Autologous connective tissue graft or xenogenic collagen matrix with coronally advanced flaps for coverage of multiple adjacent gingival recession. 36‐month follow‐up of a randomized multicentre trial

Abstract

Aim To report the 36‐month follow‐up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. Material and methods 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed‐up for 36 months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. Results No differences were observed between the randomized and the follow‐up population. Average baseline recession was 2.6 ± 1.0 mm. 3‐year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95% CI from −0.02 to 0.65 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6‐ and 36‐month follow‐up (difference 0.06 mm, 95% CI −0.17 to 0.29 mm). Conclusion CMX was not non‐inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision‐making.

Effectiveness of surgical root coverage on dentin hypersensitivity: A systematic review and meta‐analysis

“…Five studies were excluded because they did not report the method used to assess DH, and seven other studies were excluded as DH measurement was based only on patient opinion. In addition, three other studies (Rasperini et al, 2018; Neves et al, 2020; Tonetti et al, 2021) were excluded as they were published with the same patient sampling (further results) (Cortellini et al, 2009; Santamaria et al, 2017; Tonetti et al, 2018). Thus, a total of 13 studies were included in this systematic review and meta‐analysis.…”

“…The two other non-included studies Tonetti et al, 2021) had patients lost to follow-up compared with their respective original study (Cortellini et al, 2009;Tonetti et al, 2018), therefore not allowing any comparison for long-term evaluation. Thus, additional…”

“…Nevertheless, in one study not included in this systematic review (same population, further results), we observed an improvement in DH in two patients treated, respectively, with tunnel + CTG or CAF + CTG at 2 years of follow‐up (Neves et al, 2020) compared to results at 6 months from the included study by Santamaria et al (2017). The two other non‐included studies (Rasperini et al, 2018; Tonetti et al, 2021) had patients lost to follow‐up compared with their respective original study (Cortellini et al, 2009; Tonetti et al, 2018), therefore not allowing any comparison for long‐term evaluation. Thus, additional RCTs with measurements of DH as a primary outcome and long‐term follow‐up are needed to support the indication of surgical RC techniques for DH treatment.…”

Treatment of multiple adjacent RT 1 gingival recessions with the modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: 9-year results of a split-mouth randomized clinical trial

“…Most of the available literature compares different surgical techniques or reports on a single surgical technique alone and with one type of grafting material. There are only a few randomized, controlled clinical studies comparing the same surgical approach for the coverage of multiple gingival recessions using different grafting materials [ 15 , 26 – 28 ].…”

Successful management of dentin hypersensitivity: A narrative review

“…In this regard, more recent clinical studies have demonstrated promising outcomes using a gingival flap combined with connective tissue grafts to augment and promote root coverage. [58][59][60]…”