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Chambrone L, Coccaro M, Montaño AJ, Lafaurie GI. The influence of tobacco smoking on the outcomes achieved by root coverage procedures: An updated systematic review. J ESTHET RESTOR DENT 2024. [PMID: 39138953 DOI: 10.1111/jerd.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE This updated version of a systematic review (SR) originally published in 2009 evaluated the effect of smoking on the clinical outcomes achieved with root coverage (RC) procedures in the treatment of gingival recession (GR) defects. MATERIALS AND METHODS This SR includes randomized controlled trials, controlled clinical trials, and case series with a minimum follow-up of 6 months. Eligible studies involved GR defects without interproximal tissue loss submitted to RC procedures, as well as outcome measures from smokers (i.e., those smoking 10 or more cigarettes per day at baseline) and nonsmokers, recorded separately. Three electronic databases were searched up to March 31, 2024. Random effects meta-analyses were conducted thoroughly. RESULTS A total of 12 studies reporting on 181 smokers and 162 nonsmokers, submitted to different RC procedures, were included. Half of these trials were originally included in the 2009 SR, whereas the other half (six studies) were included in this update. Nonsmokers experienced greater reductions in GR and gains in clinical attachment level compared to smokers. Pooled estimates comparing smokers and nonsmokers who received coronally advanced flap (CAF) alone and subepithelial connective tissue graft (SCTG) + CAF showed that nonsmokers achieved greater mean root coverage (MRC) in both treatments. Significant differences in MRC of 10.85% (95% CI, 1.92 to 19.77) and 22.04 (95% CI, 14.25 to 29.83), favoring nonsmokers, were identified for CAF and SCTG + CAF, respectively. Similarly, nonsmokers treated with SCTG + CAF displayed superior number of sites exhibiting complete root coverage (CRF) when compared with smokers (risk ratio, 4.12; 95% CI, 1.73 to 9.80). CONCLUSIONS Smoking negatively impacts the outcomes of RC procedures, particularly those achieved by SCTG-based procedures. CLINICAL SIGNIFICANCE Smoking was linked to poorer RC outcomes. These outcomes highlight the critical need to integrate smoking cessation into periodontal treatment plans.
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Affiliation(s)
- Leandro Chambrone
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
- Evidence-based hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
- Department of Periodontics, School of Dental Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Miguelángel Coccaro
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
- Master of Science Dentistry Program, School of Dentistry, Universidad El Bosque, Bogota, Colombia
| | - Andrea Juliana Montaño
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
| | - Gloria Inés Lafaurie
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
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Rieder M, Wimmer G, Sokolowski A, Sokolowski A, Payer M, Arefnia B. Treatment of Localized Gingival Recession with an Enamel Matrix Protein-Coated Xenogeneic Dermal Matrix: A Randomized Controlled Trial. MATERIALS (BASEL, SWITZERLAND) 2024; 17:3985. [PMID: 39203163 PMCID: PMC11355834 DOI: 10.3390/ma17163985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024]
Abstract
This study aims to evaluate the influence of the additional use of enamel matrix derivate (EMD) in the treatment of gingival recession defects using a coronally advanced flap (CAF) and a xenogeneic dermal matrix (XDM) by means of digital and clinical assessment methods. In this prospective randomized controlled study, recession height and area, width and thickness of keratinized gingiva, pocket probing depth, and clinical attachment levels were measured at the baseline and followed up for one year. Fifteen patients (n = 15) with 24 gingival recession defects were treated between 2019 and 2021. On average, the digitally assessed root coverage of the control group (CAF + XDM) was not significantly different compared to the test group (CAF + XDM + EMD), with 69 ± 28% and 36 ± 32%, respectively (p = 0.094). One year postoperatively, there were no differences found regarding keratinized tissue width (KTW) between the control group and test group (p = 0.690). However, the control group showed superior results in the thickness of keratinized gingiva (p = 0.044). The present study showed that there were no statistically significant differences in the root coverage results in the CAF + XDM + EMD group compared to the CAF + XDM group. The adjunctive use of EMD to a CAF and XDM in the treatment of gingival recession defects does not appear to have any clinical benefit.
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Affiliation(s)
- Marcus Rieder
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria;
| | - Gernot Wimmer
- Division of Restorative Dentistry, Periodontology and Prosthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria; (G.W.); (A.S.); (A.S.)
| | - Alwin Sokolowski
- Division of Restorative Dentistry, Periodontology and Prosthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria; (G.W.); (A.S.); (A.S.)
| | - Armin Sokolowski
- Division of Restorative Dentistry, Periodontology and Prosthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria; (G.W.); (A.S.); (A.S.)
| | - Michael Payer
- Division of Oral Surgery and Orthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria;
| | - Behrouz Arefnia
- Division of Restorative Dentistry, Periodontology and Prosthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria; (G.W.); (A.S.); (A.S.)
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De Lauretis A, Øvrebø Ø, Romandini M, Lyngstadaas SP, Rossi F, Haugen HJ. From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308848. [PMID: 38380549 PMCID: PMC11077667 DOI: 10.1002/advs.202308848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/23/2024] [Indexed: 02/22/2024]
Abstract
Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.
