Modified coronally advanced 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: prognostic parameters for clinical treatment outcomes

Abstract

Objectives To investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls). Materials and methods Twenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT). Results The likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration. Conclusions Based on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES. Clinical relevance Additional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.

Recession coverage using the modified coronally advanced tunnel and connective tissue graft with or without enamel matrix derivative: 5-year results of a randomised clinical trial

“…In the present study, EMD did not seem to influence the clinical results, which is in contradiction with the data recently reported by Gorski and co-workers [49]. According to their regression model, EMD increased the likelihood of MRC > 85% sevenfold, of CRC 21-fold and of maximal RES tenfold after 12 months.…”

Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis

“…However, EMD accelerates soft tissue wound healing and maturation, which could contribute to decreased scar tissue formation and improvements in soft tissue texture, marginal tissue contour, MGJ alignment and gingival color [ 38 ]. We previously described similar soft tissue response to root surface modification with either EDTA or EDTA + EMD [ 12 , 22 ], but no other researchers provided results that could be directly compared with ours. However, Aydinyurt et al [ 39 ] assessed the impact of EMD application on esthetic outcomes of CAF + SCTG in treatment of Miller class I and II gingival recessions of contralateral maxillary canines.…”

“…However, there are little data in the literature on specific combination of EMD with MCAT. A clinical benefit of the application of EDTA + EMD to MCAT has been found in some trials [ 22 ], while others did not confirm such observations [ 5 , 23 ]. In our previous report, the likelihood of ARC > 85% increased sevenfold and of achieving CRC 21-fold, in favor of EDTA + EMD-treated sites [ 22 ].…”

“…A clinical benefit of the application of EDTA + EMD to MCAT has been found in some trials [ 22 ], while others did not confirm such observations [ 5 , 23 ]. In our previous report, the likelihood of ARC > 85% increased sevenfold and of achieving CRC 21-fold, in favor of EDTA + EMD-treated sites [ 22 ]. Moreover, the 12 month CAL gain was significantly higher in EDTA + EMD sites (2.1 ± 1.0 mm) when compared with controls (1.6 ± 1.4 mm).…”

“…Different studies have found beneficial effects of EMD application prior to root coverage procedures either with CAF or SCTG [ 18 , 19 , 20 ]. However, the role of EMD in periodontal plastic treatment with MCAT cannot be consistently evaluated and the extent to which outcomes of MCAT might be improved with EMD usage remains uncertain [ 5 , 7 , 21 , 22 , 23 ]. Moreover, before EMD application, the roots need to be conditioned for 2 min with a 24% EDTA to remove the smear layer, which may affect clinical outcomes.…”