Skip to main content

Advertisement

SpringerLink
Log in

Effect of EDTA root conditioning on the outcome of coronally advanced flap with connective tissue graft: a systematic review and meta-analysis

  • Review
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

CAF in combination with a connective tissue graft (CTG) is considered the technique of choice for treating gingival recessions (GRs). Among the many recognized factors that can affect the outcomes, the use of chemical agents has been proposed. The effect of EDTA, as a commonly used agent, remains controversial. Therefore, the aim of this review was to assess the efficacy of EDTA root conditioning when combined to CAF + CTG.

Material and methods

A literature search was conducted to identify randomized clinical trials (RCTs) that performed CAF + CTG with and without EDTA for root coverage procedures. The following outcomes were assessed: recession reduction (Rec Red), complete root coverage (CRC), keratinized tissue gain (KT gain), clinical attachment level changes (CAL gain), and changes in pocket depth (PD changes).

Results

Fourteen RCTs (575 GRs) were included and analyzed. Six articles were included in the EDTA group, with 8 in the non-EDTA group. Meta-analyses revealed statistically significant differences for the outcomes of Rec Red (3.68 mm versus 3.07 mm), CAL gain (4.15 mm versus 3.07 mm), and PD changes (− 0.44 mm versus 0.27 mm) in favor of the EDTA group, while outcomes of CRC (odds ratio of 1.15) and KT gain (1.98 mm versus 1.62 mm) were not significantly different.

Conclusions

Limited evidence is available when evaluating the effectiveness of EDTA root conditioning with CAF + CTG. However, the adjunct application of EDTA with CAF + CTG appears to be beneficial.

Clinical relevance

The adjunct application of EDTA may provide benefits when performing root coverage procedure via CAF + CTG.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 41(Suppl 15):S44–S62. https://doi.org/10.1111/jcpe.12182

    Article  PubMed  Google Scholar 

  2. Graziani F, Gennai S, Roldan S, Discepoli N, Buti J, Madianos P, Herrera D (2014) Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. J Clin Periodontol 41(Suppl 15):S63–S76. https://doi.org/10.1111/jcpe.12172

    Article  PubMed  Google Scholar 

  3. Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 35:136–162. https://doi.org/10.1111/j.1600-051X.2008.01267.x

    Article  PubMed  Google Scholar 

  4. Tonetti MS, Jepsen S, Working Group 2 of the European Workshop on P (2014) Clinical efficacy of periodontal plastic surgery procedures: consensus report of Group 2 of the 10th European Workshop on Periodontology. J Clin Periodontol 41(Suppl 15):S36–S43. https://doi.org/10.1111/jcpe.12219

    Article  PubMed  Google Scholar 

  5. Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Cincinelli S, Pini-Prato G (2012) Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial. J Clin Periodontol 39:760–768. https://doi.org/10.1111/j.1600-051X.2012.01903.x

    Article  PubMed  Google Scholar 

  6. Saletta D, Pini Prato G, Pagliaro U, Baldi C, Mauri M, Nieri M (2001) Coronally advanced flap procedure: is the interdental papilla a prognostic factor for root coverage? J Periodontol 72:760–766. https://doi.org/10.1902/jop.2001.72.6.760

    Article  PubMed  Google Scholar 

  7. Huang LH, Neiva RE, Wang HL (2005) Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 76:1729–1734. https://doi.org/10.1902/jop.2005.76.10.1729

    Article  PubMed  Google Scholar 

  8. Ozcelik O, Seydaoglu G, Haytac MC (2015) Prediction of root coverage for single recessions in anterior teeth: a 6-month study. J Clin Periodontol 42:860–867. https://doi.org/10.1111/jcpe.12449

    Article  PubMed  Google Scholar 

  9. Zucchelli G, Mele M, Checchi L (2006) The papilla amplification flap for the treatment of a localized periodontal defect associated with a palatal groove. J Periodontol 77:1788–1796. https://doi.org/10.1902/jop.2006.050333