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Affiliation(s)
- Angela De Lauretis
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Øystein Øvrebø
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Mario Romandini
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Ståle Petter Lyngstadaas
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
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Chambrone L, Barootchi S, Avila-Ortiz G. Efficacy of biologics in root coverage and gingival augmentation therapy: An American Academy of Periodontology best evidence systematic review and network meta-analysis. J Periodontol 2022; 93:1771-1802. [PMID: 36279123 DOI: 10.1002/jper.22-0075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this systematic review was to assess the efficacy of three biologics, namely autologous blood-derived products (ABPs), enamel matrix derivatives (EMD) and recombinant human platelet-derived growth factor BB (rhPDGF-BB), in root coverage and gingival augmentation therapy. METHODS The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021285917). After study selection, data of interest were extracted. A network meta-analysis (NMA) was conducted to assess the effect of different surgical interventions on the main clinical outcomes of interest (i.e., mean root coverage [MRC%], complete root coverage [CRC%], keratinized tissue width [KTW], gingival thickness [GT] change, and recession depth [RD] reduction). RESULTS A total of 48 trials reported in 55 articles were selected. All studies reported on the treatment of gingival recession defects for root coverage purposes. Forty-six treatment arms from 24 trials were included in the NMA. These arms consisted of treatment with coronally advanced flap (CAF) alone, EMD + CAF, platelet-rich fibrin (PRF) + CAF, and subepithelial connective tissue graft (SCTG) + CAF. Regarding MRC%, SCTG+CAF was associated with a significant higher estimate (13.41%, 95% CI [8.06-18.75], P < 0.01), while EMD+CAF (6.68%, 95% CI [-0.03 to 13.4], P = 0.061) and PRF+CAF (1.03%, 95% CI [-5.65 to 7.72], P = 0.71) failed to show statistically significant differences compared with CAF alone (control group) or with each other. Similarly, only SCTG+CAF led to a significantly higher CRC% (14.41%, 95% CI [4.21 to 24.61], P < 0.01), while treatment arms EMD + CAF (13.48%, 95% CI [-3.34 to 30.32], P = 0.11) and PRF+CAF (-0.91%, 95% CI [-15.38, 13.57], p = 0.81) did not show significant differences compared with CAF alone or with each other. Differences in the CI of PRF+CAF (symmetrical around a zero adjunctive effect) and EMD+CAF (non-symmetrical) suggest that EMD could have some additional value compared with PRF. Treatment with SCTG+CAF led to a statistically significant higher RD reduction (-0.39 mm, 95% CI [-0.55 to 0.22], P < 0.01), however EMD+CAF (-0.13 mm, 95% CI [-0.29 to 0.01], P = 0.08) and PRF+CAF (-0.06 mm, 95% CI [-0.23 to 0.09], P = 0.39) failed to show significant differences compared with CAF or with each other. While SCTG+CAF was associated with a statistically significant higher gain of KTW (0.71 mm, 95% CI [0.48 to 0.93], P < 0.01), EMD+CAF (0.24 mm, 95% CI [-0.02 to 0.51], P = 0.08) and PRF+CAF (0.08 mm, 95% CI [-0.23 to 0.41], P = 0.58) did not result into significant changes compared with CAF alone or with each other. Regarding the use of rhPDGF-BB+CAF, although available studies have reported equivalent results compared with SCTG+CAF, evidence is very limited. CONCLUSIONS The use of ABPs, EMD, or rhPDGF-BB in conjunction with a CAF for root coverage purposes is safe and generally promotes significant improvements respective to baseline clinical parameters. However, the adjunctive use of ABPs and EMD does not provide substantial additional improvements in terms of clinical outcomes and patient-reported outcome measures to those achieved using CAF alone, when baseline KTW is >2 mm. Both PRF+CAF and EMD+CAF rendered inferior MRC%, CRC%, RD reduction, and KTW gain compared with SCTG+CAF, which should still be considered the gold-standard in root coverage therapy. Although some studies have reported equivalent results for rhPDGF-BB+CAF compared with the gold-standard intervention, limited evidence precludes formal comparisons with CAF or SCTG+CAF that could be extrapolated to guide clinical practice.
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Affiliation(s)
- Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Graduate Dentistry Program, School of Dentistry, Ibirapuera University, São Paulo, Brazil.,Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia.,Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
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5
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Blasi G, Monje A, Muñoz-Peñalver J, Oates TW, Avila-Ortiz G, Nart J. Influence of vestibular depth on the outcomes of root coverage therapy: A prospective case series study. J Periodontol 2022; 93:1857-1866. [PMID: 35482935 DOI: 10.1002/jper.21-0638] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the influence of vestibular depth (VD) on the outcomes of root coverage therapy. METHODS Patients presenting gingival recession defects (GRD) with a minimum depth of 2 mm underwent root coverage therapy consisting of a coronally advanced flap plus a connective tissue graft (CAF + CTG). Clinical examinations were performed, and intraoral scans were obtained at baseline, 3 and 6 months after surgery to assess changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), GRD area, marginal gingival thickness (MGT), and VD. The influence of VD on percentage of root coverage (%RC) and the likelihood of achieving complete root coverage (CRC) were explored. RESULTS A total of 20 patients were enrolled, and 44 teeth were treated. RD decreased and MGT increased in all treated sites. At 6 months, mean %RC was 87.47 ± 18.37 and CRC was observed in 61.4% of sites. Mean baseline VD was 7.33 ± 2.67 mm. Mean VD reduction from baseline to 6 months was 1.98 ± 1.27 mm. %RC and CRC were significantly correlated with baseline VD. Each additional 1 mm of baseline VD implied a gain of 6.58% for %RC and increased 2.75 times the probability of achieving CRC. Narrow baseline KTW and mandibular arch location were associated with inferior treatment outcomes. CONCLUSION Lower %RC and likelihood of achieving CRC can be expected after root coverage therapy via CAF + CTG in sites presenting a shallow vestibulum.
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Affiliation(s)
- Gonzalo Blasi
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain.,Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore School of Dentistry, Baltimore, Maryland, USA
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jesus Muñoz-Peñalver
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
| | - Thomas W Oates
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore School of Dentistry, Baltimore, Maryland, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, Iowa, USA
| | - Jose Nart
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
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Connective Tissue Graft with or without Enamel Matrix Derivative for Treating Gingival Recession Defects: A Systematic Review and Meta-Analysis. J Evid Based Dent Pract 2021; 21:101635. [PMID: 34922714 DOI: 10.1016/j.jebdp.2021.101635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/25/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this systematic review is to compare the root coverage outcomes of using a connective tissue graft (CTG) with and without the application of enamel matrix derivative (EMD). METHODOLOGY An electronic search was performed up to July 2020 in 4 databases, including Ovid MEDLINE, EMBASE, Web of Science and Cochrane Central. Human clinical studies with data on comparing outcomes of root coverage using CTG with and without the application of EMD were included. Meta-analyses for the recorded parameters were performed and the weighted mean difference (WMD) between the 2 groups and 95% confidence interval (CI) were reported. RESULTS Nine clinical studies were selected for inclusion in this review. The WMD of clinical attachment level gain was 0.78 mm (95% CI of 0.23-1.34 mm, P = .005) and the WMD of recession depth reduction was 0.28 mm (95% CI of 0.06-0.51 mm, P = .01), favoring the CTG + EMD approach. However, the comparisons for the percentage of complete root coverage and mean root coverage between the 2 approaches were not statistically significant. CONCLUSION Although the use of a CTG with and without the application of EMD in root coverage procedures achieved a similar percentage of complete root coverage and mean root coverage, the addition of EMD to CTG may improve the outcome of recession depth reduction and clinical attachment level gain.
