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Root coverage using coronally advanced flap with porcine-derived acellular dermal matrix or subepithelial connective tissue graft: a randomized controlled clinical trial

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The aim of this study is to investigate the use of a porcine-derived acellular dermal matrix (MD) in root coverage procedures combined with extended coronally positioned flap (eCAF), in comparison to the subepithelial connective tissue graft (SCTG) associated with the eCAF.

Material and methods

Eighteen adult patients presenting bilateral type 1 gingival recession were randomly assigned to SCTG or MD groups. Clinical and patient-based outcomes were recorded at 3 and 6 months after the surgical procedure.


Both groups showed a significant reduction in the mean recession height of 3.33 ± 0.89 mm to 1.24 ± 1.10 mm (MD) and 3.21 ± 0.8 mm to 0.83 ± 0.86 mm (SCTG) without difference between groups. Six patients in the test group and eight in the control group obtained complete root coverage. The keratinized tissue height and thickness (KTT) showed a significant increase after 3 and 6 months in both groups. The average KTT gains were 0.39 ± 0.4 mm (MD) and 0.51 ± 0.5 mm (SCTG) (p < 0.05). Performing multivariate analysis suggests that MD addition to coronally advanced flaps may be similar to SCTG.


The MD had similar results in comparison to SCTG and in the context of reducing patient morbidity it can be used as an alternative for the treatment of gingival recessions.

Clinical relevance

The SCTG is the gold standard therapy for root coverage. The MD has been widely used in mucogingival surgery as a substitute for SCTG and proposed similar results. A substitute is very important for clinicians and patients. It will give a better postoperative and possibilities to treat multiples recession. ( Identifier: NCT03675334).

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  1. AlloDerm®, LifeCell, The Woodlands, TX

  2. Mucograft®, Geistlich Pharma AG, Wolhusen, Switzerland

  3. Mucoderm® Botiss Dental Berlin, Berlin, Germany

  4. Graphpad Statemate 2.0 program Graphpad software, INC., San Diego, CA, USA

  5. PCP-UNC 15; Hu-Friedy Manufacturing, Chicago, IL, USA

  6. North Caroline-type periodontal probe, Hu-Friedy, Chicago, IL, USA

  7. ImageJ, National Institute of Health, Bethesda, Maryland, USA

  8. Mucoderm® Botiss Dental Berlin, Berlin, Germany

  9. Mucograft®, Geistlich Pharma AG, Wolhusen, Switzerland

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  11. Mucoderm® Botiss Dental Berlin, Berlin, Germany


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This study was financed in part by the Higher Level Coordination—Brazil (CAPES)—finance code 001 and National Council for Scientific and Technological Development (CNPq) Research Productivity Fellowship—process number 307917/2017-7.

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Correspondence to Mario Taba Jr.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted, according to the principles outlined in the experimentation involving human subjects in the Declaration of Helsinki from the World Medical Association (2008). The study protocol was reviewed and approved by the Research Ethics Committee of the School of Dentistry of Ribeirao Preto, University of Sao Paulo (protocol CAAE 58534216.5.0000.5419), and registered at (NCT03675334).

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Informed consent was obtained from all individual participants included in the study.

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Suzuki, K.T., de Jesus Hernandez Martinez, C., Suemi, M.I. et al. Root coverage using coronally advanced flap with porcine-derived acellular dermal matrix or subepithelial connective tissue graft: a randomized controlled clinical trial. Clin Oral Invest 24, 4077–4087 (2020).

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