    Article  PubMed  Google Scholar 

  10. Mazzocco F, Comuzzi L, Stefani R, Milan Y, Favero G, Stellini E (2011) Coronally advanced flap combined with a subepithelial connective tissue graft using full- or partial-thickness flap reflection. J Periodontol 82:1524–1529. https://doi.org/10.1902/jop.2011.100586

    Article  PubMed  Google Scholar 

  11. Skurska A, Dolinska E, Sulewska M, Milewski R, Pietruski J, Sobaniec S, Pietruska M (2015) The assessment of the influence of vertical incisions on the aesthetic outcome of the Miller class I and II recession treatment: a split-mouth study. J Clin Periodontol 42:756–763. https://doi.org/10.1111/jcpe.12440

    Article  PubMed  Google Scholar 

  12. Zucchelli G, Stefanini M, Ganz S, Mazzotti C, Mounssif I, Marzadori M (2016) Coronally advanced flap with different designs in the treatment of gingival recession: a comparative controlled randomized clinical trial. Int J Periodontics Restorative Dent 36:319–327. https://doi.org/10.11607/prd.2698

    Article  PubMed  Google Scholar 

  13. de Sanctis M, Clementini M (2014) Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 41(Suppl 15):S108–S122. https://doi.org/10.1111/jcpe.12189

    Article  PubMed  Google Scholar 

  14. Pini-Prato G, Baldi C, Pagliaro U, Nieri M, Saletta D, Rotundo R, Cortellini P (1999) Coronally advanced flap procedure for root coverage. Treatment of root surface: root planning versus polishing. J Periodontol 70:1064–1076. https://doi.org/10.1902/jop.1999.70.9.1064

    Article  PubMed  Google Scholar 

  15. Zucchelli G, Mounssif I, Stefanini M, Mele M, Montebugnoli L, Sforza NM (2009) Hand and ultrasonic instrumentation in combination with root-coverage surgery: a comparative controlled randomized clinical trial. J Periodontol 80:577–585. https://doi.org/10.1902/jop.2009.080485

    Article  PubMed  Google Scholar 

  16. Oles RD, Ibbott CG, Laverty WH (1988) Effect of root curettage and sodium hypochlorite treatment on pedicle flap coverage of localized recession. J Can Dent Assoc 54:515–517

    PubMed  Google Scholar 

  17. Selvig KA, Ririe CM, Nilveus R, Egelberg J (1981) Fine structure of new connective tissue attachment following acid treatment of experimental furcation pockets in dogs. J Periodontal Res 16:123–129

    Article  PubMed  Google Scholar 

  18. Polson AM, Proye MP (1982) Effect of root surface alterations on periodontal healing. II. Citric acid treatment of the denuded root. J Clin Periodontol 9:441–454

    Article  PubMed  Google Scholar 

  19. Register AA, Burdick FA (1975) Accelerated reattachment with cementogenesis to dentin, demineralized in situ. I. Optimum range. J Periodontol 46:646–655. https://doi.org/10.1902/jop.1975.46.11.646

    Article  PubMed  Google Scholar 

  20. Polson AM, Proye MP (1983) Fibrin linkage: a precursor for new attachment. J Periodontol 54:141–147. https://doi.org/10.1902/jop.1983.54.3.141

    Article  PubMed  Google Scholar 

  21. Stabholz A, Kettering J, Aprecio R, Zimmerman G, Baker PJ, Wikesjo UM (1993) Antimicrobial properties of human dentin impregnated with tetracycline HCl or chlorhexidine. An in vitro study. J Clin Periodontol 20:557–562

    Article  PubMed  Google Scholar 

  22. Caffesse RG, Kerry GJ, Chaves ES, McLean TN, Morrison EC, Lopatin DE, Caffesse ER, Stults DL (1988) Clinical evaluation of the use of citric acid and autologous fibronectin in periodontal surgery. J Periodontol 59:565–569. https://doi.org/10.1902/jop.1988.59.9.565

    Article  PubMed  Google Scholar 

  23. Blomlof J, Lindskog S (1995a) Periodontal tissue-vitality after different etching modalities. J Clin Periodontol 22:464–468