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Panda S, Khijmatgar S, Arbildo-Vega H, Das AC, Kumar M, Das M, Mancini L, Del Fabbro M. Stability of biomaterials used in adjunct to coronally advanced flap: A systematic review and network meta-analysis. Clin Exp Dent Res 2021; 8:421-438. [PMID: 34845864 PMCID: PMC8874057 DOI: 10.1002/cre2.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 12/26/2022] Open
Abstract
AIM The objective of this network meta-analysis was to rank different biomaterials used in adjunct to coronally advanced flap (CAF), based on their performance in root-coverage for Miller's Class I and II gingival recessions. MATERIALS AND METHODS An electronic database search was carried out in PUBMED, CENTRAL, SCOPUS, and EMBASE to identify the eligible articles and compiled into the citation manager to remove the duplicates. The primary outcome was keratinized gingival tissue width (KGW) and percentage of root coverage (%RC). The treatment effect of different biomaterials was estimated using predictive interval plots and ranked based on biomaterials performance, using multidimensional scale ranking. RESULTS CAF + connective tissue graft (CTG), CAF + platelet concentrate matrix (PCM) and acellular dermal matrix (ADM) ranked at the top positions in performance in improving KGW. The highest ranked materials in improving percentage of root coverage in gingival recession were CAF + collagen matrix (CM) + gingival fibroblasts (GF), CAF + ADM + platelet rich plasma (PRP) and CAF + ADM, as compared to CAF alone. CONCLUSION CTG, ADM, platelet concentrates, and CM + GFs, when used in adjunct to CAF, showed improved stability over ≥12 months of follow-up, better percentage of root coverage, and improved keratinized gingival width.
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Affiliation(s)
- Sourav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Oral Biology and Genomic Studies, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, India
| | - Heber Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo, Peru
| | - Abhaya Chandra Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Manoj Kumar
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Mohit Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Leonardo Mancini
- Department of life health and environmental sciences, University of L'Aquila, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Shibli JA, Feres M, Figueiredo LC, Castro Dos Santos N, Retamal-Valdes B. Decontamination and Biomodification of Periodontally Affected Root Surface for Successful Regeneration: Is There Room for Improvement? Dent Clin North Am 2021; 66:11-38. [PMID: 34794549 DOI: 10.1016/j.cden.2021.06.001] [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: 11/28/2022]
Abstract
Periodontitis is a multifactorial inflammatory condition associated with an oral microbiome dysbiosis that results in gingival inflammation and clinical attachment loss. Periodontal therapies are based on scaling and root planing to disturb the bacterial biofilm mechanically and remove calculus and contaminated cementum. Research does not support the use of root modifiers for decontamination and biomodification of periodontally affected root surfaces. Standardized clinical trials in large populations, assessing biological and patient-reported outcome measures, are necessary to evaluate candidate biomaterials for decontamination and biomodification of periodontally affected root surfaces.
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Affiliation(s)
- Jamil Awad Shibli
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil.
| | - Magda Feres
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil
| | - Luciene C Figueiredo
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil
| | - Nidia Castro Dos Santos
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil.
| | - Belen Retamal-Valdes
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil
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Miguel MMV, Mathias-Santamaria IF, Rossato A, Ferraz LFF, Rangel TP, Casarin RCV, Tatakis DN, Santamaria MP. Enamel matrix derivative effects on palatal mucosa wound healing: Randomized clinical trial. J Periodontal Res 2021; 56:1213-1222. [PMID: 34541683 DOI: 10.1111/jre.12934] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study was conducted to evaluate the clinical, immunologic, and patient-centered outcomes of enamel matrix protein derivative (EMD) on excisional wounds in palatal mucosa. MATERIALS Forty-four patients in need of ridge preservation were randomly allocated into two groups: control group (n = 22): open palatal wound after free gingival graft (FGG) harvest and EMD group (n = 22): open palatal wound after FGG harvest that received 0.3 ml of EMD. Clinical and patient-centered parameters were analyzed for 3 months post-treatment. Wound fluid levels of inflammatory markers were assessed 3 and 7 days postoperatively. RESULTS No significant inter-group difference was observed in remaining wound area and re-epithelialization. EMD and control groups achieved wound closure and re-epithelialization 30 days postoperatively (p < .001), without inter-group differences. Similarly, number of analgesics and Oral Health Impact Profile scores did not present significant inter-group differences (p > .05). EMD appeared to selectively modulate wound fluid levels of monocyte chemoattractant protein-1, macrophage inflammatory protein-1α, matrix metallopeptidase 9, and tissue inhibitor of metalloproteinases-2. CONCLUSION Within the limits of the present study, it can be concluded that EMD application to excisional palatal wounds using the investigated protocol does not provide clinical healing benefits, despite an apparent modulation of selected inflammatory markers.
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Affiliation(s)
- Manuela Maria Viana Miguel
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil
| | - Ingrid Fernandes Mathias-Santamaria
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil.,Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Amanda Rossato
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil
| | - Laís Fernanda Ferreira Ferraz
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil
| | - Thiago Perez Rangel
- Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, Piracicaba, Brazil
| | - Renato Corrêa Viana Casarin
- Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, Piracicaba, Brazil
| | - Dimitris N Tatakis
- College of Dentistry, Division of Periodontology, The Ohio State University (OSU), Columbus, Ohio, USA
| | - Mauro Pedrine Santamaria
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil.,College of Dentistry - Lexington, University of Kentucky, Lexington, Kentucky, USA
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10
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Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation. Clin Oral Investig 2021; 26:1453-1463. [PMID: 34536136 DOI: 10.1007/s00784-021-04119-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2 weeks). MATERIALS AND METHODS Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6 months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1β, IL-6, IL-8, FGF, MIP-1α and β, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14 days after procedures. RESULTS The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14 days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side. CONCLUSION The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process. CLINICAL RELEVANCE EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.
