Skip to main content

Advertisement

SpringerLink
Log in

Root coverage of multiple gingival recessions treated with coronally advanced flap associated with xenogeneic acellular dermal matrix or connective tissue graft: a 6-month split-mouth controlled and randomized clinical trial

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to compare xenogeneic dermal matrix (XDM) to connective tissue graft (CTG) associated with coronally advanced flap (CAF) in treating Miller’s class I and II (RT1) multiple gingival recession in a split-mouth randomized clinical trial.

Materials and methods

Fifteen patients with bilateral Miller’s class I and II multiple recessions were selected. The patient’s side receiving each treatment was randomly allocated to receive XDM or CTG. The clinical parameters were measured at baseline and 6 months of follow-up.

Results

At 6 months, no significant difference in the root coverage (RC) (95.28 ± 6.89% for CTG and 92.68 ± 7.35% for XDM) and the keratinized tissue (KT) gain (0.91 ± 0.46 mm for CTG and 0.74 ± 0.39 mm for XDM) was observed between groups (p > 0.05). The CTG group presented higher complete root coverage (CRC) than XDM (60% and 33%, respectively) (p = 0.045). Multiple logistic regression indicated that the XDM (p = 0.01) and the XDM and KT interaction (p = 0.02) negatively interfered in the CRC. A 1-mm increase in the baseline KT when using XDM increases almost 6 times the chance of achieving CRC, and XDM reached a similar CRC probability to CTG when the receptor area presented at least 2 mm of KT.

Conclusions

Both treatments were effective for treating multiple gingival recession; similar KT gain, GR reduction, and RC were obtained for CTG and XDM, while CTG promoted higher CRC than XDM. Moreover, the amount of KT at baseline was determinant for CRC when treating multiple gingival recession with XDM.

Clinical relevance

XDM produces limited CRC in sites with a reduced amount of KT.

Trial registration

Brazilian Clinical Trials Registry (REBEC) number RBR-56NZQ6

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

Similar content being viewed by others

References

  1. Kassab MM, Cohen RE (2003) The etiology and prevalence of gingival recession. J Am Dent Assoc 134:220–225. https://doi.org/10.14219/jada.archive.2003.0137

    Article  PubMed  Google Scholar 

  2. Cortellini P, Bissada NF (2018) Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations. J Clin Periodontol 45:S190–S198. https://doi.org/10.1111/jcpe.12948

    Article  PubMed  Google Scholar 

  3. 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 

  4. 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 

  5. Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M (2009) Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol 80:1083–1094. https://doi.org/10.1902/jop.2009.090041

    Article  PubMed  Google Scholar 

  6. Harris RJ (2002) Root coverage with connective tissue grafts: an evaluation of short- and long-term results. J Periodontol 73:1054–1059. https://doi.org/10.1902/jop.2002.73.9.1054

    Article  PubMed  Google Scholar 

  7. Stähli A, Miron RJ, Bosshardt DD, Sculean A, Gruber R (2016) Collagen membranes adsorb the transforming growth factor-β receptor I kinase-dependent activity of enamel matrix derivative. J Periodontol 87:583–590. https://doi.org/10.1902/jop.2016.150538

    Article  PubMed  Google Scholar 

  8. Pabst AM, Wagner W, Kasaj A, Gebhardt S, Ackermann M, Astolfo A, Marone F, Haberthür D, Enzmann F, Konerding MA (2015) Synchrotron-based X-ray tomographic microscopy for visualization of three-dimensional collagen matrices. Clin Oral Investig 19:561–564. https://doi.org/10.1007/s00784-014-1312-4

    Article  PubMed  Google Scholar 

  9. Rothamel D, Benner M, Fienitz T, Happe A, Kreppel M, Nickenig HJ, Zöller JE (2014) Biodegradation pattern and tissue integration of native and cross-linked porcine collagen soft tissue augmentation matrices - an experimental study in the rat. Head Face Med 10:10. https://doi.org/10.1186/1746-160X-10-10

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schmitt CM, Matta RE, Moest T, Humann J, Gammel L, Neukam FW, Schlegel KA (2016) Soft tissue volume alterations after connective tissue grafting at teeth: the subepithelial autologous connective tissue graft versus a porcine collagen matrix - a pre-clinical volumetric analysis. J Clin Periodontol 43:609–617. https://doi.org/10.1111/jcpe.12547