    Article  PubMed  Google Scholar 

  24. Blomlof J, Lindskog S (1995b) Root surface texture and early cell and tissue colonization after different etching modalities. Eur J Oral Sci 103:17–24

    Article  PubMed  Google Scholar 

  25. Blomlof J, Jansson L, Blomlof L, Lindskog S (1996a) Root surface etching at neutral pH promotes periodontal healing. J Clin Periodontol 23:50–55

    Article  PubMed  Google Scholar 

  26. Blomlof L, Jonsson B, Blomlof J, Lindskog S (2000a) A clinical study of root surface conditioning with an EDTA gel. II. Surgical periodontal treatment. Int J Periodontics Restorative Dent 20:566–573

    PubMed  Google Scholar 

  27. Kassab MM, Cohen RE, Andreana S, Dentino AR (2006) The effect of EDTA in attachment gain and root coverage. Compend Contin Educ Dent 27:353–360 quiz 361

    PubMed  Google Scholar 

  28. Bittencourt S, Ribeiro Edel P, Sallum EA, Sallum AW, Nociti FH Jr, Casati MZ (2007) Root surface biomodification with EDTA for the treatment of gingival recession with a semilunar coronally repositioned flap. J Periodontol 78:1695–1701. https://doi.org/10.1902/jop.2007.060507

    Article  PubMed  Google Scholar 

  29. Mariotti A (2003) Efficacy of chemical root surface modifiers in the treatment of periodontal disease. A systematic review. Ann Periodontol 8:205–226. https://doi.org/10.1902/annals.2003.8.1.205

    Article  PubMed  Google Scholar 

  30. Karam PS, Sant'Ana AC, de Rezende ML, Greghi SL, Damante CA, Zangrando MS (2016) Root surface modifiers and subepithelial connective tissue graft for treatment of gingival recessions: a systematic review. J Periodontal Res 51:175–185. https://doi.org/10.1111/jre.12296

    Article  PubMed  Google Scholar 

  31. Oliveira GH, Muncinelli EA (2012) Efficacy of root surface biomodification in root coverage: a systematic review. J Can Dent Assoc 78:c122

    PubMed  Google Scholar 

  32. Liu X, Mao M, Ma T (2016) The effect of EDTA root conditioning on periodontal surgery outcome: a meta-analysis. Quintessence Int 47:833–841. https://doi.org/10.3290/j.qi.a36571

    Article  PubMed  Google Scholar 

  33. Mayfield L, Soderholm G, Norderyd O, Attstrom R (1998) Root conditioning using EDTA gel as an adjunct to surgical therapy for the treatment of intraosseous periodontal defects. J Clin Periodontol 25:707–714

    Article  PubMed  Google Scholar 

  34. Blomlof L, Bergman E, Forsgardh A, Foss L, Larsson A, Sjoberg B, Uhlander L, Jonsson B, Blomlof J, Lindskog S (2000b) A clinical study of root surface conditioning with an EDTA gel. I. Nonsurgical periodontal treatment. Int J Periodontics Restorative Dent 20:560–565

    PubMed  Google Scholar 

  35. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012. https://doi.org/10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  36. Miller PD Jr (1985) A classification of marginal tissue recession. Int J Periodontics Restorative Dent 5:8–13

    PubMed  Google Scholar 

  37. Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U (2011) The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 38:661–666. https://doi.org/10.1111/j.1600-051X.2011.01732.x

    Article  PubMed  Google Scholar 

  38. Roccuzzo M, Bunino M, Needleman I, Sanz M (2002) Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 29(Suppl 3):178–194 discussion 195-6

    Article  PubMed  Google Scholar 

  39. Oates TW, Robinson M, Gunsolley JC (2003) Surgical therapies for the treatment of gingival recession. A systematic review. Ann Periodontol 8:303–320. https://doi.org/10.1902/annals.2003.8.1.303