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Mercado F, Vaquette C, Hamlet S, Ivanovski S. Enamel matrix derivative promotes new bone formation in xenograft assisted maxillary anterior ridge preservation-A randomized controlled clinical trial. Clin Oral Implants Res 2021; 32:732-744. [PMID: 33715279 DOI: 10.1111/clr.13742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To compare the effectiveness of deproteinized bovine bone mineral with 10% collagen alone (DBBMC) or with enamel matrix derivative (DBBMC-EMD) in ridge preservation. METHODS 42 maxillary anterior teeth were extracted and received either a DBBMC (control) or DBBMC-EMD (test) treatment protocol. CBCT taken before and 4 months after the extraction procedure was used to measure changes in alveolar ridge width (RW), buccal bone height (BH) and palatal bone height (PH). Bone cores were harvested during implant osteotomy preparation, and the samples processed histomorphometrically to assess the fraction of new bone (%NB), residual graft (%RG) and soft tissue matrix (%STM). RESULTS Overall, both treatment groups showed significant reductions in mean RW from baseline to 4 months after extraction, but no significant change in either mean BH or PH over this time. When CBCT measurements were analysed according to the initial thickness of the buccal wall (BT < 1 mm vs. BT ≥ 1 mm), significant reductions in all ridge dimensions (RW, BH and PH) were noted in the <1 mm BT group. Histomorphometrically, the DBBMC-EMD test group showed significantly increased new bone formation (%NB): (control = 16.5 ± 6.9% cf.; test = 45.1 ± 8.8%) with less residual graft (%RG): (control = 36.8 ± 8.8% cf.; test = 20.3 ± 7.2%) compared to the DBBMC control group. CONCLUSIONS Both DBBMC alone and DBBMC-EMD treated sites 4 months after extraction lost RW but showed no significant change in BH or PH. Irrespective of treatment, maxillary anterior teeth with thick initial buccal walls (≥1 mm) exhibited less alveolar ridge reduction 4 months after treatment. The addition of EMD to DBBMC resulted in more new bone formation in the test group.
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Affiliation(s)
- Faustino Mercado
- School of Dentistry and Oral Health, Griffith University, Gold Coast, QLD, Australia.,School of Dentistry, University of Queensland, Brisbane, QLD, Australia
| | - Cedryck Vaquette
- School of Dentistry, University of Queensland, Brisbane, QLD, Australia
| | - Stephen Hamlet
- School of Dentistry and Oral Health, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia
| | - Sašo Ivanovski
- School of Dentistry, University of Queensland, Brisbane, QLD, Australia
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Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis. Clin Oral Investig 2021; 25:1613-1626. [PMID: 33474623 DOI: 10.1007/s00784-021-03782-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/06/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth. METHODS Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of p value. RESULTS From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (p ≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (p ≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW. CONCLUSION The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12 months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use. CLINICAL RELEVANCE To know if EMD could improve the results for root coverage.
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Cairo F, Barootchi S, Tavelli L, Barbato L, Wang HL, Rasperini G, Graziani F, Tonetti M. Aesthetic-And patient-related outcomes following root coverage procedures: A systematic review and network meta-analysis. J Clin Periodontol 2020; 47:1403-1415. [PMID: 32654220 DOI: 10.1111/jcpe.13346] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort). MATERIAL AND METHODS A comprehensive literature search was performed. A mixed-modelling approach to network meta-analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and post-operative pain/discomfort (visual analogue scale (VAS) of 100). RESULTS Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p = .01) and CAF + Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p = .04)) were significantly associated with higher RES than CAF. No significant difference between CAF + CTG and TUN + CTG was detected (0.09 (95% CI [-0.54, 0.72], p = .77)). Addition of CTG resulted in less natural tissue texture (-0.21 (95% CI [-0.34, -0.08]), p = .003) and gingival colour (-0.06 (95% CI [-0.12, -0.03], p = .03)) than CAF. CTG techniques were associated with increased morbidity. CONCLUSIONS Connective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.
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Affiliation(s)
- Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Giulio Rasperini
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical Surgical and Dental Sciences Foundation IRCCS Ca' Granda Policlinic, University of Milan, Milan, Italy
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Division of Periodontology, Faculty of Dentistry, Hong Kong University, Hong Kong, China.,Department of Oral and Maxillo-Facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Stomatology, Shanghai Ninth People Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Mercado F, Hamlet S, Ivanovski S. A 3-year prospective clinical and patient-centered trial on subepithelial connective tissue graft with or without enamel matrix derivative in Class I-II Miller recessions. J Periodontal Res 2019; 55:296-306. [PMID: 31808142 DOI: 10.1111/jre.12715] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVE The study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of Class I-II Miller periodontal recession defects. MATERIAL AND METHODS This prospective clinical study evaluated 80 patients over a 3 years follow-up in a private periodontal practice. A total of 144 maxillary and mandibular anterior teeth were divided into two groups: group 1 (CTG with EMD-80 teeth) and group 2 (CTG only-64 teeth). Recession (REC), keratinized tissue (KT) width, % root overage, patient-centered outcomes, and pain visual analog scale (P-VAS) were compared between the two groups. RESULTS At 3 years follow-up at a patient level, statistically significant changes in REC were achieved in both group 1 (4.65 ± 1.84 to 0.39 ± 0.19 mm) and group 2 (4.43 ± 1.11 to 0.92 ± 0.43 mm). Complete root coverage (CRC) was achieved in 66.4% of group 1 and 50.1% of group 2. At both patient and tooth level, the 3-year outcomes were superior for group 1 compared with group 2 in terms of % root coverage, REC, and KT width. Clinical attachment loss (CAL) was reduced in group 1 compared with group 2 at the tooth level analysis only (<.01). Significantly less pain was reported using the pain visual analog Scale (P < .001) at the two weeks follow-up post-surgery in group 1. CONCLUSIONS Addition of EMD results in improved root coverage outcomes and higher amounts of keratinized tissue width 36 months after treatment of multiple adjacent recessions on maxillary and mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days after the surgery.
