiliation(s)
- Nimisha Mithradas
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Uma Sudhakar
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Lalitha T. Arunachalam
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Snophia Suresh
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Manoj Raja
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
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Lu W, Qi G, Ding Z, Li X, Qi W, He F. Clinical efficacy of acellular dermal matrix for plastic periodontal and implant surgery: a systematic review. Int J Oral Maxillofac Surg 2020; 49:1057-1066. [DOI: 10.1016/j.ijom.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 12/02/2019] [Accepted: 12/12/2019] [Indexed: 11/24/2022]
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6
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Rakasevic DL, Milinkovic IZ, Jankovic SM, Soldatovic IA, Aleksic ZM, Nikolic-Jakoba NS. The use of collagen porcine dermal matrix and connective tissue graft with modified coronally advanced tunnel technique in the treatment of multiple adjacent type I gingival recessions: A randomized, controlled clinical trial. J ESTHET RESTOR DENT 2020; 32:681-690. [PMID: 32706184 DOI: 10.1111/jerd.12624] [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] [Received: 01/07/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the clinical efficacy and esthetic outcome of porcine-derived dermal collagen matrix in comparison with connective tissue graft in the treatment of multiple adjacent gingival recessions (MAGR), 6 and 12 months after the surgery. MATERIALS AND METHODS Twenty patients with bilateral type I MAGR were treated randomly with porcine-derived dermal collagen matrix (test site) or connective tissue graft (control site) in combination with a modified coronally advanced tunnel technique. The primary objectives were to evaluate the mean and complete root coverage. The secondary objectives were to assess keratinized tissue width, gingival thickness gain, and root coverage esthetic score. RESULTS Six and 12 months postoperatively, both groups achieved significant improvements in all clinical parameters compared to baseline, with no statistically significant differences between the groups. Mean root coverage change (Δ12m - 6 m) was statistically significant between the groups in favor of connective tissue graft, and twice as many patients exhibited a complete coverage of all recessions in the control group than the test group. CONCLUSION The porcine-derived dermal collagen matrix combined with a modified coronally advanced tunnel technique resulted in satisfactory clinical and esthetic outcomes, which were similar to connective tissue graft. CLINICAL SIGNIFICANCE Porcine-derived dermal collagen matrix (XDM) may be proposed as a substitute for connective tissue graft in multiple adjacent recession treatment due to successful root coverage, a significant increase of gingival thickness, and high esthetic outcomes. The clinical benefits for the use of XDM could be: (a) second surgical wound avoidance, (b) patient discomfort decrease, and (c) lower complications' rate.
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Affiliation(s)
- Dragana L Rakasevic
- Department of Periodontology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Iva Z Milinkovic
- Department of Periodontology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Sasa M Jankovic
- Department of Periodontology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan A Soldatovic
- Institute for Biostatistics, University of Belgrade, Belgrade, Serbia
| | - Zoran M Aleksic
- Department of Periodontology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Natasa S Nikolic-Jakoba
- Department of Periodontology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
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7
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Muthuraj TS, Bagchi S, Bandyopadhyay P, Mallick S, Ghosh P, Renganath MJ. A randomized split mouth clinical study to compare the clinical outcomes of subepithelial connective graft and acellular dermal matrix in Miller's Class I recession coverage therapy. J Indian Soc Periodontol 2020; 24:342-347. [PMID: 32831507 PMCID: PMC7418548 DOI: 10.4103/jisp.jisp_609_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/16/2020] [Accepted: 03/22/2020] [Indexed: 11/21/2022] Open
Abstract
Background: According to the American Association of Periodontology, subepithelial connective tissue graft (SCTG) is one the most reliable surgical technique available for the treatment of gingival recession (GR) with Miller's Class I defect. However, due to its various disadvantages, alternate grafts such as acellular dermal matrix (ADM) grafts have been introduced for recession coverage. The present study compares the clinical outcome of these two grafts in treating Miller's Class I GR. Materials and Methods: All the 15 patients participated in the study who had totally 30 bilateral Miller's Class I GR were divided randomly into SCTG group and ADM group each containing 15 defects. In the SCTG group, coronally advanced flap (CAF) with SCTG was performed, and in ADM group, CAF with ADM was done. Clinical parameters were measured on the day of surgery (baseline) and after 6 months. Data collected were statistically analyzed using paired and unpaired t-tests. Results: The analysis of the data collected at the baseline and 6 months later showed that there were no statistically significant differences in the recorded clinical parameters such as probing pocket depth, clinical attachment loss, and GR depth. ADM group showed a better color match than the SCTG group, while SCTG group achieved more keratinized tissue width than ADM group. Conclusion: From the outcome of the current study, we can conclude that ADM is an efficient substitute for SCTG for treating Miller's Class I GR. However, additional studies with greater number of samples and lengthier follow-up periods are necessary to validate the present inference.
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Affiliation(s)
- Thamil Selvan Muthuraj
- Department of Periodontics, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - Somen Bagchi
- Department of Periodontics and Implantology, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Prasanta Bandyopadhyay
- Department of Periodontics, Burdwan Dental College and Hospital, Bardhaman, West Bengal, India
| | - Soma Mallick
- Department of Oral Health, Suri Super Speciality Hospital, Suri, West Bengal, India
| | - Papita Ghosh
- Department of Periodontics and Implantology, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Murugan Jeyasree Renganath
- Department of Periodontics and Implantology, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
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8
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de Carvalho Formiga M, Nagasawa MA, Moraschini V, Ata-Ali J, Sculean A, Shibli JA. Clinical efficacy of xenogeneic and allogeneic 3D matrix in the management of gingival recession: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:2229-2245. [PMID: 32519234 DOI: 10.1007/s00784-020-03370-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/21/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVE A systematic review and meta-analysis was thus conducted to answer the following focused question based on PICO strategy: Is there any 3D matrix biomaterial used for root coverage of human Miller class I and II defects equivalent with the connective tissue graft in localized defects of at least 2 mm and 3 mm? MATERIAL AND METHODS The search on electronic database included MEDLINE, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, Web of Science, and New Zealand/Australian Clinical Trials. Only randomized clinical trials (RCTs) that compared connective tissue graft (CTG) with at least one 3D matrix alone for root coverage in Class I and II Miller localized defects of at least 2 mm, with at least 6 months follow-up, were included in this systematic review. RESULTS A total of 14 studies were included for meta-analysis (12 compared CTG with acellular dermal matrix allograft and 2 compared CTG with Xenogenic Collagen Matrix). Relative root coverage showed no significant difference among the materials, for either 2 or 3 mm minimal recessions. For keratinized tissue width, on 2 mm recessions, CTG showed superiority above other biomaterials, but on 3 mm recessions, it seemed to have the same results. The percentage of recessions with complete root coverage for both 2 and 3 mm recessions showed similar results for all biomaterials. CONCLUSIONS With their limits, the present data concluded that CTG, acellular dermal matrix allograft, and xenogenic collagen matrix provided similar results for root coverage. CLINICAL RELEVANCE To know if there is a 3D matrix with equivalent predictable results for root coverage, that we could avoid the morbidity of the connective tissue graft for these cases.
