Connective Tissue Graft with or without Enamel Matrix Derivative for Treating Gingival Recession Defects: A Systematic Review and Meta-Analysis

Dubey, Prerana; Narasimhan, Manasa; Sehgal, Navneet Kaur; Yanni, Peter; Kim, Jin Wan; Kapila, Yvonne L.; Lin, Guo‐Hao

doi:10.1016/j.jebdp.2021.101635

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…Indeed, EMD has been recommended to use when treating multiple adjacent GRs and prominent root surfaces in order to facilitate wound healing 18 . The addition of EMD to CTG has been reported to improve the outcomes of recession depth reduction and clinical attachment level gain 19 . In addition, CTG helped to achieve a substantial volume increase and gain of keratinized mucosa—thus providing more predictability to the previously described root coverage procedure.…”

Section: Discussionmentioning

confidence: 99%

Double laterally moved coronally advanced flap combined with a connective tissue graft plus enamel matrix derivatives for the management of adjacent deep gingival recessions in lower incisors: A case report

Vilarrasa

Blasi

2022

Clin Adv Periodontics

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Background: Several surgical approaches have been described for the management of deep adjacent gingival recessions (GRs) in the lower anterior sextant with contrasting clinical outcomes. A modified surgical technique is presented, which consists of a double laterally moved and coronally advanced flaps in combination with a connective tissue graft (CTG) and enamel matrix derivatives (EMDs). Methods and Results: A 42-year-old systemically healthy female presented with dentin hypersensitivity and discomfort while brushing on two adjacent Cairo recession Type 2 of 7-mm depth with a narrow band of keratinized tissue in the lower incisors. The root coverage procedure was performed using a double laterally rotated and coronally advanced flap combined with a CTG harvested from the lateral palate and EMD. At 1-year follow-up, 85% of both of the roots were covered and 6 mm of keratinized tissue width was gained. Conclusion:The presented technique is a predictable procedure for treating adjacent and deep GRs in the anterior sextant whenever keratinized tissue lateral to the gingival defects is available. K E Y W O R D S connective tissue graft, gingival recession, mucogingival, surgical technique Key points Why is this case new information?• To the best of our knowledge, this is the first case report in the literature using a double laterally moved and coronally advanced flap combined with EMD and CTG for adjacent deep recessions.What are the keys to successful management of this case?• Flap design, handling of the bilateral pedicles, and suture technique are the most important factors to obtain a predictable root coverage.

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Section: Discussionmentioning

confidence: 99%

Double laterally moved coronally advanced flap combined with a connective tissue graft plus enamel matrix derivatives for the management of adjacent deep gingival recessions in lower incisors: A case report

Vilarrasa

Blasi

2022

Clin Adv Periodontics

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“…Although CAF + CTG does still represent the gold standard in RCPs [29], adjunctive treatment options, have gained a place in recent years [30]. Regarding this, the following points could be highlighted of the most recent systematic reviews: (1) although the use of a CTG, with and without the application of EMD, achieved similar CRC and MRC values, the adjunctive treatment with EMD may improve RecRed and CAL-gain values [57];…”

Section: Discussionmentioning

confidence: 99%

Hyaluronic Acid as an Adjunct to Coronally Advanced Flap Procedures for Gingival Recessions: A Systematic Review and Meta—Analysis of Randomized Clinical Trials

Rojas

Marini

Sahrmann

et al. 2022

JPM

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Previous systematic reviews have reported that coronally advanced flap (CAF) + connective tissue graft (CTG) are the gold standard in root coverage procedures (RCP). Nevertheless, adjunctive treatment with hyaluronic acid (HA) has been proposed to aim at improving clinical outcomes and reducing patient morbidity. The aim of this systematic review and meta-analysis is to compare the use of HA as an adjunctive treatment to CAF procedures in Miller class I and II (recession type 1; RT1) gingival recession (GR) defects treatment with no adjunctive/other treatments. MEDLINE, The Cochrane Central Register of Controlled Trials, Web of Science, Scopus databases and gray literature were searched up to April 2022. The primary outcome variables were mean recession coverage (MRC) and reduction of the recession depth (RecRed). Weighted mean differences and 95% confidence intervals between treatments were estimated using a random-effect mode. From 264 titles identified, 3 RCTs reporting 90 GR defects in 60 patients were included. Overall analysis of MRC and RecRed were 0.27% (p = 0.01) and 0.40 mm (p = 0.45) in favor of CAF + HA compared to CAF alone/CAF + subepithelial connective tissue graft (SCTG), respectively, with a statistically significant difference only for MRC values. Nevertheless, due to the limited number and heterogeneity of the included studies, well-performed RCTs are needed to clarify a potential advantage of HA in RCPs in the future.