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Affiliation(s)
- Faustino Mercado
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia.,School of Dentistry, University of Queensland, Brisbane, Qld, Australia
| | - Stephen Hamlet
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
| | - Sašo Ivanovski
- School of Dentistry, University of Queensland, Brisbane, Qld, Australia
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Mercado F, Hamlet S, Ivanovski S. Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of multiple Class III-IV recessions in lower anterior teeth: A 3-year randomized clinical trial. J Periodontol 2019; 91:473-483. [PMID: 31561272 DOI: 10.1002/jper.19-0058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of multiple Class III-IV Miller periodontal recession (REC) defects on mandibular anterior teeth. METHODS This randomized clinical study evaluated 41 patients at 3 years follow-up. One hundred and fifty-six teeth were divided into two groups: test (CTG-EMD, 79 teeth) and control (CTG only, 77 teeth). Clinical REC, keratinized tissue (KT) width, percentage of root coverage, patient-centered outcomes were compared between the two groups. RESULTS At 36 months follow-up, patient level analysis showed that REC in the test group reduced significantly (5.71 ± 0.58 mm to 1.57 ± 0.85 mm) compared with the control group (5.94 ± 0.46 mm to 2.51 ± 0.62 mm) (P < 0.001), while KT width increased in the test group (1.51 ± 0.26 mm to 4.18 ± 0.34 mm) and was significantly greater than the control group (1.65 ± 0.21 mm to 2.90 ± 0.20 mm) (P < 0.001). At 36 months, tooth level analysis (Class III and Class IV groups) found less residual REC and increased KT in the test group compared with the control group (P < 0.01). Significantly less pain was reported at 2, 7, and 14 days follow-up post-surgery in the test group (P < 0.001). CONCLUSIONS The addition of EMD to CTG results in improved root coverage outcomes and higher amounts of KT width 36 months after treatment of Class III-IV REC on mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days post-surgery.
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Affiliation(s)
- Faustino Mercado
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia.,School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Hamlet
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Saso Ivanovski
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
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Discepoli N, Mirra R, Ferrari M. Efficacy of Enamel Derivatives to Improve Keratinized Tissue as Adjunct to Coverage of Gingival Recessions: A Systematic Review and Meta-Analysis. MATERIALS 2019; 12:ma12172790. [PMID: 31480232 PMCID: PMC6747963 DOI: 10.3390/ma12172790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022]
Abstract
Background: The systematic review was designed to answer the following focused question: Are enamel matrix derivatives able to improve the quantity of keratinized tissue (KT) around natural dentition in patients with recessions defects after their treatment with periodontal plastic procedures? Methods: Only Randomized Clinical Trials (RCT) in English language evaluating root coverage procedures in combination with enamel matrix derivatives (commercially known as Emdogain®—EMD), with at least 10 subjects and a minimum duration of six months, were included. The search was applied to PUBMED and SCOPUS and it consists of a combination of MeSH terms and free text words (from January 2000 to June 2019). Risk of bias in individual studies and across studies was also evaluated. Results: After the full text analysis and the exclusion of further 18 articles, 12 articles were finally included. In total 639 recessions were treated (334 tests and 305 control). The recessions defects were classified according to the classification of Miller (Class I, II, III, IV). Only one trial included Miller Class III recessions (7 in total). Enamel matrix derivatives were applied in conjunction with Coronally Advanced Flap (CAF), Coronally Advanced Flap + Sub Epithelial Connective Tissue Graft (CAF + CTG), Semilunar Flap (SF). For the group CAF vs CAF + EMD the mean difference between the keratinized tissue gain in the two procedures was 0.40 mm (95% Confindence Interval Lower/Upper: 0.014–0.81) (p < 0.058); for the comparison CAF + CTG + EMD vs. CAF + CTG the mean difference between the two groups resulted in −0.06 mm (95% Confindence Interval Lower Upper −0.45 to 0.33) (p = 0.7603). Discussion: Randomized clinical trials included medium-low quality evidence. The application of Enamel Matrix Derivatives to surgical procedures aimed to cover gingival recessions does not add robust clinical benefit to conventional plastic procedure alone.
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Affiliation(s)
- Nicola Discepoli
- Department of Medical Biotechnologies, Unit of Periodontics, University of Siena, 53100 Siena, Italy.