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Affiliation(s)
- Márcio de Carvalho Formiga
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Guarulhos, Sao Paulo, Brazil
| | - Magda Aline Nagasawa
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Guarulhos, Sao Paulo, Brazil
| | - Vittorio Moraschini
- Department of Periodontology, Fluminense Federal University, Rio de Janeiro, Brazil.,Department of Periodontology, Denta Research Division, School of Dentistry, Veiga de Almeida Univewristy, Rua Ibiturana, 108, Maracanã, Rio de Janeiro, Brazil
| | - Javier Ata-Ali
- Department of Dentistry, Faculty of Health Sciences, Universidad Europea de Valencia, Valencia, Spain
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jamil Awad Shibli
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Guarulhos, Sao Paulo, Brazil.
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9
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Reis MBL, Mandetta CDMR, Dantas CDF, Marañón-Vásquez G, Taba M, de Souza SLS, Messora MR, Bulle DBP, Novaes AB. Root coverage of gingival recessions with non-carious cervical lesions: a controlled clinical trial. Clin Oral Investig 2020; 24:4583-4589. [PMID: 32440936 DOI: 10.1007/s00784-020-03325-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/01/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The non-carious cervical lesion (NCCL) is commonly produced by improper toothbrushing techniques, occlusion trauma, anatomic mal-positioned teeth, and acid erosion, thus sharing the same etiology of gingival recession (GR). The association of a graft to the coronally advanced flap had demonstrated the best long-term outcome for root coverage (RC). However, substitutes for the autogenous graft must be studied. This split-mouth clinical trial investigates the RC and the increase in keratinized tissue (KT) when comparing RC of NCCLs associated with GR with intact roots using an extended coronally advanced flap (ECAF) associated with the acellular dermal matrix graft (ADMG), a connective tissue replacement graft. MATERIAL AND METHODS Seventeen individuals with bilateral GR were included in the study. One side had a NCCL (TG) and the opposite root was intact (CG). All patients were treated with the ECDF associated with ADMG. All clinical parameters were assessed at baseline and 6 months postoperative. RESULTS Root coverage means (CG, 69.5 ± 19 and TG. 72.2 ± 16.5; p value = 0.849570) were not significantly different between control and test groups. In addition, the KT had an increase in the follow-up period for both groups. CONCLUSION GR associated with NCCLs can be successfully treated with the ECDF and ADMG. CLINICAL RELEVANCE Patients frequently search for GR treatment due to cervical wear, root sensitivity, and compromising aesthetics. The NCCL participates with the same issues. The present study contributes to the literature that GR associated with NCCLs can be successfully treated with the ECAF and the ADMG.
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Affiliation(s)
- Marilia Bianchini Lemos Reis
- Department of Oral & Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo - USP, Avenida do Café, s/n - FORP-USP, Ribeirão Preto, 14040-904, São Paulo, Brazil
| | - Carolina de Moraes Rego Mandetta
- Department of Oral & Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo - USP, Avenida do Café, s/n - FORP-USP, Ribeirão Preto, 14040-904, São Paulo, Brazil
| | - Carolina Delmondes Freitas Dantas
- Department of Oral & Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo - USP, Avenida do Café, s/n - FORP-USP, Ribeirão Preto, 14040-904, São Paulo, Brazil
| | - Guido Marañón-Vásquez
- Department of Oral & Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo - USP, Avenida do Café, s/n - FORP-USP, Ribeirão Preto, 14040-904, São Paulo, Brazil
| | - Mario Taba
- Department of Oral & Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo - USP, Avenida do Café, s/n - FORP-USP, Ribeirão Preto, 14040-904, São Paulo, Brazil
| | - Sergio Luis Scombatti de Souza
- Department of Oral & Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo - USP, Avenida do Café, s/n - FORP-USP, Ribeirão Preto, 14040-904, São Paulo, Brazil
| | - Michel Reis Messora
- Department of Oral & Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo - USP, Avenida do Café, s/n - FORP-USP, Ribeirão Preto, 14040-904, São Paulo, Brazil
| | - Daniela Bazan Palioto Bulle
- Department of Oral & Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo - USP, Avenida do Café, s/n - FORP-USP, Ribeirão Preto, 14040-904, São Paulo, Brazil
| | - Arthur Belém Novaes
- Department of Oral & Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo - USP, Avenida do Café, s/n - FORP-USP, Ribeirão Preto, 14040-904, São Paulo, Brazil.
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10
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Long-term predictability of allogenic dermal matrix for root coverage: Three years observation period on 15 consecutive cases. Saudi Dent J 2020; 33:99-104. [PMID: 33551623 PMCID: PMC7848796 DOI: 10.1016/j.sdentj.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/05/2020] [Indexed: 11/23/2022] Open
Abstract
Gingival recession is an apical migration of gingival margin that is a common finding on patients with meticulous oral hygiene and periodontitis patients. Several surgical treatment techniques of gingival recession have been described. The most challenging situation is the presence of multiple adjacent recession defects. 15 patients with total of 53 recession defects have been treated with Acellular Dermal Matrix (ADM). The following clinical parameters were evaluated recession depth (RD), probing depth (PD); and the width of the keratinized tissue (KT). Upon completion of the study; there was statistically significant (P-value = 0.00) reduction in recession depth from baseline, one and three years after the surgery (2.6 mm, 0.32 mm, and 0.17 mm, respectively). There was statistically significant (P-value = 0.00) increase in the width of keratinized tissue from baseline to one year and three years (3.47 mm, 5.02 mm, and 5.40 mm, respectively). Based on this study the use of ADM with the coronally advanced flap resulted in a significant increase in keratinized tissue and percentage of root surface coverage.