    Article  PubMed  Google Scholar 

  11. Eeckhout C, Bouckaert E, Verleyen D, de Bruyckere T, Cosyn J (2020) A 3-year prospective study on a porcine-derived acellular collagen matrix to re-establish convexity at the buccal aspect of single implants in the molar area: a volumetric analysis. J Clin Med 9:1568. https://doi.org/10.3390/jcm9051568

    Article  PubMed Central  Google Scholar 

  12. Papi P, Pranno N, Di Murro B, Pompa G (2020) Early implant placement and peri-implant augmentation with a porcine-derived acellular dermal matrix and synthetic bone in the aesthetic area: a 2-year follow-up prospective cohort study. Int J Oral Maxillofac Surg 50:258–266. https://doi.org/10.1016/j.ijom.2020.07.002

    Article  PubMed  Google Scholar 

  13. Papi P, Pompa G (2018) The use of a novel porcine derived acellular dermal matrix (mucoderm) in peri-implant soft tissue augmentation: preliminary results of a prospective pilot cohort study. Biomed Res Int 2018:1–9. https://doi.org/10.1155/2018/6406051

    Article  Google Scholar 

  14. Nocini PF, Castellani R, Zanotti G, Gelpi F, Covani U, Marconcini S, de Santis D (2014) Extensive keratinized tissue augmentation during implant rehabilitation after Le Fort I osteotomy. J Craniofac Surg 25:799–803. https://doi.org/10.1097/SCS.0000000000000524

    Article  PubMed  Google Scholar 

  15. Puišys A, Žukauskas S, Kubilius R, Vindašiūtė E, Linkevičius T (2017) Bone augmentation and simultaneous soft tissue thickening with collagen tissue matrix derivate membrane in an aesthetic area. A case report. Stomatologija 19:64–68

    PubMed  Google Scholar 

  16. Zafiropoulos G-G, Deli G, Hoffmann O, John G (2016) Changes of the peri-implant soft tissue thickness after grafting with a collagen matrix. J Indian Soc Periodontol 20:441–445. https://doi.org/10.4103/0972-124X.181245

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pietruska M, Skurska A, Podlewski Ł, Milewski R, Pietruski J (2019) Clinical evaluation of Miller class I and II recessions treatment with the use of modified coronally advanced tunnel technique with either collagen matrix or subepithelial connective tissue graft: a randomized clinical study. J Clin Periodontol 46:86–95. https://doi.org/10.1111/jcpe.13031

    Article  PubMed  Google Scholar 

  18. Vincent-Bugnas S, Borie G, Charbit Y (2018) Treatment of multiple maxillary adjacent class I and II gingival recessions with modified coronally advanced tunnel and a new xenogeneic acellular dermal matrix. J Esthet Restor Dent 30:89–95. https://doi.org/10.1111/jerd.12337

    Article  PubMed  Google Scholar 

  19. Rakasevic DL, Milinkovic IZ, Jankovic SM, Soldatovic IA, Aleksic ZM, Nikolic-Jakoba NS (2020) The use of collagen porcine dermal matrix and connective tissue graft with modified coronally advanced tunnel technique in the treatment of multiple adjacent type I gingival recessions: a randomized, controlled clinical trial. J Esthet Restor Dent 32:681–690. https://doi.org/10.1111/jerd.12624

    Article  PubMed  Google Scholar 

  20. Gürlek Ö, Gümüş P, Nizam N, Buduneli N (2020) Coronally advanced flap with connective tissue graft or xenogeneic acellular dermal matrix in the treatment of multiple gingival recessions: a split-mouth randomized clinical trial. J Esthet Restor Dent 32:380–388. https://doi.org/10.1111/jerd.12547

    Article  PubMed  Google Scholar 

  21. 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 

  22. 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 

  23. Santamaria MP, Silveira CA, Mathias IF, Neves FLS, Santos LM, Jardini MAN, Tatakis DN, Sallum EA, Bresciani E (2018) Treatment of single maxillary gingival recession associated with non-carious cervical lesion: randomized clinical trial comparing connective tissue graft alone to graft plus partial restoration. J Clin Periodontol 45:968–976. https://doi.org/10.1111/jcpe.12907