| | - Raffaele Mirra
- Department of Medical Biotechnologies, Unit of Periodontics, University of Siena, 53100 Siena, Italy
| | - Marco Ferrari
- Department of Medical Biotechnologies, Unit of Prosthodontic and Fixed Material, University of Siena, 53100 Siena, Italy
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Sezgin Y, İnönü E. Serbest Dişeti Grefti Uygulamalarının Uzun Dönemde Yaşam Kalitesine Etkisinin Değerlendirilmesi. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.530329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Root surface demineralization by citric acid/tetracycline gel and aPDT associated to subepithelial connective tissue graft improves root coverage outcomes. A 12-month preliminary randomized clinical trial. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2019; 197:111528. [DOI: 10.1016/j.jphotobiol.2019.111528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/14/2019] [Accepted: 06/03/2019] [Indexed: 01/19/2023]
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Adam K, Staufenbiel I, Geurtsen W, Günay H. Root coverage using a connective tissue graft with epithelial striation in combination with enamel matrix derivatives - a long-term retrospective clinical interventional study. BMC Oral Health 2019; 19:148. [PMID: 31307447 PMCID: PMC6631897 DOI: 10.1186/s12903-019-0849-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background The application of a connective tissue graft with epithelial striation (CTG-ES) has been shown to improve the outcome of root coverage (RC) using the coronally advanced flap (CAF) and adjunctive administration of enamel matrix derivatives (EMD). Aim of the present study was to evaluate the long-term (mean: 16.19 ± 1.80 years, range: 13 to 18 years) stability of this treatment method with special focus on the location of the gingival margin and the width of keratinized tissue (WKT). Methods 16 patients (10 female, 6 male, aged 35.36 ± 14.70 years at surgery) with 25 Miller class I or II gingival recession (GR) defects were treated using the CAF combined with the CTG-ES and EMD. The clinical measurements recorded at baseline (t0), 6 months (t1), and 13 to 18 years (t2) after surgery included recession depth (RED), probing pocket depth (PPD), clinical attachment level (CAL), and WKT. In addition, the number of sites with complete RC (CRC) and the mean RC (MRC) were documented at t1 and t2. The statistical analysis was performed using a linear mixed model. Results The RED (t0: 4.52 ± 1.56 mm; t1: 0.36 ± 0.76 mm; t2: 0.30 ± 0.60 mm) and CAL (t0: 6.16 ± 1.62 mm; t1: 1.86 ± 0.87 mm; t2: 1.54 ± 0.92 mm) were significantly reduced at t1 and t2 compared to t0 (p < 0.001). The PPD was significantly reduced at t2 compared to t0 (p = 0.016). The WKT (t0: 1.18 ± 1.28 mm; t1: 3.26 ± 0.98 mm; t2: 4.26 ± 1.83 mm) significantly increased from t0 to t1, from t0 to t2 (p < 0.001) and from t1 to t2 (p = 0.007). A CRC was recorded at 19 sites (76.0%) at t1 and t2. The MRC was 93.6 ± 12.8% at t1 and 93.3 ± 13.3% at t2. Conclusions The use of the CAF combined with CTG-ES and EMD leads to stable long-term outcomes on teeth with Miller Class I or II GR defects. The CTG-ES represents a hybrid graft with increased position stability and advantageous properties for the healing process. We assume that the ES is responsible for the increase of the WKT.
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Affiliation(s)
- Knut Adam
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Ingmar Staufenbiel
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Werner Geurtsen
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hüsamettin Günay
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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AYDINYURT HS, TEKIN Y, ERTUGRUL AS. The effect of enamel matrix derivatives on root coverage: a 12-month follow-up of a randomized clinical trial. Braz Oral Res 2019; 33:e006. [DOI: 10.1590/1807-3107bor-2019.vol33.0006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 12/06/2018] [Indexed: 11/22/2022] Open
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Split-mouth evaluation of connective tissue graft with or without enamel matrix derivative for the treatment of isolated gingival recession defects in dogs. Clin Oral Investig 2018; 23:3339-3349. [PMID: 30506228 DOI: 10.1007/s00784-018-2750-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The potential additive effect of an enamel matrix derivative (EMD) to a subepithelial connective tissue graft (CTG) for recession coverage is still controversially discussed. Therefore, the aim of this study was to histologically evaluate the healing of gingival recessions treated with coronally advanced flap (CAF) and CTG with or without EMD in dogs. MATERIALS AND METHODS Gingival recession defects (5 mm wide and 7 mm deep) were surgically created on the labial side of bilateral maxillary canines in 7 dogs. After 8 weeks of plaque accumulation and subsequent 2 weeks of chemical plaque control, the 14 chronic defects were randomized to receive either CAF with CTG (CAF/CTG) or CAF with CTG and EMD (CAF/CTG/EMD). The animals were sacrificed 10 weeks after reconstructive surgery for histologic evaluation. RESULTS Treatment with CAF/CTG/EMD demonstrated statistically significantly better results in terms of probing pocket depth reduction (P < 0.05) and clinical attachment level gain (P < 0.001). The length of the epithelium was statistically significantly shorter in the CAF/CTG/EMD group than in the CAF/CTG group (1.00 ± 0.75 mm vs. 2.38 ± 1.48 mm, respectively, P < 0.01). Cementum formation was statistically significantly greater in the CAF/CTG/EMD group than following treatment with the CAF/CTG group (3.20 ± 0.89 mm vs. 1.88 ± 1.58 mm, respectively, P < 0.01). The CAF/CTG/EMD group showed statistically significantly greater complete periodontal regeneration (i.e., new cementum, new periodontal ligament, and new bone) than treatment with CAF/CTG (0.54 ± 0.73 mm vs. 0.07 ± 0.27 mm, respectively, P < 0.05). CONCLUSION Within their limits, the present findings indicate that the additional use of EMD in conjunction with CAF + CTG favors periodontal regeneration in gingival recession defects. CLINICAL RELEVANCE The present findings support the use of EMD combined with CTG and CAF for promoting periodontal regeneration in isolated gingival recession defects.
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Effect of EDTA root conditioning on the outcome of coronally advanced flap with connective tissue graft: a systematic review and meta-analysis. Clin Oral Investig 2018; 22:2727-2741. [DOI: 10.1007/s00784-018-2635-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
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Chambrone L, Salinas Ortega MA, Sukekava F, Rotundo R, Kalemaj Z, Buti J, Pini Prato GP. Root coverage procedures for treating localised and multiple recession-type defects. Cochrane Database Syst Rev 2018; 10:CD007161. [PMID: 30277568 PMCID: PMC6517255 DOI: 10.1002/14651858.cd007161.pub3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable root coverage periodontal plastic surgery (RCPPS) procedures. This review is an update of the original version that was published in 2009. OBJECTIVES To evaluate the efficacy of different root coverage procedures in the treatment of single and multiple recession-type defects. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (searched 15 January 2018), MEDLINE Ovid (1946 to 15 January 2018), and Embase Ovid (1980 to 15 January 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 January 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) only of at least 6 months' duration evaluating recession areas (Miller's Class I or II ≥ 3 mm) and treated by means of RCPPS procedures. DATA COLLECTION AND ANALYSIS Screening of eligible studies, data extraction and risk of bias assessment were conducted independently and in duplicate. Authors were contacted for any missing information. We expressed results as random-effects models using mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes with 95% confidence intervals (CI). We used GRADE methods to assess the quality of the body of evidence of our main comparisons. MAIN RESULTS We included 48 RCTs in the review. Of these, we assessed one as at low risk of bias, 12 as at high risk of bias and 35 as at unclear risk of bias. The results indicated a greater reduction in gingival recession for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (MD -0.37 mm; 95% CI -0.60 to -0.13, P = 0.002; 3 studies; 98 participants; low-quality evidence). There was insufficient evidence of a difference in gingival recession reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix protein (EMP) + CAF and SCTG + CAF. Regarding clinical attachment level changes, GTR rm + CAF promoted additional gains compared to SCTG + CAF (MD 0.35; 95% CI 0.06 to 0.63, P = 0.02; 3 studies; 98 participants; low-quality evidence) but there was insufficient evidence of a difference between ADMG + CAF and SCTG + CAF or between EMP + CAF and SCTG + CAF. Greater gains in the keratinized tissue were found for SCTG + CAF when compared to EMP + CAF (MD -1.06 mm; 95% CI -1.36 to -0.76, P < 0.00001; 2 studies; 62 participants; low-quality evidence), and SCTG + CAF when compared to GTR rm + CAF (MD -1.77 mm; 95% CI -2.66 to -0.89, P < 0.0001; 3 studies; 98 participants; very low-quality evidence). There was insufficient evidence of a difference in keratinized tissue gain between ADMG + CAF and SCTG + CAF. Few data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure. AUTHORS' CONCLUSIONS Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for treating localised or multiple recession-type defects. The available evidence base indicates that in cases where both root coverage and gain in the width of keratinized tissue are expected, the use of subepithelial connective tissue grafts shows a slight improvement in outcome. There is also some weak evidence suggesting that acellular dermal matrix grafts appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by subepithelial connective tissue grafts. RCTs are necessary to identify possible factors associated with the prognosis of each RCPPS procedure. The potential impact of bias on these outcomes is unclear.