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11
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Balderrama ÍDF, Ferreira R, Rezende DRB, Nogueira ALRN, Greghi SLA, Zangrando MSR. Root coverage stability with acellular dermal matrix in multiple gingival recessions in esthetic zone: A clinical case report with 12-year follow-up. J Indian Soc Periodontol 2019; 23:584-588. [PMID: 31849407 PMCID: PMC6906899 DOI: 10.4103/jisp.jisp_582_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Ísis De Fátima Balderrama
- Department of Prosthodontics and Periodontics, Division of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rafael Ferreira
- Department of Prosthodontics and Periodontics, Division of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | | | | | - Sebastião Luiz Aguiar Greghi
- Department of Prosthodontics and Periodontics, Division of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Mariana Schutzer Ragghianti Zangrando
- Department of Prosthodontics and Periodontics, Division of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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Sallum EA, Ribeiro FV, Ruiz KS, Sallum AW. Experimental and clinical studies on regenerative periodontal therapy. Periodontol 2000 2019; 79:22-55. [PMID: 30892759 DOI: 10.1111/prd.12246] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Enilson A Sallum
- Division of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Fernanda V Ribeiro
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, São Paulo, Brazil
| | - Karina S Ruiz
- Division of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Antonio W Sallum
- Division of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
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Novaes AB, Palioto DB. Experimental and clinical studies on plastic periodontal procedures. Periodontol 2000 2019; 79:56-80. [PMID: 30892770 DOI: 10.1111/prd.12247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Arthur Belém Novaes
- Department of Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela Bazan Palioto
- Department of Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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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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Acellular Dermal Matrix as a Barrier for Guided Bone Regeneration of Dehiscence Defects Around Dental Implants. IMPLANT DENT 2018; 27:521-524. [DOI: 10.1097/id.0000000000000796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Akram Z, Vohra F, Javed F. Low-level laser therapy as an adjunct to connective tissue graft procedure in the treatment of gingival recession defects: A systematic review and meta-analysis. J ESTHET RESTOR DENT 2018; 30:299-306. [PMID: 29582585 DOI: 10.1111/jerd.12377] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to systematically evaluate the effectiveness of low level laser therapy (LLLT) as an adjunct to connective tissue graft (CTG) procedure for the treatment of gingival recession (GR). MATERIALS AND METHODS The addressed PICO question was; "In patients with Miller Class I or II recession defects (Population), what is the effect of LLLT as adjunct to CTG (Intervention) in comparison to CTG alone (Comparison) on gingival recession depth (Outcome)" Electronic databases were searched up to December 2017. Primary outcomes included gingival recession depth (GRD), whereas secondary outcomes were width of keratinized tissue (WKT) and relative clinical attachment level gain (RCAL). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. RESULTS Four randomized clinical studies were included. Two studies showed significantly greater improvements with LLLT whereas, 2 studies showed comparable outcomes between LLLT and CTG group. Considering the effects of adjunctive LLLT as compared to CTG, a high degree of heterogeneity for GRD (Q value = 9.40, P = .02, I2 =68.11%) and WKT ((Q value = 16.04, P = .001, I2 =81.31%) was noticed among both the groups. Meta-analysis showed a statistically significant GRD (WMD= -0.61, 95% CI= -1.23 to 0.004, P = .05) for LLLT + CTG treatment versus CTG alone only. CONCLUSIONS LLLT improves clinical and patient-centered outcomes of CTG procedures for the treatment of GR remains debatable. However, due to the small number of included studies and high heterogeneity in the laser parameters, precautions must be exercised when interpreting the results of the present systematic review. CLINICAL SIGNIFICANCE Gingival recessions in dentistry are of major esthetic concern. Minimal gingival recessions can be treated by flap operations, but the predictability and stability of the outcomes is debatable. In the present review, low level laser therapy (LLLT) adjunct to connective tissue graft (CTG) depicted a significant improvement in the predictability and stability of root coverage outcomes compared with CTG alone.
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Affiliation(s)
- Zohaib Akram
- Department of Periodontology, Faculty of Dentistry, Ziauddin University, Karachi, Pakistan
| | - Fahim Vohra
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Fawad Javed
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, New York, 14620
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Gallagher SI, Matthews DC. Acellular dermal matrix and subepithelial connective tissue grafts for root coverage: A systematic review. J Indian Soc Periodontol 2017; 21:439-448. [PMID: 29551861 PMCID: PMC5846239 DOI: 10.4103/jisp.jisp_222_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/09/2017] [Indexed: 01/28/2023] Open
Abstract
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.
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Affiliation(s)
- Sarah Ivy Gallagher
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Debora Candace Matthews
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
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Cieślik-Wegemund M, Wierucka-Młynarczyk B, Tanasiewicz M, Gilowski Ł. Tunnel Technique With Collagen Matrix Compared With Connective Tissue Graft for Treatment of Periodontal Recession: A Randomized Clinical Trial. J Periodontol 2016; 87:1436-1443. [PMID: 27424564 DOI: 10.1902/jop.2016.150676] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study is to compare efficacy of the tunnel technique for root coverage using collagen matrix (CM) versus connective tissue graft (CTG) for treatment of multiple recessions of Miller Classes I and II over a short period of time. METHODS Twenty-eight patients were enrolled in the study. Patients in the control group were treated with the tunnel technique using CTGs, whereas patients in the test group were treated with the tunnel technique using xenogeneic CM. Clinical recordings were obtained at baseline and after 3 and 6 months. Percentages of average recession coverage (ARC) and complete recession coverage (CRC) were evaluated 3 and 6 months after surgery. RESULTS Significant decreases were recorded in both groups of recession parameters compared with baseline measurements. Mean recession depth (0.21 versus 0.39 mm) and recession area (0.31 versus 0.53 mm2) after 6 months were significantly higher in the test group (P <0.05). Mean keratinized tissue width (KTW) increased at a similar rate in both groups (1.0 versus 0.8 mm for control and test groups, respectively). ARC after 6 months was 95% in the control group and 91% in the test group (P <0.05), and CRC was 71.4% (10/14) in the control group and 14.3% (2/14) in the test group (P <0.05). CONCLUSION Xenogeneic CM combined with tunnel technique leads to satisfactory ARC and increase in KTW similar to CTG, but yields lower unsatisfactory CRC.
