Treating Public Health Dilemma of Gingival Recession by the Dehydrated Amnion Allograft: A 5-Year Longitudinal Study

Efficacy of amniotic membrane with coronally advanced flap in the treatment of gingival recession: an updated systematic review and meta-analysis

OBJECTIVES

This systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR).

METHODS

The protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct.

RESULTS

Two independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009).

CONCLUSION

With the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities.

CLINICAL SIGNIFICANCE

While AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR.

A meta-analysis of amnion membrane in gingival recession

This systematic review was conducted to evaluate the effects of Amniotic Membrane (AM) as compared with other treatment modalities on the clinical outcomes, in gingival recession defects. Only Randomized controlled clinical trials published before 2020 were included. Studies were divided into 5 subgroups (1) Coronally advanced flap (CAF)+AM v/s Chorion membrane (CM) (2) CAF+AM v/s CAF+PRF (3) CAF+AM v/s CAF+Collagen membrane (4) CAF+AM v/s CAF (5) CAF+AM v/s CAF+ Subepithelial connective tissue graft (SCTG). Studies were evaluated for Recession Depth (RD) (Primary outcome); Clinical Attachment Level (CAL), Recession Width (RW) and Width of Keratinized Gingiva (WKG) (Secondary outcomes). The inverse variance approach was utilised in fixed or random effect models for the meta-analysis, which were chosen based on heterogeneity. Results suggested that the use of AM membrane showed comparable results in improving RD, RW, or CAL in the treatment of Miller Class-I and Class-II gingival recession compared to the other treatment modalities. However, CAF+AM resulted in statistically significant improvement in RD and RW than CAF+SCTG, though CAL gain was statistically more with CAF+SCTG. However, increase of WKG was found to be statistically significantly more in all the other treatment modalities as compared to CAF+AM. With properties like self-adherence, bioavailability and presence of growth factors AM with CAF can produce good aesthetic root coverage comparable to SCTG and PRF, where width of keratinized gingiva is adequate.

Role of Placental Extracts in Periodontal Regeneration: A Literature Review

Periodontium is a specialized tissue surrounding the teeth. It is made up of the gingiva, periodontal ligament, cementum, and alveolar bone. The healing of periodontal tissues when infected occurs through repair and regeneration. The central dogma of regenerative periodontics is to stimulate a cascade of healing events that, if coordinated well, can lead to proper tissue synthesis which in turn would play a very important part in managing periodontitis and preventing tooth loss.

Many regenerative procedures are being followed in periodontics using newer and modified barrier membranes. Placental membranes like amnion, chorion and amnion-chorion membranes are one among these that serve the purpose because of their active components and therapeutic effects. This literature review highlights the benefits of placental extracts in regenerative periodontal therapy.