    Article  PubMed  Google Scholar 

  40. Pagliaro U, Nieri M, Franceschi D, Clauser C, Pini-Prato G (2003) Evidence-based mucogingival therapy. Part 1: a critical review of the literature on root coverage procedures. J Periodontol 74:709–740. https://doi.org/10.1902/jop.2003.74.5.709

    Article  PubMed  Google Scholar 

  41. Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini-Prato G (2003) Evidence-based mucogingival therapy. Part 2: ordinary and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the outcome variable. J Periodontol 74:741–756. https://doi.org/10.1902/jop.2003.74.5.741

    Article  PubMed  Google Scholar 

  42. Al-Hamdan K, Eber R, Sarment D, Kowalski C, Wang HL (2003) Guided tissue regeneration-based root coverage: meta-analysis. J Periodontol 74:1520–1533. https://doi.org/10.1902/jop.2003.74.10.1520

    Article  PubMed  Google Scholar 

  43. Gapski R, Parks CA, Wang HL (2005) Acellular dermal matrix for mucogingival surgery: a meta-analysis. J Periodontol 76:1814–1822. https://doi.org/10.1902/jop.2005.76.11.1814

    Article  PubMed  Google Scholar 

  44. Hwang D, Wang HL (2006) Flap thickness as a predictor of root coverage: a systematic review. J Periodontol 77:1625–1634. https://doi.org/10.1902/jop.2006.060107

    Article  PubMed  Google Scholar 

  45. Cheng YF, Chen JW, Lin SJ, Lu HK (2007) Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage? A systemic review. J Periodontal Res 42:474–485. https://doi.org/10.1111/j.1600-0765.2007.00971.x

    Article  PubMed  Google Scholar 

  46. Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA (2008) Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller class I and II recession-type defects? J Dent 36:659–671. https://doi.org/10.1016/j.jdent.2008.05.007

    Article  PubMed  Google Scholar 

  47. Chambrone LA, Chambrone L (2009) Treatment of Miller class I and II localized recession defects using laterally positioned flaps: a 24-month study. Am J Dent 22:339–344

    PubMed  Google Scholar 

  48. Chambrone L, Sukekava F, Araujo MG, Pustiglioni FE, Chambrone LA and Lima LA (2009) Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev CD007161. doi: https://doi.org/10.1002/14651858.CD007161.pub2

  49. Chambrone L, Pannuti CM, Tu YK, Chambrone LA (2012) Evidence-based periodontal plastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage. J Periodontol 83:477–490. https://doi.org/10.1902/jop.2011.110382

    Article  PubMed  Google Scholar 

  50. Buti J, Baccini M, Nieri M, La Marca M, Pini-Prato GP (2013) Bayesian network meta-analysis of root coverage procedures: ranking efficacy and identification of best treatment. J Clin Periodontol 40:372–386. https://doi.org/10.1111/jcpe.12028

    Article  PubMed  Google Scholar 

  51. Cheng GL, Fu E, Tu YK, Shen EC, Chiu HC, Huang RY, Yuh DY, Chiang CY (2015) Root coverage by coronally advanced flap with connective tissue graft and/or enamel matrix derivative: a meta-analysis. J Periodontal Res 50:220–230. https://doi.org/10.1111/jre.12199

    Article  PubMed  Google Scholar 

  52. Chambrone L, Tatakis DN (2015) Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 86:S8–S51. https://doi.org/10.1902/jop.2015.130674

    Article  PubMed  Google Scholar 

  53. Atieh MA, Alsabeeha N, Tawse-Smith A, Payne AG (2016) Xenogeneic collagen matrix for periodontal plastic surgery procedures: a systematic review and meta-analysis. J Periodontal Res 51:438–452. https://doi.org/10.1111/jre.12333

    Article  PubMed  Google Scholar 

  54. Cairo F, Pagliaro U, Buti J, Baccini M, Graziani F, Tonelli P, Pagavino G, Tonetti MS (2016) Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta-analysis. J Clin Periodontol 43:965–975. https://doi.org/10.1111/jcpe.12603

    Article  PubMed  Google Scholar 

  55. Zucchelli G, De Sanctis M (2000) Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol 71:1506–1514. https://doi.org/10.1902/jop.2000.71.9.1506

