Skip to main content

Coronally advanced flap with or without porcine collagen matrix for root coverage: a randomized clinical trial

Clinical Oral Investigations volume 20, pages 2539–2549 (2016)Cite this article

Abstract

Objectives

The objective of this study is to clinically evaluate the outcomes following treatment of single gingival recessions with either coronally advanced flap technique (CAF) alone or combined with a porcine collagen matrix graft (CM).

Materials and methods

This is a randomized parallel design clinical trial, including forty patients with single Miller Class I or II gingival recession, with a depth ≥ 2 mm and located at upper canines or premolars. The patients were randomly assigned to receive either CAF or CAF + CM. The primary outcome variable was gingival recession reduction (Rec Red).

Results

Baseline recession depth was 3.14 ± 0.51 mm for CAF group and 3.16 ± 0.65 mm for CAF + CM group (p > 0.05). Both groups showed significant Rec Red (p < 0.05), up to 6 months. Rec Red for CAF + CM was 2.41 ± 0.73 mm and was 2.25 ± 0.50 mm for CAF alone (p > 0.05). Root coverage was 77.2 % in the CAF + CM group and 72.1 % in the CAF group (p > 0.05). Complete root coverage (CRC) was found in 40 % of the cases in the CAF + CM group and in 35 % of the sites treated with CAF. Keratinized tissue thickness (KTT) was 0.26 mm higher in CAF + CM group (p < 0.05).

Conclusions

It can be concluded that CAF + CM does not provide a superior recession reduction when compared to CAF; however, it may offer a small gain in KTT after 6 months.

Clinical relevance

CAF + CM can be suggested as a valid therapeutic option to achieve root coverage and some increase in soft tissue thickness after 6 months.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2
Fig. 3

References

  1. Wennström JL (1996) Mucogingival therapy. Ann Periodontol 1:671–701

    Article  PubMed  Google Scholar 

  2. Serino G, Wennström JL, Lindhe J, Eneroth L (1994) The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. J Clin Periodontol 21:57–63

    Article  PubMed  Google Scholar 

  3. Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM (2004) Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol 75:1377–1386

    Article  PubMed  Google Scholar 

  4. Toker H, Ozdemir H (2009) Gingival recession: epidemiology and risk indicators in a university dental hospital in Turkey. Int J Dent Hyg 7:115–120

    Article  PubMed  Google Scholar 

  5. Sarfati A, Bourgeois D, Katsahian S, Mora F, Bouchard P (2010) Risk assessment for buccal gingival recession defects in an adult population. J Periodontol 81:1419–1425

    Article  PubMed  Google Scholar 

  6. Nguyen-Hieu T, Ha-Thi B (2012) Gingival recession associated with predisposing factors in young vietnamese: a pilot study. Oral Health Dent Manag 11:134–144

    PubMed  Google Scholar 

  7. Sangnes G, Gjermo P (1976) Prevalence of oral soft and hard tissue lesions related to mechanical toothcleansing procedures. Community Dent Oral Epidemiol 4:77–83

    Article  PubMed  Google Scholar 

  8. Litonjua LA, Andreana S, Bush PJ, Cohen RE (2003) Toothbrushing and gingival recession. Int Dent J 53:67–72

    Article  PubMed  Google Scholar 

  9. Rajapakse PS, McCracken GI, Gwynnett E, Steen ND, Guentsch A, Heasman PA (2007) Does tooth brushing influence the development and progression of non-inflammatory gingival recession? A systematic review. J Clin Periodontol 34:1046–1061

    Article  PubMed  Google Scholar 

  10. Allen EP, Miller PD (1989) Coronal positioning of existing gingiva: short term results in the treatment of shallow marginal tissue recession. J Periodontol 60:316–319

    Article  PubMed  Google Scholar 

  11. Tonetti MS, Jepsen S (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 1):S36–S43

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  13. Wennström JL (1996) Mucogingival considerations in orthodontic treatment. Semin Orthod 2:46–54

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. Langer B, Langer L (1985) Subepithelial connective tissue graft technique for root coverage. J Periodontol 56:715–720

    Article  PubMed  Google Scholar 

  16. Côrtes Ade Q, Martins AG, Nociti FH, Sallum AW, Casati MZ, Sallum EA (2004) Coronally positioned flap with or without acellular dermal matrix graft in the treatment of Class I gingival recessions: a randomized controlled clinical study. J Periodontol 75:1137–1144

    Article  PubMed  Google Scholar 

  17. Prato GP, Tinti C, Cortellini P, Magnani C, Clauser C (1992) Periodontal regenerative therapy with coverage of previously restored root surfaces: case reports. Int J Periodontics Restorative Dent 12:450–461

