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

Abstract

Porcine acellular dermal matrix has recently been introduced in dentistry as an alternative to the gold standard connective tissue graft especially for the use in gingival recession treatments and soft tissue augmentation in implant surgery. Connective tissue grafts are inconvenient and require a second surgical site leading to greater morbidity, longer surgical procedures, and a more painful postoperative phase for the patient. Other options such as allografts have ethical concerns and are less available in Europe. Thus, dental professionals have sought other techniques and materials. Porcine acellular dermal matrix results in periodontal recession treatment with a gain in recession coverage as well as increased keratinized tissue and soft tissue augmentation. This leads to more keratinized mucosa and greater tissue thickness. Many studies have been published using collagen matrices, but a few strictly use porcine acellular dermal matrix, which have been studied in prospective randomized clinical trials with a large number of patients and longer follow-up periods (more than 5 years). Nevertheless, more data are needed to confirm that the porcine acellular dermal matrix is a suitable alternative although its favourable results to date suggest a positive future.

Acellular dermal matrix in reconstructive surgery: Applications, benefits, and cost

“…It is applied in periorbital soft tissue, dura mater, extraoral and intraoral, and oropharyngeal defects. It also has applications in skeletal support, nasal soft tissue, and tympanic membrane repair (1,(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

“…Chest wall defects are frequently caused by tumor herniation and resection (1,2,21,29,30,(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91). Defects in the chest wall impair the strong framework that supports breathing and safeguards the viscera (92).…”

“…Consequently, it is essential to repair the chest wall properly (50). The material typically employed in chest wall repair is synthetic mesh (1,2,21,29,30,(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91). It does, however, have drawbacks (for example, infection) (93).…”

Soft Tissue Substitutes to Increase the Thickness of Attached Gingiva: An Animal Study

“…Therefore, soft tissue augmentation is needed to increase the thickness of soft tissue around the implant. However, autogenous connective tissue grafts (ACTG) need second surgical site, which will prolong the surgical time and increase the pain of patients [9]. This makes soft tissue substitutes become a research hotspot.…”

Gingival healing with an acellular dermal matrix

“…The autologous tissue grafts are still considered as gold standard for gingival healing procedures [1]. However, they require a second surgical site which is why the collagen based acellular dermal matrices (ADMs) have been introduced as an alternative to autologous soft tissue transplants [2]. The ADMs have 3D structure with high interconnected porosity and native collagen structure, which makes an excellent scaffold for ingrowing blood vessels and cells, that supports a fast revascularization and tissue integration [3].…”