Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta‐analysis

Boltelho, João; Machado, Vanessa; Mascarenhas, Paulo; Mendes, José João; Ávila‐Ortiz, Gustavo

doi:10.1002/jper.22-0167

Cited by 37 publications

(37 citation statements)

References 63 publications

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“…Autogenous SCTG remains the gold standard in bilaminar root coverage procedures. 10 When SCTG is not selected, clinicians may consider soft tissue graft substitutes (e.g., xenografts or allografts) combined with a biologic. 3.…”

Section: Expert Opinionmentioning

confidence: 99%

“…The following statements summarize the consensus of the panel of experts: Adjunctive use of biologics enhances initial postoperative healing after root coverage and gingival augmentation therapy. Autogenous SCTG remains the gold standard in bilaminar root coverage procedures 10 . When SCTG is not selected, clinicians may consider soft tissue graft substitutes (e.g., xenografts or allografts) combined with a biologic. The safety of ABPs, EMD, and rhPDGF‐BB in the context of root coverage therapy is well documented, and there are no known therapeutic downsides to their routine use in clinical practice. …”

Section: Focused Clinical Questionmentioning

confidence: 99%

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American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice

Ávila‐Ortiz

Ambruster

Barootchi

et al. 2022

Journal of Periodontology

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A biologic is a therapeutic agent with biological activity that is administered to achieve an enhanced regenerative or reparative effect. The use of biologics has progressively become a core component of contemporary periodontal practice. However, some questions remain about their safety, indications, and effectiveness in specific clinical scenarios. Given their availability for routine clinical use and the existing amount of related evidence, the goal of this American Academy of Periodontology (AAP) best evidence consensus (BEC) was to provide a state‐of‐the‐art, evidence‐based perspective on the therapeutic application of autologous blood‐derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet‐derived growth factor BB (rhPDGF‐BB), and recombinant human bone morphogenetic protein 2 (rhBMP‐2). A panel of experts with extensive knowledge on the science and clinical application of biologics was convened. Three systematic reviews covering the areas of periodontal plastic surgery, treatment of infrabony defects, and alveolar ridge preservation/reconstruction and implant site development were conducted a priori and provided the foundation for the deliberations. The expert panel debated the merits of published data and exchanged experiential information to formulate evidence‐based consensus statements and recommendations for clinical practice and future research. Based on an analysis of the current evidence and expert opinion, the panel concluded that the appropriate use of biologics in periodontal practice is generally safe and provides added benefits to conventional treatment approaches. However, therapeutic benefits and risks range based on the specific biologics used as well as patient‐related local and systemic factors. Given the limited evidence available for some indications (e.g., gingival augmentation therapy, alveolar ridge preservation/reconstruction, and implant site development), future clinical studies that can expand the knowledge base on the clinical use of biologics in periodontal practice are warranted.

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Section: Expert Opinionmentioning

confidence: 99%

Section: Focused Clinical Questionmentioning

confidence: 99%

American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice

Ávila‐Ortiz

Ambruster

Barootchi

et al. 2022

Journal of Periodontology

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“…5,9,26 Further, a recent study concluded that although adjunctive use of ABPs may result in enhanced root coverage and soft-tissue phenotype modification, the uses of other treatment modalities, including CAF + sCTG, CAF + ADM, and CAF + xenograft collagen matrix, have been shown to result in more predictable clinical outcomes compared with CAF + ABPs alone. 30 Clinically, there are also limitations to ABP use. Collection of blood requires venipuncture, which patients may consider to be onerous and could decrease patient acceptance of ABP use.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have established that CAF + sCTG remains the gold standard for root coverage based upon current randomized controlled trials 5,9,26 . Further, a recent study concluded that although adjunctive use of ABPs may result in enhanced root coverage and soft‐tissue phenotype modification, the uses of other treatment modalities, including CAF + sCTG, CAF + ADM, and CAF + xenograft collagen matrix, have been shown to result in more predictable clinical outcomes compared with CAF + ABPs alone 30 . Clinically, there are also limitations to ABP use.…”

Section: Discussionmentioning

confidence: 99%

Clinical applications of mucogingival therapies utilizing adjunctive autologous blood products