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Affiliation(s)
| | | | | | | | | | - Jacopo Buti
- UCL Eastman Dental InstituteUnit of PeriodontologyLondonUK
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Rocha dos Santos M, Sangiorgio JPM, Neves FLDS, França-Grohmann IL, Nociti FH, Silverio Ruiz KG, Santamaria MP, Sallum EA. Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part II: Patient-Reported Outcomes. J Periodontol 2017; 88:1319-1328. [DOI: 10.1902/jop.2017.170127] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Manuela Rocha dos Santos
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - João Paulo Menck Sangiorgio
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Felipe Lucas da Silva Neves
- Department of Diagnosis and Surgery, Division of Periodontics, State University of São Paulo Campus, São José dos Campos, Brazil
| | - Isabela Lima França-Grohmann
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Francisco Humberto Nociti
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Karina Gonzales Silverio Ruiz
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Mauro Pedrine Santamaria
- Department of Diagnosis and Surgery, Division of Periodontics, State University of São Paulo Campus, São José dos Campos, Brazil
| | - Enilson Antonio Sallum
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
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Sangiorgio JPM, Neves FLDS, Rocha Dos Santos M, França-Grohmann IL, Casarin RCV, Casati MZ, Santamaria MP, Sallum EA. Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part I: Clinical Outcomes. J Periodontol 2017; 88:1309-1318. [PMID: 28753100 DOI: 10.1902/jop.2017.170126] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Considering xenogeneic collagen matrix (CM) and enamel matrix derivative (EMD) characteristics, it is suggested that their combination could promote superior clinical outcomes in root coverage procedures. Thus, the aim of this parallel, double-masked, dual-center, randomized clinical trial is to evaluate clinical outcomes after treatment of localized gingival recession (GR) by a coronally advanced flap (CAF) combined with CM and/or EMD. METHODS Sixty-eight patients presenting one Miller Class I or II GRs were randomly assigned to receive either CAF (n = 17); CAF + CM (n = 17); CAF + EMD (n = 17), or CAF + CM + EMD (n = 17). Recession height, probing depth, clinical attachment level, and keratinized tissue width and thickness were measured at baseline and 90 days and 6 months after surgery. RESULTS The obtained root coverage was 68.04% ± 24.11% for CAF; 87.20% ± 15.01% for CAF + CM; 88.77% ± 20.66% for CAF + EMD; and 91.59% ± 11.08% for CAF + CM + EMD after 6 months. Groups that received biomaterials showed greater values (P <0.05). Complete root coverage (CRC) for CAF + EMD was 70.59%, significantly superior to CAF alone (23.53%); CAF + CM (52.94%), and CAF + CM + EMD (51.47%) (P <0.05). Keratinized tissue thickness gain was significant only in CM-treated groups (P <0.05). CONCLUSIONS The three approaches are superior to CAF alone for root coverage. EMD provides highest levels of CRC; however, the addition of CM increases gingival thickness. The combination approach does not seem justified.
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Affiliation(s)
- João Paulo Menck Sangiorgio
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Felipe Lucas da Silva Neves
- Department of Diagnosis and Surgery, Division of Periodontics, State University of São Paulo Campus, São José dos Campos, Brazil
| | - Manuela Rocha Dos Santos
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Isabela Lima França-Grohmann
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Renato Corrêa Viana Casarin
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Márcio Zaffalon Casati
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Mauro Pedrine Santamaria
- Department of Diagnosis and Surgery, Division of Periodontics, State University of São Paulo Campus, São José dos Campos, Brazil
| | - Enilson Antonio Sallum
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
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Cairo F, Pagliaro U, Buti J, Baccini M, Graziani F, Tonelli P, Pagavino G, Tonetti MS. Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta-analysis. J Clin Periodontol 2016; 43:965-975. [PMID: 27454460 DOI: 10.1111/jcpe.12603] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to perform a systematic review (SR) of randomized controlled trials (RCTs) to explore if periodontal plastic surgery procedures for the treatment of single and multiple gingival recessions (Rec) may improve aesthetics at patient and professional levels. MATERIAL AND METHODS In order to combine evidence from direct and indirect comparisons by different trials a Bayesian network meta-analysis (BNM) was planned. A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until January 2016 was conducted to identify RCTs presenting aesthetic outcomes after root coverage using standardized evaluations at patient and professional level. RESULTS A total of 16 RCTs were selected in the SR; three RTCs presenting professional aesthetic evaluation with Root coverage Aesthetic Score (RES) and three showing final self-perception using the Visual Analogue Scale (VAS Est) could be included in a BNM model. Coronally Advanced Flap plus Connective Tissue Graft (CAF + CTG) and CAF + Acellular Dermal Matrix (ADM) and Autologous Fibroblasts (AF) were associated with the best RES outcomes (best probability = 24% and 64%, respectively), while CAF + CTG and CAF + CTG + Enamel matrix Derivatives (EMD) obtained highest values of VAS Est score (best probability = 44% and 26%, respectively). CONCLUSIONS Periodontal Plastic Surgery (PPS) techniques applying grafts underneath CAF with or without the adding of EMD are associated with improved aesthetics assessed by final patient perception and RES as professional evaluation system.