    Article  PubMed  Google Scholar 

  56. de Sanctis M, Zucchelli G (2007) Coronally advanced flap: a modified surgical approach for isolated recession-type defects: three-year results. J Clin Periodontol 34:262–268. https://doi.org/10.1111/j.1600-051X.2006.01039.x

    Article  PubMed  Google Scholar 

  57. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  58. McGuire MK, Nunn M (2003) Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: comparison of clinical parameters. J Periodontol 74:1110–1125. https://doi.org/10.1902/jop.2003.74.8.1110

    Article  PubMed  Google Scholar 

  59. McGuire MK, Scheyer ET (2010) Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. J Periodontol 81:1108–1117. https://doi.org/10.1902/jop.2010.090698

    Article  PubMed  Google Scholar 

  60. Zucchelli G, Marzadori M, Mounssif I, Mazzotti C, Stefanini M (2014a) Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors. A controlled randomized clinical trial. J Clin Periodontol 41:806–813. https://doi.org/10.1111/jcpe.12269

    Article  PubMed  Google Scholar 

  61. Zucchelli G, Mounssif I, Mazzotti C, Montebugnoli L, Sangiorgi M, Mele M, Stefanini M (2014b) Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. J Clin Periodontol 41:708–716. https://doi.org/10.1111/jcpe.12256

    Article  PubMed  Google Scholar 

  62. Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L (2014c) Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: a comparative short- and long-term controlled randomized clinical trial. J Clin Periodontol 41:396–403. https://doi.org/10.1111/jcpe.12224

    Article  PubMed  Google Scholar 

  63. Azaripour A, Kissinger M, Farina VS, Van Noorden CJ, Gerhold-Ay A, Willershausen B, Cortellini P (2016) Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial. J Clin Periodontol 43:1142–1150. https://doi.org/10.1111/jcpe.12627

    Article  PubMed  Google Scholar 

  64. Kuis D, Sciran I, Lajnert V, Snjaric D, Prpic J, Pezelj-Ribaric S, Bosnjak A (2013) Coronally advanced flap alone or with connective tissue graft in the treatment of single gingival recession defects: a long-term randomized clinical trial. J Periodontol 84:1576–1585. https://doi.org/10.1902/jop.2013.120451

    Article  PubMed  Google Scholar 

  65. Roman A, Soanca A, Kasaj A, Stratul SI (2013) Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of Miller class I and II gingival recessions: a controlled randomized clinical trial. J Periodontal Res 48:563–572. https://doi.org/10.1111/jre.12039

    Article  PubMed  Google Scholar 

  66. Zucchelli G, Amore C, Sforza NM, Montebugnoli L, De Sanctis M (2003) Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study. J Clin Periodontol 30:862–870

    Article  PubMed  Google Scholar 

  67. Zucchelli G, Marzadori M, Mele M, Stefanini M, Montebugnoli L (2012) Root coverage in molar teeth: a comparative controlled randomized clinical trial. J Clin Periodontol 39:1082–1088. https://doi.org/10.1111/jcpe.12002

    Article  PubMed  Google Scholar 

  68. Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M (2010) Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 37:728–738. https://doi.org/10.1111/j.1600-051X.2010.01550.x

    Article  PubMed  Google Scholar 

  69. Gobbato L, Nart J, Bressan E, Mazzocco F, Paniz G, Lops D (2016) Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial. Clin Oral Investig 20:2191–2202. https://doi.org/10.1007/s00784-016-1721-7

    Article  PubMed  Google Scholar 

  70. Nemcovsky CE, Artzi Z, Tal H, Kozlovsky A, Moses O (2004) A multicenter comparative study of two root coverage procedures: coronally advanced flap with addition of enamel matrix proteins and subpedicle connective tissue graft. J Periodontol 75:600–607. https://doi.org/10.1902/jop.2004.75.4.600

    Article  PubMed  Google Scholar 

  71. Rasperini G, Roccuzzo M, Francetti L, Acunzo R, Consonni D, Silvestri M (2011) Subepithelial connective tissue graft for treatment of gingival recessions with and without enamel matrix derivative: a multicenter, randomized controlled clinical trial. Int J Periodontics Restorative Dent 31:133–139