Geisinger

Kaur

Arraj

et al. 2022

Clin Adv Periodontics

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Background Mucogingival deformities are prevalent oral conditions and can result in esthetic compromise, dentinal hypersensitivity, and an increase in radicular caries rates. Mucogingival treatments address thin periodontal phenotype and/or gingival recession defects. Although many of these grafting procedures are predictable in improving soft‐tissue quality and quantity around teeth and dental implants, patients often complain of discomfort at both the donor and recipient sites. Free gingival grafts and coronally advanced flaps alone or in combination with subepithelial connective tissue graft and/or acellular dermal matrix are among the most common surgical procedures employed to achieve root coverage and enhance periodontal phenotype. Autologous blood products (ABPs) contain platelets, growth factors, leukocytes, and stem cells that contribute to cell mitosis, collagen production, and angiogenesis, leading to the healing and regeneration of hard and soft tissue. Evaluation of the adjunctive role of ABPs in mucogingival surgery and their impacts on clinical and patient‐centered data is critical to achieve optimal patient‐reported outcome measures based upon the current scientific evidence. Methods We present exemplar cases in which adjunctive ABPs were utilized in mucogingival treatment to enhance treatment outcomes. Results No adverse events were noted. Satisfactory treatment outcomes were achieved in patients with local and/or systemic compromise when mucogingival therapies were used in combination with ABPs. Conclusions Adjunctive use of ABPs may enhance outcomes of mucogingival therapy. Utilization of adjunctive ABPs may be particularly advantageous in situations where the predictability of clinical and esthetic outcomes is limited due to anatomical and/or patient factors.

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“…Also, it can be suggested that the use of ADM can reduce the complexity of the surgical procedure (because of the absence of a second surgical site) and chair‐time 30,31 . Taking into consideration the above‐mentioned aspects for the treatment of patients in need of root coverage and soft tissue phenotype modification (i.e., KT thickness and width gains), treatment options based on ADM + CAF (primarily), followed by XCM + CAF (secondarily) and PRF + CAF (tertiarily) have been ranked as the most suitable alternatives to the use SCTG + CAF 8,9,14 …”

Section: Overviewmentioning

confidence: 99%

Periodontal phenotype modification of complexes periodontal‐orthodontic case scenarios: A clinical review on the applications of allogenous dermal matrix as an alternative to subepithelial connective tissue graft

Garcia-Valenzuela

2022

J Esthet Restor Dent

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Objectives The aim of this review is to address the potential applications of allogenous dermal matrix (ADM), as an alternative to subepithelial connective tissue graft (SCTG), in promoting periodontal phenotype modification (PPM) of challenging periodontal‐orthodontic clinical scenarios. Overview The rationale behind the need of changing thin to thick gingival tissues is associated to the superior and more stable treatment outcomes promoted by PPM therapy. PPM, via soft tissue grafting, leads to clinical and histological changes of the pre‐established original genetic conditions of the gingiva. Although SCTG‐based procedures are recognized as the “gold standard” for the treatment of sites requiring root coverage and gingival augmentation, ADM has been recognized as the most suitable alternative to SCTG, particularly in clinical scenarios where the use of autogenous grafts is not possible. Thus, ADM is considered an optimal option for the treatment of patients with a history (or in need) of orthodontic tooth movement, due its two‐fold potential indication: (1) the promotion of periodontal soft tissue phenotype modification; and (2) its use, as a barrier membrane, in hard tissues augmentation procedures. Conclusions ADM is a viable option for soft tissue augmentation, as well as for treatment approaches involving buccal bone gain. Clinical Significance Periodontal phenotype modification therapy, when applied in challenging periodontal‐orthodontic clinical scenarios, promotes root coverage and prevents the onset and development clinical attachment loss.

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Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta‐analysis

Cited by 37 publications

References 63 publications

American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice

American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice

Clinical applications of mucogingival therapies utilizing adjunctive autologous blood products

Periodontal phenotype modification of complexes periodontal‐orthodontic case scenarios: A clinical review on the applications of allogenous dermal matrix as an alternative to subepithelial connective tissue graft

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