Root Coverage Technique with Enamel Matrix Derivative

Abstract

Various periodontal plastic surgical techniques are employed in obtaining root coverage. Recently, the use of an enamel matrix derivative (EMD) has been reported in such treatment. We report 2 cases of root coverage surgery with a coronally positioned flap in combination with EMD (CPF‫ם‬EMD) and connective tissue graft in combination with EMD (CTG‫ם‬EMD). Case 1: The patient was a 25-year-old woman referred to Suidobashi Hospital, Tokyo Dental College for root coverage surgery on the lower right first premolar. Gingival recession was classified as Miller Class II, as no alveolar bone loss or loss of attachment was observed in the interdental area, although recession had progressed to the mucogingival junction. The patient was diagnosed with local gingival recession caused by excessive tooth brushing. Primary conservative treatment failed to reduce the gingival recession. Subsequently, root coverage surgery with CPF‫ם‬EMD was carried out. As observation at the 1-year follow-up revealed complete root coverage and no recurrence of root exposure or subjective symptoms, the postoperative course was considered to be favorable. Case 2: The patient was a 39-year-old woman referred to Suidobashi Hospital, Tokyo Dental College for root coverage surgery on the lower left canine. Gingival recession was classified as Miller Class II. Root coverage surgery with CTG‫ם‬EMD was carried out. As observation at the 2-month follow-up revealed complete root coverage and no recurrence of root exposure, the postoperative course was considered to be favorable. These 2 cases indicate the effectiveness of root coverage surgery with CPF‫ם‬EMD and CTG‫ם‬EMD.

The Adjunctive Effect of Platelet‐Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects: Results of a Randomized, Parallel‐Group Controlled Trial

“…The predictive role of TT on gingival recession development and CRC after treatment has been emphasized clearly, and TT of 1 mm was indicated as a threshold for CRC by Moriyama et al 37 In the present study, seven patients from the CAF + CTG + PRF group and eight patients from the CAF + CTG group show TT <1 mm at BL examination, and the mean TT is statistically similar in both study groups. When the influence of TT on treatment success was evaluated, a positive and strong correlation, compatible with the aforementioned mechanism, was established between TT and RC (or RC%) in both study groups.…”

Clinical Considerations on the Root Coverage of Gingival Recessions in Thin or Thick Biotype

“…According to the Miller classification system, complete coverage is 20 Other studies have affirmed that flap thicknesses < 1 mm had a negative influence on obtaining complete coverage in procedures that involved coronally advanced flaps. 14,16,20 A systematic review on the influence of flap thickness on obtaining better root coverage using different techniques (connective tissue graft, guided tissue regeneration, and coronally advanced flaps) demonstrated that flaps with a thickness ≥ 1.1 mm were positively correlated to complete coverage of roots. 21 On the other hand, Harris observed that the success of root coverage surgeries have no relationship to flap thickness.…”

“…[17][18][19] The influence of flap thickness and gingival biotype on periodontal surgical techniques and their relation with the clinical outcome of root coverage procedures have been briefly discussed in the literature. 17,[20][21][22][23][24] Therefore, the aim of the present study was to evaluate the influence of gingival biotype on the root coverage rates of localized Miller Class I or II gingival recessions using the subepithelial connective tissue graft plus the coronally advanced flap technique.…”

EMD or subepithelial connective tissue graft for the treatment of single gingival recessions: a pilot study

“…Moriyama et al. (34) reported that a flap thickness of ≥ 1 mm was associated with 100% root coverage. In the present study, the baseline GT was not significantly different between groups, so there was homogeneity of the experimental sites at the start of the study.…”