Coronally advanced flap with connective tissue graft or xenogeneic acellular dermal matrix in the treatment of multiple gingival recessions: A split‐mouth randomized clinical trial

Abstract

Objective: To evaluate the clinical efficacy of xenogeneic acellular dermal matrix (XADM) or connective tissue graft (CTG) combined with modified-coronally advanced flap (M-CAF) in the treatment of multiple gingival recessions. Materials and methods: Twelve participants with bilateral MGRs (multiple gingival recession) (82 gingival recessions) randomly received XADM (test group, 41 teeth) on one side and subepithelial CTG (control group, 41 teeth) on the other side in conjunction with M-CAF in the same session and completed the 18-months study period. Recession depth (RD), recession width (RW), keratinized tissue width (KTW), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, and 6-, 18-months postoperatively.Results: PD was significantly higher in the test group at 18-months (P < .05). PD in the test group was also significantly higher at 6-and 18-months compared to baseline (P < .05). RD and RW were significantly lower at 6-and 18-months compared to baseline in both groups (P < .05) and both parameters were significantly higher in the test group at 18-months (P < .05). Percentage of teeth with complete root coverage in the test and control groups were similar at 6-months (78% and 70.7%, respectively) and at 18-months (both 87.8%) (P > .05). Conclusion:Within the limits of the study, M-CAF combined with XADM or CTG seems to be similarly effective in RD reduction of class I and II MGRs at least in the short term. Soft tissue shrinkage and increase in PD may be observed with XADM, while; CTG seems to provide stable clinical outcomes for 18-months follow-up.Clinical significance: Even though the CTG and XADM in conjunction with M-CAF may provide similar RD reduction in class I and II multiple gingival recessions in the short term. CTGs may be superior in terms of soft tissue shrinkage and PD values.

Comparison of two types of xenogeneic matrices to treat single gingival recessions: A randomized clinical trial

“…Conversely, the XDM literature is still scarce. To date, most of the available studies that evaluate the use of this XDM involve multiple gingival recessions [16][17][18][19][20] or investigate different flap designs. Nevertheless, to the best of our knowledge, this is the first randomized clinical trial to evaluate the use of XDM associated with the conventional CAF technique in the treatment of single gingival recessions and to compare directly the use of two different matrices (i.e., the new XDM and the CM for root coverage).…”

“…However, the XDM literature is limited, and the studies evaluating the effects of XDM in treatments of single gingival recession is still insufficient 8,12 . Most of the XDM available evidence is restricted to the use of this biomaterial to increase the peri‐implant soft tissue 13–15 or to treat multiple recessions 16–21 . Furthermore, most of the root coverage procedures reported were associated with the coronally advanced tunnel flap technique, with little information regarding the use of this biomaterial associated with the CAF technique 16,19,20 …”

“…8,12 Most of the XDM available evidence is restricted to the use of this biomaterial to increase the peri-implant soft tissue [13][14][15] or to treat multiple recessions. [16][17][18][19][20][21] Furthermore, most of the root coverage procedures reported were associated with the coronally advanced tunnel flap technique, with little information regarding the use of this biomaterial associated with the CAF technique. 16,19,20 In addition, because the matrices have different manufacturing processes that lead to different structural and physical characteristics, they may have different outcomes.…”

Porcine Acellular Dermal Matrix: An Alternative to Connective Tissue Graft—A Narrative Review

“…In 2019, Gurlek et al compared PADM and CTG and combined these materials with a modified coronal advanced flap in the treatment of multiple recessions of Miller class I and II [ 1 , 22 ]. Both procedures were very effective during the 18-month follow-up, although CTG resulted with a higher gain in keratinized tissue.…”

“…e porcine acellular dermal matrix (PADM) is a collagen matrix known commercially as mucoderm (Botiss Dental, Berlin, Germany). It has recently been introduced in dentistry as a substitute for the gold standard connective tissue graft (CTG) in periodontal and implant plastic surgery [1][2][3][4]. CTGs have limited availability especially when treating multiple gingival recessions.…”