To evaluate the treatment of gingival recessions by semilunar coronally positioned flap plus enamel matrix derivative (SCPF + EMD).
Materials and methods
Thirty patients with class I localized gingival recession were included. They were randomly allocated in two groups: SCPF + EMD and SCPF. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline, 6 and 12 months post-surgery. Patient/professional evaluation of esthetics and root sensitivity was performed.
After 12 months, mean root coverage was 1.98 ± 0.33 mm for SCPF + EMD (90.86 ± 14.69%) and 1.85 ± 0.41 mm (79.76 ± 17.44%) for SCPF (p > 0.05). The esthetic evaluation by the patient showed preference for SCPF + EMD. According to the professional evaluation (QCE), the use of EMD decreases the appearance of postoperative scar tissue line. There was a significant reduction in root hypersensitivity with no further complaints by the patients.
The addition of EMD provides significantly better esthetics to SCPF, according to patient and professional assessments. SCPF + EMD is effective but not superior to SCPF for root coverage, after 12 months.
Previous clinical trials showed that the combination of EMD with coronally advanced flaps may enhance the outcome of root coverage. There is a lack of studies testing the combination of EMD with SCPF. The combination SCPF + EMD provides better esthetics when compared to the SCPF and is effective, but not superior, to SCPF for root coverage, after 12 months.
Trial registration: NCT02459704
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Bouchard P, Malet J, Borghetti A (2001) Decision-making in aesthetics: root coverage revisited. Periodontol 2000 27:97–120
Roccuzzo M, Bunino M, Needleman I, Sanz M (2002) Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 29:178–194
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
Tarnow DP (1986) Semilunar coronally repositioned flap. J Clin Periodontol 13(3):182–185
Tarnow DP (1994) Solving restorative esthetic dilemmas with the semilunar coronally positioned flap. J Esthet Dent 6(2):61–64
Thompson BK, Meyer R, Singh GB, Mitchell W (2000) Densitization of exposed of root surfaces using a semilunar coronally positioned flap. Gen Dent 48(1):68–71
Casati MZ, Nociti FH Jr, Sallum EA, Nogueira GR, Sallum AW (2001) Tratamento de recessões gengivaispela técnica de retalho semilunar posicionado coronariamente. Rev Assoc Paul Cir Dent 55(3):169–172
Haghighat K (2006) Modified semilunar coronally advanced flap. J Periodontol 77(7):1274–1279
de Campos GV, Bittencourt S, Sallum AW, Nociti Júnior FH, Sallum EA, Casati MZ (2006) Achieving primary closure and enhancing aesthetics with periodontal microsurgery. Pract Proced Aesthet Dent 18(7):449–454
Bittencourt S, Ribeiro E. del 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(9):1695–1701
Bittencourt S, Del Peloso Ribeiro E, Sallum EA, Sallum AW, Nociti FH Jr, Casati MZ (2006) Comparative 6-month clinical study of a semilunar coronally positioned flap and subepithelial connective tissue graft for the treatment of gingival recession. J Periodontol 77(2):174–181
Bittencourt S, Ribeiro E, del P, Sallum EA, Sallum AW, Nociti FH Jr, Casati MZ (2009) Semilunar coronally positioned flap or subepithelial connective tissue graft for the treatment of gingival recession: a 30-month follow-up study. J Periodontol 80(7):1076–1082
Hammarström L (1997) Enamel matrix, cementum development and regeneration. J Clin Periodontol 24:658–668
Lyngstadaas SP, Wohlfahrt JC, Brookes SJ, Paine ML, Snead ML, Reseland JE (2009) Enamel matrix proteins: old molecules for new applications. Orthod Craniofac Res 12(3):243–253
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(2):220–230
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(15):44–62
Koop R, Merheb J, Quirynen M (2012) Periodontal regeneration with enamel matrix derivative in reconstructive periodontal therapy: a systematic review. J Periodontol 83(6):707–720
Miron RJ, Dard M, Weinreb M (2015) Enamel matrix derivative, inflammation and soft tissue wound healing. J Periodontal Res 50(5):555–569
Schiff T, Dotson M, Cohen S, DeVizio W, Volpe A (1994) Efficacy of a dentifrice containing potassium nitrate, soluble pyrophosphate, PVM/MA copolymer, and sodium fluoride on dentinal hypersensitivity: a twelve week clinical study. J Clin Dent 5(Sp Is):87–92
Kerner S, Sarfati A, Katsahian S, Jaumet V, Micheau C, Mora F, Monnet-Corti V, Bouchard P (2009) Qualitative cosmetic evaluation after root-coverage procedures. J Periodontol 80(1):41–47
Santamaria MP, Queiroz LA, Mathias IF, Neves FL, Silveira CA, Bresciani E, Jardini MA, Sallum EA (2016) Resin composite plus connective tissue graft to treat single maxillary gingival recession associated with non-carious cervical lesion: randomized clinical trial. J Clin Periodontol 43(5):461–468
Langer B, Langer L (1985) Subepithelial connective tissue graft technique for root coverage. J Periodontol 56:715–720
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(11):1693–1698
Del Pizzo M, Zucchelli G, Modica F, Villa R, Debernardi C (2005) Coronally advanced flap with or without enamel matrix derivative for root coverage: a 2-year study. J Clin Periodontol 32(11):1181–1187
Castellanos TA, de la Rosa RM, de la Garza M, Caffesse RG (2006) Enamel matrix derivative and coronal flaps to cover marginal tissue recessions. J Periodontol 77(1):7–14
Pilloni A, Paolantonio M, Camargo PM (2006) Root coverage with a coronally positioned flap used in combination with enamel matrix derivative: 18-month clinical evaluation. J Periodontol 77(12):2031–2039
Tonetti MS, Jepsen S (2014) Working Group 2 of the European Workshop on Periodontology. 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):36–43
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 Periodont Res 42:474–485
Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 35(8):136–162
Rebele SF, Zuhr O, Schneider D, Jung RE, Hürzeler M (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(6):593–603
Sculean A, Alessandri R, Miron RJ, Salvi EG, Bosshardt DD (2011) Enamel matrix proteins and periodontal wound healing and regeneration. Clin Adv Periodontics 1:101–117
Gruber R, Stähli A, Miron RJ, Bosshardt DD, Sculean A (2015) Common target genes of palatal and gingival fibroblasts for EMD: the microarray approach. J Periodontal Res 50(1):103–112
The authors appreciate the financial support (masters scholarship) provided by the Research Funding Agency from São Paulo State (FAPESP), São Paulo, SP, Brazil (process #2013/13098-9).
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
França-Grohmann, I.L., Sangiorgio, J.P.M., Bueno, M.R. et al. Does enamel matrix derivative application improve clinical outcomes after semilunar flap surgery? A randomized clinical trial. Clin Oral Invest 23, 879–887 (2019). https://doi.org/10.1007/s00784-018-2506-y
- Dental enamel proteins
- Gingival recession/therapy
- Tooth root/surgery, surgical flap