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Affiliation(s)
- Marta Cieślik-Wegemund
- Department of Periodontal and Oral Mucosa Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Conservative Dentistry with Endodontics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia
| | - Beata Wierucka-Młynarczyk
- Department of Periodontal and Oral Mucosa Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Conservative Dentistry with Endodontics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia
| | - Marta Tanasiewicz
- Department of Conservative Dentistry with Endodontics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia
| | - Łukasz Gilowski
- Department of Pharmacology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia
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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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20
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Guan W, Liao H, Guo L, Wang C, Cao Z. Root coverage using a coronally advanced flap with or without acellular dermal matrix: a meta-analysis. J Periodontal Implant Sci 2016; 46:22-34. [PMID: 26937291 PMCID: PMC4771835 DOI: 10.5051/jpis.2016.46.1.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 01/26/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose Gingival recession is a major esthetic concern and may lead to root sensitivity during periodontal treatment. Coronally advanced flaps (CAFs) with and without acellular dermal matrix (ADM) are widely used in root coverage procedures. The aim of this study was to analyze the efficacy of CAF in combination with ADM in the treatment of gingival recession. Methods PubMed, The Cochrane Library, and Embase were used to identify relevant articles. The articles were screened, data were extracted, and the quality of the studies was assessed by three reviewers with expertise in clinical practice, trials, statistics, and biomedical editing. The clinical endpoints of interest included changes in recession, probing depth (PD), clinical attachment level (CAL), and keratinized tissue (KT). Results Ten randomized controlled trials were identified, including six studies that compared CAFs with ADM and CAFs using connective tissue grafting (CTG) and four studies that compared CAFs with or without ADM. No statistically significant differences were found between the use of ADM and CTG, whereas statistically significant differences were found between groups in which ADM and CAF were combined and groups that underwent CAF alone with regard to recession coverage, CAL, and KT. The combination of CAF with an ADM allograft achieved more favorable recession coverage and recovery of CAL and KT than CAF alone. Conclusions The results from the ADM and CTG groups suggest that both procedures may be equally effective in clinical practice. Given the limitations of this study, further investigation is needed to clarify the effectiveness of ADM and CAF in clinical practice.
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Affiliation(s)
- Wei Guan
- Department of Periodontology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST KLOS) & Key Laboratory for Oral Biomedical Engineering of Ministry of Education (KLOBME), School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Haiqing Liao
- Department of Periodontology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST KLOS) & Key Laboratory for Oral Biomedical Engineering of Ministry of Education (KLOBME), School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Li Guo
- Department of Periodontology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST KLOS) & Key Laboratory for Oral Biomedical Engineering of Ministry of Education (KLOBME), School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Changning Wang
- Department of Periodontology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST KLOS) & Key Laboratory for Oral Biomedical Engineering of Ministry of Education (KLOBME), School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhengguo Cao
- Department of Periodontology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST KLOS) & Key Laboratory for Oral Biomedical Engineering of Ministry of Education (KLOBME), School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Ozenci I, Ipci SD, Cakar G, Yilmaz S. Tunnel technique versus
coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions. J Clin Periodontol 2016; 42:1135-42. [DOI: 10.1111/jcpe.12477] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Ilknur Ozenci
- Department of Periodontology; Faculty of Dentistry; Yeditepe University; Istanbul Turkey
| | - Sebnem Dirikan Ipci
- Department of Periodontology; Faculty of Dentistry; Yeditepe University; Istanbul Turkey
| | - Gokser Cakar
- Department of Periodontology; Faculty of Dentistry; Yeditepe University; Istanbul Turkey
| | - Selcuk Yilmaz
- Department of Periodontology; Faculty of Dentistry; Yeditepe University; Istanbul Turkey
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22
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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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Barros RRM, Macedo GO, de Queiroz AC, Novaes AB. A Modified Surgical Flap for Root Coverage in Association with Grafting Materials. J ESTHET RESTOR DENT 2015; 27:84-91. [DOI: 10.1111/jerd.12122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Raquel R. M. Barros
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirão Preto; University of São Paulo; Avenida do Café - s/n Ribeirão Preto SP 14040-904 Brazil
| | - Guilherme O. Macedo
- School of Dentistry; Tiradentes University; R. Lagarto 264-Centro Aracaju SE 49010-390 Brazil
| | - Adriana Corrêa de Queiroz
- School of Dentistry; Federal University of Amazonas; Av. Ministro Valdemar Pedrosa 1539 Centro Manaus AM 69025-050 Brazil
| | - Arthur B. Novaes
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirão Preto; University of São Paulo; Avenida do Café - s/n Ribeirão Preto SP 14040-904 Brazil
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Wang HL, Romanos GE, Geurs NC, Sullivan A, Suárez-López del Amo F, Eber RM. Comparison of Two Differently Processed Acellular Dermal Matrix Products for Root Coverage Procedures: A Prospective, Randomized Multicenter Study. J Periodontol 2014; 85:1693-701. [DOI: 10.1902/jop.2014.140198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Esfahanian V, Farhad S, Sadighi Shamami M. Comparison of ADM and Connective Tissue Graft as the Membrane in Class II Furcation Defect Regeneration: A Randomized Clinical Trial. J Dent Res Dent Clin Dent Prospects 2014; 8:101-6. [PMID: 25093054 PMCID: PMC4120901 DOI: 10.5681/joddd.2014.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/17/2014] [Indexed: 11/17/2022] Open
Abstract
Background and aims. Furcally-involved teeth present unique challenges to the success of periodontal therapy and influence treatment outcomes. This study aimed to assess to compare use of ADM and connective tissue membrane in class II furcation defect regeneration. Materials and methods. 10 patient with 2 bilaterally class II furcation defects in first and/or second maxilla or man-dibular molar without interproximal furcation involvement, were selected. Four weeks after initial phase of treatment, before and thorough the surgery pocket depth (PD), clinical attachment level to stent (CAL-S), free gingival margin to stent(FGM-S) , crestal bone to stent (Crest-S), horizontal defect depth to stent (HDD-S) and vertical defect depth to stent (VDD-S) and crestal bone to defect depth measured from stent margin. Thereafter, one side randomly treated using connective tissue and DFDBA (study group) and opposite side received ADM and DFDBA (control group). After 6 months, soft and hard tissue parameters measured again in re-entry. Results. Both groups presented improvements after therapies (P & 0.05). No inter-group differences were seen in PD re-duction (P = 0.275), CAL gain (P = 0.156), free gingival margin (P = 0.146), crest of the bone (P = 0.248), reduction in horizontal defects depth (P = 0.139) and reduction in vertical defects depth (P = 0.149). Conclusion. Both treatments modalities have potential of regeneration without any adverse effect on healing process. Connective tissue grafts did not have significant higher bone fill compared to that of ADM.
