Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non‐inferiority in root coverage and superiority in oral health‐related quality of life

Abstract

AimTo evaluate the non‐inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient‐reported outcomes (PROM).Material and methodsOne hundred and eighty‐seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient‐reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates.ResultsAverage baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six‐month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8–8.8).ConclusionReplacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.

Extracellular matrix‐based scaffolding technologies for periodontal and peri‐implant soft tissue regeneration

“…45 Furthermore, root coverage procedures may also benefit from the addition of xenogeneic allografts. 42 An excellent color match with the surrounding tissue was reported when CM was used in soft tissue augmentation. These findings examined odds of achieving complete root coverage, although CM was related to a shortened surgical and recovery time.…”

“…[39][40][41] The compact layer, made from porcine peritoneum, acts as a barrier and provides stability, while the porous layer, obtained from the porcine skin, is designed for supporting blood clot stabilization and the promotion of cellular ingrowth. [41][42][43] Among its main advantages are the reduced surgical time and patient morbidity compared with autogenous soft tissue grafts. [41][42][43] Among its main advantages are the reduced surgical time and patient morbidity compared with autogenous soft tissue grafts.…”

“…39 These properties demonstrate the potential clinical applications of the biomaterial in periodontal plastic surgical procedures, where CM has been used to increase keratinized tissue, cover single and multiple gingival recession(s), and augment soft tissue thickness. 41,42 Clinical trials have shown that CM is able to increase the keratinized tissue width, 41,44 but some have questioned this potential because it lacks the cellular component needed for keratinized tissue formation. 41,42 Clinical trials have shown that CM is able to increase the keratinized tissue width, 41,44 but some have questioned this potential because it lacks the cellular component needed for keratinized tissue formation.…”

The influence of tooth location on the outcomes of multiple adjacent gingival recessions treated with coronally advanced flap: A multicenter re‐analysis study

“…While several reviews and meta‐analyses have been performed to evaluate the most effective approaches for treating single GRs, ‒ evidence regarding the efficacy of periodontal plastic surgery in treating multiple adjacent gingival recessions (MAGRs) is scarce . It has been suggested that MAGRs should be treated concurrently for minimizing patient discomfort . Additionally, their treatment may pose more challenges compared with localized GRs due the more likely encounter of anatomical factors (such as shallow vestibule, root prominence, and limited keratinized tissue width [KTW]) that need to be taken into consideration.…”

“…According to a recent meta‐analysis, the CAF was able to yield superior outcomes in terms of complete root coverage (CRC) than the tunnel approach . The CAF for the treatment of MAGRs has been performed with either two vertical releasing incisions or an envelope approach, with oblique or horizontal incisions at the papillae, alone or with the addition of a connective tissue graft (CTG) or substitute materials …”