    PubMed  Google Scholar 

  18. Modica F, Del Pizzo M, Roccuzzo M, Romagnoli R (2000) Coronally advanced flap for the treatment of buccal gingival recessions with and without enamel matrix derivative. A Split-mouth Study J Periodontol 71:1693–1698

    Article  PubMed  Google Scholar 

  19. Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A Syst Rev J Clin Periodontol 41(Suppl 1):S44–S62

    Article  Google Scholar 

  20. 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 

  21. 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

    Article  PubMed  Google Scholar 

  22. Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA (2010) Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol 81:452–478

    Article  PubMed  Google Scholar 

  23. Cortellini P, Tonetti M, Baldi C, Francetti L, Rasperini G, Rotundo R, et al. (2009) Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi-centre, randomized, double-blind, clinical trial. J Clin Periodontol 36:68–79

    Article  PubMed  Google Scholar 

  24. Romagna-Genon C (2001) Comparative clinical study of guided tissue regeneration with a bioabsorbable bilayer collagen membrane and subepithelial connective tissue graft. J Periodontol 72:1258–1264

    Article  PubMed  Google Scholar 

  25. 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 

  26. Keceli HG, Sengun D, Berberoğlu A, Karabulut E (2008) Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial. J Clin Periodontol 35:255–262

    Article  PubMed  Google Scholar 

  27. De Queiroz CA, Sallum AW, Casati MZ, Nociti FH, Sallum EA (2006) A two-year prospective study of coronally positioned flap with or without acellular dermal matrix graft. J Clin Periodontol 33:683–689

    Article  Google Scholar 

  28. Alves LB, Costa PP, Scombatti de Souza SL, de Moraes Grisi MF, Palioto DB, Taba M Jr, et al. (2012) Acellular dermal matrix graft with or without enamel matrix derivative for root coverage in smokers: a randomized clinical study. J Clin Periodontol 39:393–399

    Article  PubMed  Google Scholar 

  29. 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

    Article  PubMed  Google Scholar 

  30. Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L (2012) Treatment of gingival recession defects using coronally advanced flap with a porcine collagen matrix compared to coronally advanced flap with connective tissue graft: a randomized controlled clinical trial. J Periodontol 83:321–328

    Article  PubMed  Google Scholar 

  31. Aroca S, Molnár B, Windisch P, Gera I, Salvi GE, Nikolidakis D, et al. (2013) Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. J Clin Periodontol 40:713–720

    Article  PubMed  Google Scholar 

  32. Jepsen K, Jepsen S, Zucchelli G, Stefanini M, de Sanctis M, Baldini N, et al. (2013) Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol 40:82–89

    Article  PubMed  Google Scholar 

  33. Molnár B, Aroca DMDS, Keglevich T, Gera I, Windisch P, Sculean A, et al. (2013) Treatment of multiple adjacent Miller Class I and II gingival recessions with collagen matrix and the modified coronally advanced tunnel technique 44:17–25

  34. Ghanaati S, Schlee M, Webber MJ, Willershausen I, Barbeck M, Balic E, et al. (2011) Evaluation of the tissue reaction to a new bilayered collagen matrix in vivo and its translation to the clinic. Biomed Mater 6:015010

    Article  PubMed  Google Scholar 

  35. Camelo M, Nevins M, Nevins ML, Schupbach P, Kim DM (2012) Treatment of gingival recession defects with xenogenic collagen matrix: a histologic report. Int J Periodontics Restor Dent 32:167–173

    Google Scholar 

  36. Pini-Prato G, Franceschi D, Cairo F, Nieri M, Rotundo R (2010) Classification of dental surface defects in areas of gingival recession. J Periodontol 81:885–890

    Article  PubMed  Google Scholar 

  37. Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229–235

    PubMed  Google Scholar 

  38. Mühlemann H, Son S (1971) Gingival sulcus bleeding—a leading symptom in initial gingivitis. Helv Odontol Acta 15:107–113

    PubMed  Google Scholar 

  39. Cairo F, Rotundo R, Miller PD, Pini Prato GP (2009) Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 80:705–710

    Article  PubMed  Google Scholar 

  40. Kerner S, Sarfati A, Katsahian S, Jaumet V, Micheau C, Mora F, et al. (2009) Qualitative cosmetic evaluation after root-coverage procedures. J Periodontol 80:41–47

    Article  PubMed  Google Scholar 

  41. 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

    Article  PubMed  Google Scholar 

  42. Da Silva RC, Joly JC, de Lima AFM, Tatakis DN (2004) Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. J Periodontol 75:413–419

    Article  PubMed  Google Scholar 

  43. Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, et al. (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

    PubMed  Google Scholar 

  44. Ahmedbeyli C, Ipçi ŞD, Cakar G, Kuru BE, Yılmaz S (2014) Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype. J Clin Periodontol 41:303–310