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Affiliation(s)
- Vahid Esfahanian
- Assistant Professor, Department of Periodontology, Faculty of Dentistry, Islamic Azad University Khorasgan (Isfahan) Branch, Isfahan, Iran
| | - Shirin Farhad
- Assistant Professor, Department of Periodontology, Faculty of Dentistry, Islamic Azad University Khorasgan (Isfahan) Branch, Isfahan, Iran
| | - Mehrnaz Sadighi Shamami
- Assistant Professor, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
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Goyal N, Gupta R, Pandit N, Dahiya P. Analysis of patient acceptance following treatment of Miller's class II gingival recession with acellular dermal matrix and connective tissue graft. J Indian Soc Periodontol 2014; 18:352-6. [PMID: 25024550 PMCID: PMC4095629 DOI: 10.4103/0972-124x.134574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 11/19/2013] [Indexed: 11/17/2022] Open
Abstract
Objective: Obtaining predictable and aesthetic root coverage has become an important part of periodontal therapy. The search for the appropriate root coverage techniques has resulted in many different approaches. The goal of this study was to evaluate the degree of patient acceptance with acellular dermal matrix (ADM) allograft in the treatment of buccal gingival recession and to compare it with subepithelial connective tissue graft. Materials and Methods: Thirty patients with Miller's class II recessions were treated and randomly assigned to the test group (ADM) and control group (subepithelial connective tissue graft). All patients underwent full periodontal evaluation and pre-surgical preparation, including oral hygiene instructions and scaling and root planing. The exposed roots were thoroughly planed and covered by a graft without any further root treatment. Results were evaluated based on the parameters measuring patient satisfaction and clinical outcome after 6 months of the surgical procedure. Results: Postoperatively, significant root coverage, reduction in probing depth, gain in clinical attachment level, and increase in widths of keratinized tissue and attached gingiva were observed on intra-group comparison. There was no significant difference in any of the parameters between test and control groups. Conclusion: The subepithelial connective tissue graft and ADM graft were able to successfully treat gingival recession defects; however, the ADM showed better patient acceptance than the connective tissue graft.
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Affiliation(s)
- Niti Goyal
- Department of Periodontics, Himachal Institute of Dental Sciences, Poanta Sahib, Himachal Pradesh, India
| | - Rajan Gupta
- Department of Periodontics, Himachal Institute of Dental Sciences, Poanta Sahib, Himachal Pradesh, India
| | - Nymphea Pandit
- Department of Periodontics, DAV Centenary Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Parveen Dahiya
- Department of Periodontics, Himachal Institute of Dental Sciences, Poanta Sahib, Himachal Pradesh, India
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Taiyeb Ali TB, Shapeen IM, Ahmed HB, Javed F. Efficacy of acellular dermal matrix and autogenous connective tissue grafts in the treatment of gingival recession defects among Asians. ACTA ACUST UNITED AC 2014; 6:125-32. [DOI: 10.1111/jicd.12085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/11/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Tara B. Taiyeb Ali
- Department of Oral Pathology, Oral Medicine & Periodontology; Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
| | | | | | - Fawad Javed
- 3D Imaging and Biomechanical Laboratory; College of Applied Medical Sciences; King Saud University; Riyadh Saudi Arabia
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Thomas LJ, Emmadi P, Thyagarajan R, Namasivayam A. A comparative clinical study of the efficacy of subepithelial connective tissue graft and acellular dermal matrix graft in root coverage: 6-month follow-up observation. J Indian Soc Periodontol 2013; 17:478-83. [PMID: 24174728 PMCID: PMC3800411 DOI: 10.4103/0972-124x.118320] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 07/18/2013] [Indexed: 11/24/2022] Open
Abstract
Aims: The purpose of this study was to compare the clinical efficacy of subepithelial connective tissue graft and acellular dermal matrix graft associated with coronally repositioned flap in the treatment of Miller's class I and II gingival recession, 6 months postoperatively. Settings and Design: Ten patients with bilateral Miller's class I or class II gingival recession were randomly divided into two groups using a split-mouth study design. Materials and Methods: Group I (10 sites) was treated with subepithelial connective tissue graft along with coronally repositioned flap and Group II (10 sites) treated with acellular dermal matrix graft along with coronally repositioned flap. Clinical parameters like recession height and width, probing pocket depth, clinical attachment level, and width of keratinized gingiva were evaluated at baseline, 90th day, and 180th day for both groups. The percentage of root coverage was calculated based on the comparison of the recession height from 0 to 180th day in both Groups I and II. Statistical Analysis Used: Intragroup parameters at different time points were measured using the Wilcoxon signed rank test and Mann–Whitney U test was employed to analyze the differences between test and control groups. Results: There was no statistically significant difference in recession height and width, gain in CAL, and increase in the width of keratinized gingiva between the two groups on the 180th day. Both procedures showed clinically and statistically significant root coverage (Group I 96%, Group II 89.1%) on the 180th day. Conclusions: The results indicate that coverage of denuded root with both subepithelial connective tissue autograft and acellular dermal matrix allograft are very predictable procedures, which were stable for 6 months postoperatively.
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Affiliation(s)
- Libby John Thomas
- Department of Periodontology and Implantology, Meenakshiammal Dental College and Hospital, Alapakkam Main Road, Maduravoyal, Chennai, Tamil Nadu, India
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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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Carney CM, Rossmann JA, Kerns DG, Cipher DJ, Rees TD, Solomon ES, Rivera-Hidalgo F, Beach MM. A comparative study of root defect coverage using an acellular dermal matrix with and without a recombinant human platelet-derived growth factor. J Periodontol 2011; 83:893-901. [PMID: 22149763 DOI: 10.1902/jop.2011.110144] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The objective of this case series is to compare root defect coverage results and healing responses of bilateral recession defects treated with acellular dermal matrix (ADM) with and without recombinant human platelet-derived growth factor (rhPDGF). METHODS Seventeen patients with 40 bilateral gingival recession defects were compared. Each defect was ≥2 mm and treated with ADM and a coronally advanced flap. Using split-mouth design, the control-side ADM was hydrated in sterile saline, whereas the test-side ADM was hydrated in rhPDGF. The patients were evaluated at 1 week, 1 month, 3 months, and 6 months. Standardized measurements were taken preoperatively at 3 and 6 months. Healing was clinically assessed at 1 week and 1 month post-surgically. RESULTS Both test and control groups showed significant gain in root defect coverage over the 6-month period for all individuals, with the test group showing a 69.0% gain and the control group showing a 76.7% gain. Patients divided into Miller Class I and Class III defects were also found to have a significant gain in root defect coverage over 6 months. The test group showed 84.1% gain, and the control group showed 84.7% gain for Miller Class I defects. For Miller Class III defects, the test group showed 51.5% gain, and the control group showed a 60.8% gain. One week after surgery, 35% of the test group showed better healing, whereas 15% of the control group showed better healing. One month after surgery, 20% of the test group showed better healing, whereas 15% of the control group showed better healing. CONCLUSION Based on the results of this case series, there were no statistically or clinically significant differences in root defect coverage, keratinized tissue, clinical attachment level, or clinical healing for treatment of root recession with a coronally advanced flap and ADM with and without rhPDGF.
