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Effect of enamel matrix derivative on wound healing following gingival recession coverage using the modified coronally advanced tunnel and subepithelial connective tissue graft: a randomised, controlled, clinical study

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Abstract

Objectives

The potential effect of enamel matrix derivative (EMD) on wound healing following recession coverage surgery is still controversially discussed in the literature. The aim of this randomised, controlled, single blinded clinical study was, therefore, to investigate clinically and immunologically the potential effects of EMD on early wound healing and clinical results following treatment of single and multiple gingival recessions by the modified coronally advanced tunnel technique (MCAT) and subepithelial connective tissue graft (sCTG).

Materials and methods

A total of 40 systemically healthy patients with Miller class I, II or III single or multiple gingival recessions were treated with MCAT + sCTG with or without EMD. Patients were consecutively enrolled and randomly assigned to test or control treatment. Inflammatory markers (interleukin (IL)-1β, IL-8, IL-10 and matrix metalloprotease (MMP)-8) were measured at baseline, 2 days and 1 week postoperatively. The following clinical parameters were assessed at baseline and at 6 months postoperatively: Recession Depth (RD), Recession Width (RW), Width of Keratinized Tissue (KT) and Probing Depth (PD). Patient-reported outcomes were analysed by means of a visual analogue scale.

Results

No statistically significant differences were detected between the 2 groups in terms of inflammatory markers and patient-reported outcomes during early wound healing. In the test group, RD was reduced from 4.0 ± 1.2 mm at baseline to 0.9 ± 1.3 mm at 6 months (p < 0.001), while the corresponding values in the control group were 4.5 ± 2.0 mm at baseline and 1.0 ± 1.0 mm at 6 months, respectively. At 6 months, mean root coverage measured 78 ± 26% in the test group and 77 ± 18% in the control group, respectively.

Conclusion

Within their limits, the present data have failed to show an influence of EMD on the clinical and immunological parameters related to wound healing following recession coverage surgery using MCAT and sCTG.

Clinical relevance

Early wound healing following recession coverage by means of MCAT and sCTG does not seem to be influenced by the additional application of EMD.

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Funding

The work was supported by the Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland, and by Straumann, Basel, Switzerland.

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Author notes

  1. Alexandra Stähli and Jean-Claude Imber contributed equally to this work.

Authors and Affiliations

  1. Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland

    Alexandra Stähli, Jean-Claude Imber, Elena Raptis, Giovanni E. Salvi, Sigrun Eick & Anton Sculean

  2. Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, Mainz, Germany

    Jean-Claude Imber

  3. Laboratory of Oral Microbiology, Department of Periodontology, University of Bern, Bern, Switzerland

    Sigrun Eick

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  1. Alexandra Stähli
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  2. Jean-Claude Imber
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Correspondence to Anton Sculean.

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Stähli, A., Imber, JC., Raptis, E. et al. Effect of enamel matrix derivative on wound healing following gingival recession coverage using the modified coronally advanced tunnel and subepithelial connective tissue graft: a randomised, controlled, clinical study. Clin Oral Invest 24, 1043–1051 (2020). https://doi.org/10.1007/s00784-019-03008-6

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