    Article  PubMed  Google Scholar 

  45. Müller HP, Eger T (1997) Gingival phenotypes in young male adults. J Clin Periodontol 24:65–71

    Article  PubMed  Google Scholar 

  46. Bernimoulin JP, Son S, Regolati B (1971) Biometric comparison of three methods for determining the mucogingival junction. Helv Odontol Acta 15:118–120

    PubMed  Google Scholar 

  47. Tenenbaum H (1982) A clinical study comparing the width of attached gingiva and the prevalence of gingival recessions. J Clin Periodontol 9:86–92

    Article  PubMed  Google Scholar 

  48. Wennström JL (1987) Lack of association between width of attached gingiva and development of soft tissue recession. A 5-year longitudinal study. J Clin Periodontol 14:181–184

    Article  PubMed  Google Scholar 

  49. Pasquinelli KL (1995) The histology of new attachment utilizing a thick autogenous soft tissue graft in an area of deep recession: a case report. Int J Periodontics Restor Dent 15:248–257

    Google Scholar 

  50. Goldstein M, Boyan BD, Cochran DL, Schwartz Z (2001) Human histology of new attachment after root coverage using subepithelial connective tissue graft. J Clin Periodontol 28:657–662

    Article  PubMed  Google Scholar 

  51. Cummings LC, Kaldahl WB, Allen EP (2005) Histologic evaluation of autogenous connective tissue and acellular dermal matrix grafts in humans. J Periodontol 76:178–186

    Article  PubMed  Google Scholar 

  52. McGuire MK, Scheyer ET, Schupbach P (2009) Growth factor-mediated treatment of recession defects: a randomized controlled trial and histologic and microcomputed tomography examination. J Periodontol 80:550–564

    Article  PubMed  Google Scholar 

  53. Caffesse RG, Kon S, Castelli WA, Nasjleti CE (1984) Revascularization following the lateral sliding flap procedure. J Periodontol 55:352–358

    Article  PubMed  Google Scholar 

  54. Kon S, Caffesse RG, Castelli WA, Nasjleti CE (1984) Revascularization following a combined gingival flap-split thickness flap procedure in monkeys. J Periodontol 55:345–351

    Article  PubMed  Google Scholar 

  55. Sculean A, Gruber R, Bosshardt DD (2014) Soft tissue wound healing around teeth and dental implants. J Clin Periodontol 41(Suppl 1):S6–22

    Article  PubMed  Google Scholar 

  56. Vignoletti F, Nuñez J, Discepoli N, De Sanctis F, Caffesse R, Muñoz F, et al. (2011) Clinical and histological healing of a new collagen matrix in combination with the coronally advanced flap for the treatment of Miller class-I recession defects: an experimental study in the minipig. J Clin Periodontol 38:847–855

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Renato Corrêa Viana Casarin for their valuable comments with respect to the statistical analysis of this manuscript and Geistlich Pharma AG that provided the porcine collagen matrix tested in the present study.

Author information

Authors and Affiliations

  1. Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, State University of Campinas – UNICAMP, Av. Limeira, 901, Areião, Piracicaba, São Paulo, Brazil

    Ana Regina Oliveira Moreira, Karina Gonzales Silvério, Marcio Zaffalon Casati, Francisco Humberto Nociti Junior & Enilson Antonio Sallum

  2. Department of Periodontology, São José dos Campos Dental School, State University of São Paulo, São José dos Campos, São Paulo, Brazil

    Mauro Pedrine Santamaria

  3. Department of Periodontology, University of Bern, Bern, Switzerland

    Anton Sculean

Authors
  1. Ana Regina Oliveira Moreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mauro Pedrine Santamaria
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karina Gonzales Silvério
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcio Zaffalon Casati
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francisco Humberto Nociti Junior
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anton Sculean
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Enilson Antonio Sallum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Enilson Antonio Sallum.

Ethics declarations

This study was performed in accordance with ethical standards of the Institutional Review Board of the State University of Campinas (CEP-UNICAMP 130/2010).

Conflict of interest

The authors declare that they have no competing interests.

Funding

The work was supported by the Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, State University of Campinas—UNICAMP.

Informed consent

Written informed consent was obtained of each subject included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Moreira, A.R.O., Santamaria, M.P., Silvério, K.G. et al. Coronally advanced flap with or without porcine collagen matrix for root coverage: a randomized clinical trial. Clin Oral Invest 20, 2539–2549 (2016). https://doi.org/10.1007/s00784-016-1757-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-016-1757-8

Keywords

  • Gingival recession/surgery
  • Collagen/therapeutic use
  • Root coverage
  • Treatment outcome