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Affiliation(s)
- Christopher M Carney
- Department of Periodontics, Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas, TX 75246, USA
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Moslemi N, Mousavi Jazi M, Haghighati F, Morovati SP, Jamali R. Acellular dermal matrix allograft versus subepithelial connective tissue graft in treatment of gingival recessions: a 5-year randomized clinical study. J Clin Periodontol 2011; 38:1122-9. [DOI: 10.1111/j.1600-051x.2011.01789.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Neda Moslemi
- Laser Research Center in Dentistry, Dental Research Center; Periodontics Department; Faculty of Dentistry; Tehran University of Medical Sciences; Tehran; Iran
| | - Mahvash Mousavi Jazi
- Periodontics Department; Faculty of Dentistry; Tehran University of Medical Sciences; Tehran; Iran
| | - Farideh Haghighati
- Periodontics Department; Faculty of Dentistry; Tehran University of Medical Sciences; Tehran; Iran
| | | | - Raika Jamali
- Student Scientific Research Center; Tehran University of Medical Sciences; Tehran; Iran
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Rodrigues AZ, Oliveira PTD, Novaes AB, Maia LP, Souza SLSD, Palioto DB. Evaluation of in vitro human gingival fibroblast seeding on acellular dermal matrix. Braz Dent J 2011; 21:179-89. [PMID: 21203697 DOI: 10.1590/s0103-64402010000300001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/11/2010] [Indexed: 11/21/2022] Open
Abstract
The acellular dermal matrix (ADM) was introduced in periodontology as a substitute for the autogenous grafts, which became restricted because of the limited source of donor's tissue. The aim of this study was to investigate, in vitro, the distribution, proliferation and viability of human gingival fibroblasts seeded onto ADM. ADM was seeded with human gingival fibroblasts for up to 21 days. The following parameters were evaluated: cell distribution, proliferation and viability. Results revealed that, at day 7, fibroblasts were adherent and spread on ADM surface, and were unevenly distributed, forming a discontinuous single cell layer; at day 14, a confluent fibroblastic monolayer lining ADM surface was noticed. At day 21, the cell monolayer exhibited a reduction in cell density. At 7 days, about to 90% of adherent cells on ADM surface were cycling while at 14 and 21 days this proportion was significantly reduced. A high proportion of viable cell was detected on AMD surface both on 14 and 21 days. The results suggest that fibroblast seeding onto ADM for 14 days can allow good conditions for cell adhesion and spreading on the matrix; however, migration inside the matrix was limited.
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Affiliation(s)
- Annelissa Zorzeto Rodrigues
- Department of Oral and Maxillofacial Surgery and Traumatology and Periodontology, University of São Paulo, Ribeirão Preto, SP, Brazil
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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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Barker TS, Cueva MA, Rivera-Hidalgo F, Beach MM, Rossmann JA, Kerns DG, Crump TB, Shulman JD. A Comparative Study of Root Coverage Using Two Different Acellular Dermal Matrix Products. J Periodontol 2010; 81:1596-603. [DOI: 10.1902/jop.2010.090291] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maia LP, Novaes AB, Souza SLS, Grisi MFM, Taba M, Palioto DB. In vitro evaluation of acellular dermal matrix as a three-dimensional scaffold for gingival fibroblasts seeding. J Periodontol 2010; 82:293-301. [PMID: 20812778 DOI: 10.1902/jop.2010.100121] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tissue engineering principles could improve the incorporation of acellular dermal matrix (ADM). The aim of this study is to verify if ADM is a suitable three-dimensional matrix for gingival fibroblasts and cancerous cells ingrowth, and also if cultured medium conditioned in ADM affect cellular behavior. METHODS Canine gingival fibroblasts (CGF), human gingival fibroblasts (HGF), and murine melanoma cell line (B16F10) were seeded on ADM for up to 14 days. The following parameters were assessed: morphology and distribution of CGF, HGF, and B16F10; CGF and HGF viability; and the effect of ADM conditioned medium (CM) on CGF viability. RESULTS Epifluorescence revealed that CGF were unevenly distributed on the ADM surface, showing no increase in cell number over the periods of study; HGF formed a monolayer on the ADM surface in a higher number at 14 days (P <0.05); B16F10 exhibited an increase in cell number within 7 days (P <0.05), and were mainly arranged in cell aggregates on the ADM, forming a continuous layer at 14 days. A higher percentage of cells on the ADM surface (P <0.05) compared to inside was observed for all cell types. 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) values indicated higher cell viability in samples cultured with HGF compared to CGF (P = 0.024). A significantly lower cell viability for CGF grown in CM compared to cells grown in non-CM was observed at 48 and 72 hours (P <0.05). CONCLUSIONS ADM is not suitable as a three-dimensional matrix for gingival fibroblasts ingrowth. Gingival fibroblasts and highly proliferative cells as B16F10 can only be superficially located on ADM, and CGF are negatively affected by culture medium conditioned in ADM, reducing its viability.
