Effect of enamel matrix derivative on wound healing following gingival recession coverage using the modified coronally advanced tunnel and subepithelial connective tissue graft: a randomised, controlled, clinical study

Abstract

Objectives The potential effect of enamel matrix derivative (EMD) on wound healing following recession coverage surgery is still controversially discussed in the literature. The aim of this randomised, controlled, single blinded clinical study was, therefore, to investigate clinically and immunologically the potential effects of EMD on early wound healing and clinical results following treatment of single and multiple gingival recessions by the modified coronally advanced tunnel technique (MCAT) and subepithelial connective tissue graft (sCTG). Materials and methods A total of 40 systemically healthy patients with Miller class I, II or III single or multiple gingival recessions were treated with MCAT + sCTG with or without EMD. Patients were consecutively enrolled and randomly assigned to test or control treatment. Inflammatory markers (interleukin (IL)-1β, IL-8, IL-10 and matrix metalloprotease (MMP)-8) were measured at baseline, 2 days and 1 week postoperatively. The following clinical parameters were assessed at baseline and at 6 months postoperatively: Recession Depth (RD), Recession Width (RW), Width of Keratinized Tissue (KT) and Probing Depth (PD). Patient-reported outcomes were analysed by means of a visual analogue scale. Results No statistically significant differences were detected between the 2 groups in terms of inflammatory markers and patientreported outcomes during early wound healing. In the test group, RD was reduced from 4.0 ± 1.2 mm at baseline to 0.9 ± 1.3 mm at 6 months (p < 0.001), while the corresponding values in the control group were 4.5 ± 2.0 mm at baseline and 1.0 ± 1.0 mm at 6 months, respectively. At 6 months, mean root coverage measured 78 ± 26% in the test group and 77 ± 18% in the control group, respectively. Conclusion Within their limits, the present data have failed to show an influence of EMD on the clinical and immunological parameters related to wound healing following recession coverage surgery using MCAT and sCTG. Clinical relevance Early wound healing following recession coverage by means of MCAT and sCTG does not seem to be influenced by the additional application of EMD.

Tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: a randomized clinical trial

“…The abovementioned differences were not statistically significant. These outcomes compare well with those reported by other studies, where MCAT was used [10,12,23,24], and are consistent with the conclusion of a recent systematic review and meta-analysis [8]. Consequently, the tunnel approach was found to be highly effective in treatment of multiple GR, exhibiting an overall root coverage of 87.9%, in addition to CRC of 57.5%.…”

“…Cheng et al [26] performed meta-analysis and concluded that higher PPD reduction tends to occur when EMD was used additionally to SCTG. However, written evidence that took a comparative approach to efficacy of analyzed treatment modalities is rather scarce and only one study was found to compare clinical outcomes following treatment of Miller class I, II, or III recessions by means of MCAT+SCTG combined with and without EMD [12]. At 6 months, ARC measured 78 ± 26% in the test group and 77 ± 18% in the control group, while mean GR was 0.9 ± 1.3 mm and 1.0 ± 1.0 mm, respectively.…”

“…These findings are not in accordance with the results from the previously mentioned study. Stähli et al [12] analyzed postoperative pain 2, 7, and 14 days after recession coverage. Mean VAS scores at the tooth site were 2.9, 2.9, and 1.1 for the SCTG+EMD group and 5.1, 3.5, and 1.6 for the SCTG group, without statistically significant differences.…”

“…Recommendations were made for an addition of enamel matrix derivative (EMD) as an adjunct to soft-tissue grafting to improve treatment efficacy [10,12]. EMD was applied for root coverage to improve the level of gingival margin and enhance periodontal regeneration along the root, which was confirmed with histologic analysis.…”

Three-Dimensional Quantitative Measurement of Buccal Augmented Tissue After MCAT Technique With SCTG: Preliminary Results of a Prospective Case Series

“…The modi ed coronally advanced tunnel in combination with subepithelial connective tissue graft used in this study showed successful root coverage at 1-year post-op. This is consistent with other publications [7,28], showing a high degree of root coverage of Miller I and II gingival recession. With the help of three-dimensional measurement, the present study found that the gingival HG, AG, VG and MTG were signi cantly higher at 2 weeks after surgery than baseline.…”