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“…4,5 Previous studies have demonstrated the clinical and experimental efficacy of enamel matrix derivatives (EMDs) in promoting periodontal regeneration. [6][7][8][9][10][11] EMDs are hierarchical complexes of proteins, with amelogenin being the main component found in enamel matrix, secreted by ameloblasts. Our previous research has focused on the development of recombinant human amelogenin (rhAm) and its ability to enhance the proliferation, osteogenic differentiation, and migration of human periodontal ligament cells (hP-DLCs).…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have demonstrated the clinical and experimental efficacy of enamel matrix derivatives (EMDs) in promoting periodontal regeneration 6–11 . EMDs are hierarchical complexes of proteins, with amelogenin being the main component found in enamel matrix, secreted by ameloblasts.…”

Section: Introductionmentioning

confidence: 99%

A photoresponsive recombinant human amelogenin‐loaded hyaluronic acid hydrogel promotes bone regeneration

Hsia,

Lin,

Xia

et al. 2024

J of Periodontal Research

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ObjectivesIn order to evaluate the effect of methacrylated hyaluronic acid (HAMA) hydrogels containing the recombinant human amelogenin (rhAm) in vitro and in vivo.BackgroundThe ultimate goal in treating periodontal disease is to control inflammation and achieve regeneration of periodontal tissues. In recent years, methacrylated hyaluronic acid (HAMA) containing recombinant human amyloid protein (rhAm) has been widely used as a new type of biomaterial in tissue engineering and regenerative medicine. However, there is a lack of comprehensive research on the periodontal regeneration effects of this hydrogel. This experiment aims to explore the application of photoresponsive recombinant human amelogenin‐loaded hyaluronic acid hydrogel for periodontal tissue regeneration and provide valuable insights into its potential use in this field.Materials and MethodsThe effects of rhAm‐HAMA hydrogel on the proliferation of human periodontal ligament cells (hPDLCs) were assessed using the CCK‐8 kit. The osteogenic differentiation of hPDLCs was evaluated through ALP staining and real‐time PCR. Calvarial parietal defects were created in 4‐week‐old Sprague Dawley rats and implanted with deproteinized bovine bone matrix in different treatment groups. The animals were euthanized after 4 and 8 weeks of healing. The bone volume of the defect was observed by micro‐CT and histological analysis.ResultsStimulating hPDLCs with rhAm‐HAMA hydrogel did not significantly affect their proliferation (p > .05). ALP staining and real‐time PCR results demonstrated that the rhAm‐HAMA group exhibited a significant upregulation of osteoclastic gene expression (p < .05). Micro‐CT results revealed a significant increase in mineralized tissue volume fraction (MTV/TV%), trabecular bone number (Tb.N), and mineralized tissue density (MTD) of the bone defect area in the rhAm‐HAMA group compared to the other groups (p < .05). The results of hematoxylin and eosin staining and Masson staining at 8 weeks post‐surgery further supported the results of the micro‐CT.ConclusionsThe results of this study indicate that rhAm‐HAMA hydrogel could effectively promote the osteogenic differentiation of hPDLCs and stabilize bone substitutes in the defects that enhance the bone regeneration in vivo.

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Connective Tissue Graft with or without Enamel Matrix Derivative for Treating Gingival Recession Defects: A Systematic Review and Meta-Analysis

Cited by 4 publications

References 34 publications

Double laterally moved coronally advanced flap combined with a connective tissue graft plus enamel matrix derivatives for the management of adjacent deep gingival recessions in lower incisors: A case report

Double laterally moved coronally advanced flap combined with a connective tissue graft plus enamel matrix derivatives for the management of adjacent deep gingival recessions in lower incisors: A case report

Hyaluronic Acid as an Adjunct to Coronally Advanced Flap Procedures for Gingival Recessions: A Systematic Review and Meta—Analysis of Randomized Clinical Trials

A photoresponsive recombinant human amelogenin‐loaded hyaluronic acid hydrogel promotes bone regeneration

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