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Affiliation(s)
- Luciana P Maia
- Department of Bucco-Maxillofacial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Espinosa L, Sosnik A, Fontanilla MR. Development and Preclinical Evaluation of Acellular Collagen Scaffolding and Autologous Artificial Connective Tissue in the Regeneration of Oral Mucosa Wounds. Tissue Eng Part A 2010; 16:1667-79. [DOI: 10.1089/ten.tea.2008.0571] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Lady Espinosa
- Pharmacy Department, Faculty of Sciences, National University of Colombia, Bogotá D.C., Colombia
- Graduate Program in Biotechnology, Faculty of Sciences, National University of Colombia, Bogotá D.C., Colombia
| | - Alejandro Sosnik
- Department of Pharmaceutical Technology, Faculty of Pharmacy and Biochemistry and National Science Research Council (CONICET), University of Buenos Aires, Buenos Aires, Argentina
| | - Marta R. Fontanilla
- Pharmacy Department, Faculty of Sciences, National University of Colombia, Bogotá D.C., Colombia
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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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Jhaveri HM, Chavan MS, Tomar GB, Deshmukh VL, Wani MR, Miller PD. Acellular Dermal Matrix Seeded With Autologous Gingival Fibroblasts for the Treatment of Gingival Recession: A Proof-of-Concept Study. J Periodontol 2010; 81:616-25. [DOI: 10.1902/jop.2009.090530] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ko HY, Lu HK. Systematic Review of the Clinical Performance of Connective Tissue Graft and Guided Tissue Regeneration in the Treatment of Gingival Recessions of Miller's Classification Grades I and II. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1878-3317(10)60011-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bittencourt S, Ribeiro EDP, Sallum EA, Sallum AW, Nociti FH, Casati MZ. Semilunar coronally positioned flap or subepithelial connective tissue graft for the treatment of gingival recession: a 30-month follow-up study. J Periodontol 2009; 80:1076-82. [PMID: 19563287 DOI: 10.1902/jop.2009.080498] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The objective of this prospective, controlled clinical trial was to evaluate the long-term outcomes of subepithelial connective tissue graft (SCTG) or semilunar coronally positioned flap (SCPF) for the treatment of Miller Class I gingival recession defects. METHODS Seventeen patients with bilateral Miller Class I gingival recessions (< or =4.0 mm) in maxillary canines or premolars were selected. The recessions were randomly assigned to receive SCPF or SCTG. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline and at 6 and 30 months post-surgery. Patient satisfaction with esthetics and root sensitivity was also evaluated. RESULTS The root-coverage outcomes obtained at 6 months were maintained throughout the study. At the 30-month examination, the average percentage of root coverage was 89.25% for SCPF and 96.83% for SCTG (P >0.05); complete root coverage was observed in 58.82% and 88.24% of patients, respectively. SCTG maintained a statistically significant increase in TKT (P <0.05) at 30 months. At this time, there were no significant differences between the two groups with regard to RH, RW, WKT, PD, and CAL. The evaluation of the esthetic outcome by the patient showed a preference for the SCTG treatment. Furthermore, in this group, no patient complained of residual or additional root hypersensitivity. In the SCPF group, three patients had this complaint at 30 months. CONCLUSIONS SCPF and SCTG can be successfully used to treat Class I gingival recession, presenting outcomes with long-term stability. However, patient-oriented outcomes, such as esthetics and root sensitivity, favor SCTG therapy.
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Affiliation(s)
- Sandro Bittencourt
- Department of Prosthodontics and Periodontics, Division of Periodontics, School of Dentistry at Piracicaba, University of Campinas, Piracicaba, SP, Brazil
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Borges GJ, Novaes AB, de Moraes Grisi MF, Palioto DB, Taba M, de Souza SLS. Acellular dermal matrix as a barrier in guided bone regeneration: a clinical, radiographic and histomorphometric study in dogs. Clin Oral Implants Res 2009; 20:1105-15. [DOI: 10.1111/j.1600-0501.2009.01731.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev 2009:CD007161. [PMID: 19370675 DOI: 10.1002/14651858.cd007161.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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 periodontal plastic surgery (PPS) procedures. OBJECTIVES To evaluate the effectiveness of different root coverage procedures in the treatment of recession-type defects. SEARCH STRATEGY The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched up to October 2008. The main international periodontal journals were handsearched. There were no restrictions with regard to publication status or language of publication. SELECTION CRITERIA Only randomised controlled clinical trials (RCTs) of at least 6 months' duration evaluating recession areas (Miller's Class I or II > 3 mm) and that were treated by means of PPS procedures were included. DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. MAIN RESULTS Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significant greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTG) compared to guided tissue regeneration with resorbable membranes (GTR rm). A significant greater gain in the keratinized tissue was found for enamel matrix protein when compared to coronally advanced flap (0.40 mm) and for SCTG when compared to GTR rm plus bone substitutes. Limited 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 the treatment of localised recession-type defects. In cases where both root coverage and gain in the keratinized tissue are expected, the use of subepithelial connective tissue grafts seems to be more adequate. Randomised controlled clinical trials are necessary to identify possible factors associated with the prognosis of each PPS procedure. The potential impact of bias on these outcomes is unclear.
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Affiliation(s)
- Leandro Chambrone
- Department of Periodontology, University of São Paulo, Av. Prof. Lineu Prestes, 2227 Cidade Universitária, São Paulo, SP, Brazil, 05508-000.
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The Influence of Tobacco Smoking on the Outcomes Achieved by Root-Coverage Procedures. J Am Dent Assoc 2009; 140:294-306. [PMID: 19255173 DOI: 10.14219/jada.archive.2009.0158] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 2009; 35:136-62. [PMID: 18724847 DOI: 10.1111/j.1600-051x.2008.01267.x] [Citation(s) in RCA: 252] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The treatment of buccal gingival recessions is a common requirement due to aesthetic concern or root sensitivity. The aim of this manuscript was to systematically review the literature on coronally advanced flap (CAF) alone or in combination with tissue grafts, barrier membranes (BM), enamel matrix derivative (EMD) or other material for treating gingival recession. MATERIAL AND METHODS Randomized clinical trials on treatment of Miller Class I and II gingival recessions with at least 6 months of follow-up were identified. Data sources included electronic databases and hand-searched journals. The primary outcome variable was complete root coverage (CRC). The secondary outcome variables were recession reduction, clinical attachment gain, keratinized tissue gain, aesthetic satisfaction, root sensitivity, post-operative patient pain and complications. RESULTS A total of 794 Miller Class I and II gingival recessions in 530 patients from 25 RCTs were evaluated in this systematic review. CAF was associated with mean recession reduction and CRC. The addition of connective tissue graft (CTG) or EMD enhanced the clinical outcomes of CAF in terms of CRC, while BM did not. The results with respect to the adjunctive use of acellular dermal matrix were controversial. CONCLUSIONS CTG or EMD in conjunction with CAF enhances the probability of obtaining CRC in Miller Class I and II single gingival recessions.
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Affiliation(s)
- Francesco Cairo
- Department of Periodontology, University of Florence, Florence, Italy.