    PubMed  Google Scholar 

  72. Cortellini P, Pini Prato G (2012) Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience. Periodontol 2000(59):158–184. https://doi.org/10.1111/j.1600-0757.2011.00434.x

    Article  Google Scholar 

  73. Guiha R, el Khodeiry S, Mota L, Caffesse R (2001) Histological evaluation of healing and revascularization of the subepithelial connective tissue graft. J Periodontol 72:470–478. https://doi.org/10.1902/jop.2001.72.4.470

    Article  PubMed  Google Scholar 

  74. Blomlof J, Blomlof L, Lindskog S (1997) Effect of different concentrations of EDTA on smear removal and collagen exposure in periodontitis-affected root surfaces. J Clin Periodontol 24:534–537

    Article  PubMed  Google Scholar 

  75. Blomlof JP, Blomlof LB, Lindskog SF (1996b) Smear removal and collagen exposure after non-surgical root planing followed by etching with an EDTA gel preparation. J Periodontol 67:841–845. https://doi.org/10.1902/jop.1996.67.9.841

    Article  PubMed  Google Scholar 

  76. Ruggeri A Jr, Prati C, Mazzoni A, Nucci C, Di Lenarda R, Mazzotti G, Breschi L (2007) Effects of citric acid and EDTA conditioning on exposed root dentin: an immunohistochemical analysis of collagen and proteoglycans. Arch Oral Biol 52:1–8. https://doi.org/10.1016/j.archoralbio.2006.07.001

    Article  PubMed  Google Scholar 

  77. Lowenberg B, Thibault J, Lawrence C, Sodek J (1986) The influence of chemically-induced modifications of root surfaces on cell migration, attachment, and orientation. J Dent Res 65:1010–1015. https://doi.org/10.1177/00220345860650070301

    Article  PubMed  Google Scholar 

  78. Babay N (2001a) The effect of EDTA on the attachment and growth of cultured human gingival fibroblasts in periodontitis-affected root surface. J Contemp Dent Pract 2:13–23

    PubMed  Google Scholar 

  79. Babay N (2001b) Attachment of human gingival fibroblasts to periodontally involved root surface following scaling and/or etching procedures: a scanning electron microscopy study. Braz Dent J 12:17–21

    PubMed  Google Scholar 

  80. Kasaj A, Klein MO, Dupont J, Willershausen B, Krahn U, Gotz H, Zeiler J, Brullmann D, Duschner H (2013) Early root surface colonization by human periodontal ligament fibroblasts following treatment with different biomaterials. Acta Odontol Scand 71:1579–1587. https://doi.org/10.3109/00016357.2013.777115

    Article  PubMed  Google Scholar 

  81. Gamal AY, Abdel-Ghaffar KA, Zouair MG, Salama MH, Destawy MTE (2018) Dimensional evaluation of blood clot gap distances within the intrabony defects following grafting and EDTA root surface treatment—experimental study in dogs. J Periodontol 89:691–698. https://doi.org/10.1002/JPER.17-0361

    Article  PubMed  Google Scholar 

  82. Wikesjo UM, Claffey N, Egelberg J (1991) Periodontal repair in dogs. Effect of heparin treatment of the root surface. J Clin Periodontol 18:60–64

    Article  PubMed  Google Scholar 

  83. Wikesjo UM, Nilveus R (1990) Periodontal repair in dogs: effect of wound stabilization on healing. J Periodontol 61:719–724. https://doi.org/10.1902/jop.1990.61.12.719

    Article  PubMed  Google Scholar 

  84. Agudio G, Nieri M, Rotundo R, Franceschi D, Cortellini P, Pini Prato GP (2009) Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study. J Periodontol 80:1399–1405. https://doi.org/10.1902/jop.2009.090122

    Article  PubMed  Google Scholar 

  85. Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P (2010) Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol 37:644–650. https://doi.org/10.1111/j.1600-051X.2010.01559.x

