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

Abstract

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.

Influence of immediate postoperative gingival thickness and gingival margin position on the outcomes of root coverage therapy: A 6 months prospective case series study using 3D digital measuring methods

“…Extensive evidence is available in the literature on the efficacy of ADM in root coverage procedures such as tunneling or CAF techniques at short term 27,28,44–49 …”

“…Extensive evidence is available in the literature on the efficacy of ADM in root coverage procedures such as tunneling or CAF techniques at short term. 27,28,[44][45][46][47][48][49] The present prospective study sought to evaluate the linear and volumetric changes from the immediate postoperative period to 6 months following the treatment of GRs using a MTUN combined with the use of ADM. Although similar research has been previously published and discussed, this is the first study to digitally assess the keratinized tissue over time.…”

Comparison Between Autologous Albumin Gel and Liquid Platelet-Rich Fibrin Mixture Versus Connective Tissue Graft to Modify the Gingival Phenotype: A Randomized Controlled Trial

“…The use of Alb-PRF in thin gingival tissue is a minimally invasive, affordable, painless, and side-effect-free technique. Therefore, this study aims to compare Alb-PRF membrane and connective tissue graft (CTG) (the gold standard for treating areas that need gingival augmentation and root coverage) [ 14 ] to modify the thin gingival phenotype. The null hypothesis suggests that there is no significant difference in GTH and KTW after modifying the thin gingival phenotype using CTG or Alb-PRF.…”

Periodontal Phenotype Modification Using Subepithelial Connective Tissue Graft and Bone Graft in the Mandibular Anterior Teeth with Mucogingival Problems Following Orthodontic Treatment

“…Although various techniques have been used for the treatment of gingival recession after orthodontic treatment [ 16 , 20 ], to the best of the authors’ knowledge, the use of a bone graft substitute with a subepithelial connective tissue graft for treatment of gingival recession in the mandibular incisors has not been reported. Herein, a patient case with a complex mucogingival problem accompanied by thin periodontal biotype and labial root prominence in which the gingival recession was treated with a bone graft substitute and a subepithelial connective tissue graft is reported.…”