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Affiliation(s)
- Francesco Cairo
- Section of Periodontology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
| | | | - Jacopo Buti
- School of Dentistry, University of Manchester, Manchester, UK
| | - Michela Baccini
- Department of Statistics, Informatics and Applications "G. Parenti", University of Florence, Florence, Italy.,Biostatistics Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | - Filippo Graziani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Paolo Tonelli
- Section of Oral Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Gabriella Pagavino
- Section of Endodontics, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Maurizio S Tonetti
- European Research Group on Periodontology (ERGOPERIO), Berne, Switzerland
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Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, Donos N, Lyngstadaas SP, Deschner J, Dard M, Stavropoulos A, Zhang Y, Trombelli L, Kasaj A, Shirakata Y, Cortellini P, Tonetti M, Rasperini G, Jepsen S, Bosshardt DD. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol 2016; 43:668-83. [PMID: 26987551 DOI: 10.1111/jcpe.12546] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 12/27/2022]
Abstract
BACGROUND On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20 years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarström demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibres, and new alveolar bone formation. This pioneering work and vision by Lars Hammarström has paved the way to an enormous amount of publications related to its biological basis and clinical use. Twenty years later, it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium. AIMS This review article aims to: (1) provide the biological background necessary to understand the rational for the use of EMD for periodontal regeneration, (2) present animal and human histological evidence of periodontal regeneration following EMD application, (3) provide clinically relevant indications for the use of EMD and (4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, Nova Southeastern University, Fort Lauderdale, Florida, USA.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - David L Cochran
- Department of Periodontics, Dental School, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stuart Froum
- Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlos Nemcovsky
- Department of Periodontology and Dental Implantology, Dental School, Tel-Aviv University, Tel-Aviv, Israel
| | - Nikos Donos
- Department of Periodontology, Queen Marry University of London, London, UK
| | | | - James Deschner
- Section of Experimental Dento-Maxillo-Facial Medicine, University of Bonn, Bonn, Germany
| | - Michel Dard
- New York University, College of Dentistry, New York, NY, USA
| | | | - Yufeng Zhang
- Department of Oral Implantology, Wuhan University, Wuhan, China
| | - Leonardo Trombelli
- Department of Periodotology, Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Adrian Kasaj
- Department of Operative Dentistry and Periodontology, University Medical Center, Mainz, Germany
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPerio), Genova, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Foundation IRCCS Ca' Granda Polyclinic, Milan, Italy
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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28
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Karam PSBH, Sant'Ana ACP, de Rezende MLR, Greghi SLA, Damante CA, Zangrando MSR. Root surface modifiers and subepithelial connective tissue graft for treatment of gingival recessions: a systematic review. J Periodontal Res 2015; 51:175-85. [PMID: 26095265 DOI: 10.1111/jre.12296] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Many techniques and flap designs have been used to treat gingival recession by root coverage, but subepithelial connective tissue graft (SCTG) seems to be the gold standard procedure. In an attempt to improve the healing process and increase the success rate of root coverage, some authors have used root modifiers, including different root conditioners, lasers, EMD, recombinant human growth factors and platelet-rich plasma (PRP). The aim of this systematic review was to evaluate the effects of root biomodification in clinical outcomes of gingival recessions treated with SCTG. MATERIAL AND METHODS Studies reporting SCTG associated with any form of root surface biomodification for root coverage of gingival recessions (Miller Class I and Class II) were considered as eligible for inclusion. Studies needed to have data of clinical outcomes in a follow up of at least 6 months. Screening of the articles, data extraction and quality assessment were conducted independently and in duplicate. RESULTS None of the products evaluated (citric acid, EDTA, PRP, lasers and EMD) showed evident benefits in clinical outcomes. Test and control groups presented similar outcomes related to root coverage and periodontal parameters, with no statistical differences between them. The exception was root biomodification with the neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, which impaired root coverage and had a detrimental effect on clinical outcomes. CONCLUSION Based on the present clinical data, the use of root surface modifiers to improve clinical outcomes in gingival recessions treated with SCTG is not justified. More in vivo studies, and randomized clinical trials with larger sample sizes and extended follow up, are necessary.
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Affiliation(s)
- P S B H Karam
- Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - A C P Sant'Ana
- Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - M L R de Rezende
- Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - S L A Greghi
- Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - C A Damante
- Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - M S R Zangrando
- Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil
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29
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Cheng GL, Fu E, Tu YK, Shen EC, Chiu HC, Huang RY, Yuh DY, Chiang CY. Root coverage by coronally advanced flap with connective tissue graft and/or enamel matrix derivative: a meta-analysis. J Periodontal Res 2014; 50:220-30. [DOI: 10.1111/jre.12199] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 01/04/2023]
Affiliation(s)
- G.-L. Cheng
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - E. Fu
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - Y.-K. Tu
- Institute of Epidemiology & Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | - E.-C. Shen
- Department of Dentistry; Buddhist Tzu Chi General Hospital, Taipei Branch; Taipei Taiwan
| | - H.-C. Chiu
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - R.-Y. Huang
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - D.-Y. Yuh
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
| | - C.-Y. Chiang
- Department of Periodontology; School of Dentistry; National Defense Medical Center; Tri-Service, General Hospital; Taipei Taiwan
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30
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Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 2014; 41 Suppl 15:S44-62. [DOI: 10.1111/jcpe.12182] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/06/2013] [Accepted: 10/13/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Francesco Cairo
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Florence; Florence Italy
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Siena; Siena Italy
| | - Michele Nieri
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Florence; Florence Italy
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Siena; Siena Italy
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31
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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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