Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of multiple Class III‐IV recessions in lower anterior teeth: A 3‐year randomized clinical trial

Abstract

Background:This study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of multiple Class III-IV Miller periodontal recession (REC) defects on mandibular anterior teeth.Methods: This randomized clinical study evaluated 41 patients at 3 years followup. One hundred and fifty-six teeth were divided into two groups: test (CTG-EMD, 79 teeth) and control (CTG only, 77 teeth). Clinical REC, keratinized tissue (KT) width, percentage of root coverage, patient-centered outcomes were compared between the two groups.Results: At 36 months follow-up, patient level analysis showed that REC in the test group reduced significantly (5.71 ± 0.58 mm to 1.57 ± 0.85 mm) compared with the control group (5.94 ± 0.46 mm to 2.51 ± 0.62 mm) (P < 0.001), while KT width increased in the test group (1.51 ± 0.26 mm to 4.18 ± 0.34 mm) and was significantly greater than the control group (1.65 ± 0.21 mm to 2.90 ± 0.20 mm) (P < 0.001). At 36 months, tooth level analysis (Class III and Class IV groups) found less residual REC and increased KT in the test group compared with the control group (P < 0.01). Significantly less pain was reported at 2, 7, and 14 days follow-up post-surgery in the test group (P < 0.001). Conclusions:The addition of EMD to CTG results in improved root coverage outcomes and higher amounts of KT width 36 months after treatment of Class III-IV REC on mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days post-surgery. K E Y W O R D S enamel matrix proteins, gingival recession, keratinized tissue, pain level, periodontal plastic surgical flaps, root coverage J Periodontol. 2020;91:473-483.

Enamel matrix derivative promotes new bone formation in xenograft assisted maxillary anterior ridge preservation—A randomized controlled clinical trial

“…Numerous subsequent studies eventually supported this broad spectrum of biofunctionality of EMD(Miron et al 2016b, Grandin et al 2012, Bosshardt et al 2008. Indeed, the general pro-wound healing effects of EMD are reflected in its established clinical effectiveness in periodontal regeneration(Esposito et al 2009), root overage procedures(Mercado et al 2020a, Mercado et al 2020b and the management of peri-implantitis(Mercado et al 2018, Isehed et al 2018. Furthermore, a number of other human histological studies have confirmed the periodontal regenerative potential of EMD(Rasperini et al 2000, Roman et al 2013, Sculean et al 2000, Cochran et al 2003.…”

Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow‐up

“…However, due to the extra financial burden for the patient and the overall limited and unclear data on the histological outcome of healing after adjunct use of EMD, future long-term trials assessing EMD as only or as additional adjunct are warranted.There was no evidence from controlled clinical trials about the long-term outcome of treatment of GR with interdental attachment loss (i.e., Miller class III/IV or RT 2/3)neither for single nor for multiple defects. Nevertheless, there are medium-term data (i.e., 3 years follow-up;Cairo et al, 2015;Mercado et al, 2020b) as well as 20-year case series(Pini Prato, Franceschi, et al, 2018;Pini Prato, Magnani, & Chambrone, 2018) available with the latter probably providing the best long-term evidence available at the moment with a direct comparison of the outcome of GR without(Miller class I) or with interdental attachment loss (Miller class III) treated either by CAF(Pini Prato, Magnani, & Chambrone, 2018) or CAF + CTG (Pini…”

Two-stage approach for class II mandibular furcation defect with insufficient keratinized mucosa: a case report with 3 years’ follow-up

“…In addition, the combination of an EMD and a CTG has been reported to result in better root coverage and KMW outcomes than CTG alone. 25 Therefore, we applied EMD with CTG in the first surgery in the current case, to treat the furcation involvement with an insufficient KMW and GR.…”