    Article  PubMed  Google Scholar 

  86. Zuhr O, Baumer D, Hurzeler M (2014) The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 41(Suppl 15):S123–S142. https://doi.org/10.1111/jcpe.12185

    Article  PubMed  Google Scholar 

  87. Zucchelli G, Mounssif I (2015) Periodontal plastic surgery. Periodontol 2000(68):333–368. https://doi.org/10.1111/prd.12059

    Article  Google Scholar 

  88. Rebele SF, Zuhr O, Schneider D, Jung RE, Hurzeler MB (2014) Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II. Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol 41:593–603. https://doi.org/10.1111/jcpe.12254

    Article  PubMed  Google Scholar 

  89. Agudio G, Chambrone L, Pini Prato G (2017) Biologic remodeling of periodontal dimensions of areas treated with gingival augmentation procedure: a 25-year follow-up observation. J Periodontol 88:634–642. https://doi.org/10.1902/jop.2017.170010

    Article  PubMed  Google Scholar 

  90. Matter J (1980) Creeping attachment of free gingival grafts. A five-year follow-up study. J Periodontol 51:681–685. https://doi.org/10.1902/jop.1980.51.12.681

    Article  PubMed  Google Scholar 

  91. Harris RJ (1997) Creeping attachment associated with the connective tissue with partial-thickness double pedicle graft. J Periodontol 68:890–899. https://doi.org/10.1902/jop.1997.68.9.890

    Article  PubMed  Google Scholar 

Download references

Funding

This paper was partially supported by the University of Michigan Periodontal Graduate Student Research Fund.

Author information

Authors and Affiliations

  1. Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, 1011 North University Avenue, Ann Arbor, MI, 48109-1078, USA

    Shayan Barootchi, Lorenzo Tavelli, Andrea Ravidà, Chin-Wei Wang & Hom-Lay Wang

Authors
  1. Shayan Barootchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lorenzo Tavelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Ravidà
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chin-Wei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hom-Lay Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shayan Barootchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Electronic supplementary material

Data S1

Characteristics and references of the excluded articles. (DOCX 14 kb)

Data S2

Bias risk assessment for the included RCTs using The Cochrane Risk of Bias Tool for Randomized Controlled Trials (DOCX 16 kb)

Data S3

Meta-analysis and comparisons of baseline characteristics and WMV for the EDTA and non-EDTA groups for Initial Recession and KT height. A) Initial recession of EDTA studies, B) Initial recession of non-EDTA studies, C) Comparison of both groups for Initial recession, D) KT height of EDTA studies at baseline, E) KT height of non-EDTA studies at baseline, F) comparison of baseline KT height for both groups. (PNG 1195 kb)

High resolution image (TIF 2398 kb)

Data S4

Meta-analysis and comparisons of baseline characteristics and WMV for the EDTA and non-EDTA groups for CAL and PD. A) Initial CAL for EDTA studies, B) Initial CAL for non-EDTA studies, C) Comparison of Initial CAL in both groups, D) Initial PD for EDTA studies, E) Initial PD for non-EDTA studies, F) Comparison of initial PD for both groups (PNG 1037 kb)

High resolution image (TIF 2245 kb)

Data S5

Funnel plots assessing potential publication bias among the selected trials for the evaluated outcomes of: Rec Red in A) EDTA studies, and B) non-EDTA studies; CRC of C) EDTA studies, and D) non-EDTA studies; KT gain of E) EDTA studies, and F) non-EDTA studies; CAL gain of G) EDTA studies, and H) non-EDTA studies; PD reduction of I) EDTA studies, and J) non-EDTA studies. (PNG 739 kb)

High resolution image (TIF 5958 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barootchi, S., Tavelli, L., Ravidà, A. et al. Effect of EDTA root conditioning on the outcome of coronally advanced flap with connective tissue graft: a systematic review and meta-analysis. Clin Oral Invest 22, 2727–2741 (2018). https://doi.org/10.1007/s00784-018-2635-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-018-2635-3

Keywords

Search

Navigation