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Papageorgakopoulos G, Greenwell H, Hill M, Vidal R, Scheetz JP. Root Coverage Using Acellular Dermal Matrix and Comparing a Coronally Positioned Tunnel to a Coronally Positioned Flap Approach. J Periodontol 2008; 79:1022-30. [DOI: 10.1902/jop.2008.070546] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Andrade PF, Felipe MEMC, Novaes AB, Souza SLS, Taba M, Palioto DB, Grisi MFM. Comparison between two surgical techniques for root coverage with an acellular dermal matrix graft. J Clin Periodontol 2008; 35:263-9. [DOI: 10.1111/j.1600-051x.2007.01193.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Andrade PF, de Souza SLS, de Oliveira Macedo G, Novaes AB, de Moraes Grisi MF, Taba M, Palioto DB. Acellular Dermal Matrix as a Membrane for Guided Tissue Regeneration in the Treatment of Class II Furcation Lesions: A Histometric and Clinical Study in Dogs. J Periodontol 2007; 78:1288-99. [PMID: 17608584 DOI: 10.1902/jop.2007.060325] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate acellular dermal matrix (ADM) as a membrane for guided tissue regeneration (GTR) in the treatment of mandibular Class II furcation lesions and to compare it to a bioabsorbable membrane. METHODS Class II furcation lesions were created surgically and chronified in six mongrel dogs on the buccal surfaces of mandibular third and fourth premolars, bilaterally. After 1 month, GTR was performed. Each side was assigned randomly to the control group (CGr: bioabsorbable membrane made of polyglycolic acid: trimethylene carbonate) or the test group (TGr: ADM as a membrane). Clinical measurements of the width and thickness of the keratinized tissue (WKT and TKT, respectively) were made before GTR. The dogs were sacrificed 12 weeks following GTR, and histomorphometric analysis was performed. Area measurements were taken of new tissue, epithelium, connective tissue, and new bone; bone height and new cementum were measured. RESULTS The formation of new bone, cementum, and periodontal ligament were similar in both groups. There were no statistically significant differences between the groups for any histomorphometric measurement. The TGr had a statistically significant increase in WKT and TKT after 3 months. The mean TKT gain was 1.03 mm for the TGr and 0.26 mm for the CGr (P <0.05). CONCLUSION The ADM demonstrated histomorphometric results similar to the bioabsorbable membrane and resulted in a greater increase in the thickness of the keratinized tissue.
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Affiliation(s)
- Patrícia Freitas de Andrade
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Felipe MEMC, Andrade PF, Grisi MFM, Souza SLS, Taba M, Palioto DB, Novaes AB. Comparison of Two Surgical Procedures for Use of the Acellular Dermal Matrix Graft in the Treatment of Gingival Recessions: A Randomized Controlled Clinical Study. J Periodontol 2007; 78:1209-17. [PMID: 17608575 DOI: 10.1902/jop.2007.060356] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this randomized, controlled, clinical investigation was to compare two surgical techniques for root coverage with the acellular dermal matrix graft to evaluate which technique provided better root coverage, a better esthetic result, and less postoperative discomfort. METHODS Fifteen patients with bilateral Miller Class I or II gingival recessions were selected. Fifteen pairs of recessions were treated and assigned randomly to the test group, and the contralateral recessions were assigned to the control group. The control group was treated with a broader flap and vertical releasing incisions; the test group was treated with the proposed surgical technique, without vertical releasing incisions. The clinical parameters evaluated were probing depth, relative clinical attachment level, gingival recession (GR), width of keratinized tissue, thickness of keratinized tissue, esthetic result, and pain evaluation. The measurements were taken before the surgeries and after 6 months. RESULTS At baseline, all parameters were similar for both groups. At 6 months, a statistically significant greater reduction in GR favored the control group. The percentage of root coverage was 68.98% and 84.81% for the test and control groups, respectively. The esthetic result was equivalent between the groups, and all patients tolerated both procedures well. CONCLUSIONS Both techniques provided significant root coverage, good esthetic results, and similar levels of postoperative discomfort. However, the control technique had statistically significantly better results for root coverage of localized gingival recessions.
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Affiliation(s)
- Maria Emília M C Felipe
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Joly JC, Carvalho AM, da Silva RC, Ciotti DL, Cury PR. Root Coverage in Isolated Gingival Recessions Using Autograft Versus Allograft: A Pilot Study. J Periodontol 2007; 78:1017-22. [PMID: 17539714 DOI: 10.1902/jop.2007.060428] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Different surgical techniques have been used to treat gingival recessions. This preliminary study compared clinical findings for the treatment of isolated gingival defects using a coronally positioned flap associated with a subepithelial connective tissue graft or an acellular dermal matrix graft. METHODS Ten subjects with bilateral and comparable Miller Class I or II defects were selected. The defects were > or =3.0 mm deep and were assigned randomly to the test group, which was treated with a coronally positioned flap associated with an acellular dermal matrix, or to the control group, which was treated with a coronally positioned flap associated with a subepithelial connective tissue graft. Probing depth (PD), clinical attachment level (CAL), gingival recession depth (GRD), and width (KT) and thickness (GT) of the keratinized tissue were assessed at baseline and 6 months after the surgery. RESULTS Mean root coverage was 50% in the test group (representing a gingival margin shift of 2.1 +/- 0.99 mm) and 79.5% in the control group (representing a gingival margin shift of 3.5 +/- 1.20 mm). These results were statistically different on intra- and intergroup comparisons (P <0.05). Between-group comparisons revealed statistically significantly greater gains in CAL, GRD, and GT in the control group (P < or =0.05); no differences were found for PD or KT (P > or =0.05). CONCLUSIONS The coronally positioned flap associated with a subepithelial connective tissue graft or an acellular dermal matrix graft was effective in root coverage. However, the coronally positioned flap associated with a connective tissue graft provided a more favorable clinical outcome. More expanded studies are needed to confirm the present findings.
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Affiliation(s)
- Julio C Joly
- Department of Periodontics, São Leopoldo Mandic Dental Research Center, Campinas, SP, Brazil.
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Shin SH, Cueva MA, Kerns DG, Hallmon WW, Rivera-Hidalgo F, Nunn ME. A Comparative Study of Root Coverage Using Acellular Dermal Matrix With and Without Enamel Matrix Derivative. J Periodontol 2007; 78:411-21. [PMID: 17335405 DOI: 10.1902/jop.2007.060170] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to compare root coverage using acellular dermal matrix (ADM) with and without enamel matrix derivative (EMD) on the percentage of root coverage, probing attachment level, and the amount of keratinized tissue in the treatment of localized recession. METHODS Eighty-two contralateral sites in 14 patients with >or=2 mm of Miller Class I or III buccal tissue recession were treated. Forty-one test sites were treated with coronally advanced flap (CAF) using ADM in conjunction with EMD, whereas 41 control sites were treated with CAF using ADM alone. A split-mouth design was used for this study with 82 sites. Patients were followed for 3 and 6 months. A paired t test was conducted with the subject as the unit of analysis. RESULTS Based on paired t tests, both groups had significant improvement in the percentage of root coverage, probing attachment levels, and increased keratinized tissue. Only keratinized tissue in the test group demonstrated a statistically significant greater increase compared to controls at the 6-month evaluation (P = 0.006). CONCLUSION The use of EMD in conjunction with ADM resulted in a statistically significant effect on keratinized tissue increase, but no significant effects on probing attachment level or percentage of root surface coverage.
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Affiliation(s)
- Sang Ho Shin
- Department of Periodontics, Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas, TX 75246, USA
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