    Article  PubMed  Google Scholar 

  24. Zucchelli G, Testori T, De Sanctis M (2006) Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage. J Periodontol 77:714–721. https://doi.org/10.1902/jop.2006.050038

    Article  PubMed  Google Scholar 

  25. Langer B, Langer L (1985) Subepithelial connective tissue graft technique for root coverage. J Periodontol 56:715–720. https://doi.org/10.1902/jop.1985.56.12.715

    Article  PubMed  Google Scholar 

  26. Tonetti MS, Cortellini P, Pellegrini G, Nieri M, Bonaccini D, Allegri M, Bouchard P, Cairo F, Conforti G, Fourmousis I, Graziani F, Guerrero A, Halben J, Malet J, Rasperini G, Topoll H, Wachtel H, Wallkamm B, Zabalegui I, Zuhr O (2018) Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: randomized trial assessing non-inferiority in root coverage and superiority in oral health-related. J Clin Periodontol 45:78–88. https://doi.org/10.1111/jcpe.12834

    Article  PubMed  Google Scholar 

  27. Pini Prato GP, Franceschi D, Cortellini P, Chambrone L (2018) Long-term evaluation (20 years) of the outcomes of subepithelial connective tissue graft plus coronally advanced flap in the treatment of maxillary single recession-type defects. J Periodontol 89:1290–1299. https://doi.org/10.1002/JPER.17-0619

    Article  PubMed  Google Scholar 

  28. 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 59:158–184. https://doi.org/10.1111/j.1600-0757.2011.00434.x

    Article  Google Scholar 

  29. Rotundo R, Genzano L, Patel D, D'Aiuto F, Nieri M (2019) Adjunctive benefit of a xenogenic collagen matrix associated with coronally advanced flap for the treatment of multiple gingival recessions: a superiority, assessor-blind, randomized clinical trial. J Clin Periodontol 46:1013–1023. https://doi.org/10.1111/jcpe.13168

    Article  PubMed  Google Scholar 

  30. Chambrone L, Salinas Ortega MA, Sukekava F, Rotundo R, Kalemaj Z, Buti J, Pini Prato GP, Cochrane Oral Health Group (2018) Root coverage procedures for treating localised and multiple recession-type defects. Cochrane Database Syst Rev 10:CD007161. https://doi.org/10.1002/14651858.CD007161.pub3

    Article  PubMed  Google Scholar 

  31. 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 

  32. Cieślik-Wegemund M, Wierucka-Młynarczyk B, Tanasiewicz M, Gilowski Ł (2016) Tunnel technique with collagen matrix compared with connective tissue graft for treatment of periodontal recession: a randomized clinical trial. J Periodontol 87:1436–1443. https://doi.org/10.1902/jop.2016.150676

    Article  PubMed  Google Scholar 

  33. Aroca S, Molnár B, Windisch P, Gera I, Salvi GE, Nikolidakis D, Sculean A (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. https://doi.org/10.1111/jcpe.12112

    Article  PubMed  Google Scholar 

  34. AlSarhan MA, Al Jasser R, Tarish MA et al (2019) Xenogeneic collagen matrix versus connective tissue graft for the treatment of multiple gingival recessions: a systematic review and meta-analysis. Clin Exp Dent Res 5:566–579. https://doi.org/10.1002/cre2.210

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Implantology and Periodontology, São Leopoldo Mandic Research Institute, R. Dr. José Rocha Junqueira, 13 - Pte. Preta, Campinas, SP, 13045-755, Brazil

    Renato Maluta, Daiane Cristina Peruzzo & Julio Cesar Joly

  2. Department of Prosthodontics and Periodontics, Piracicaba Dental School, University of Campinas, Av. Limeira, 901 - Areião, Piracicaba, SP, 13414-903, Brazil

    Mabelle Freitas Monteiro

Authors
  1. Renato Maluta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mabelle Freitas Monteiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daiane Cristina Peruzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julio Cesar Joly
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors have made substantial contributions to the conception and design of the study. RM and MFM have been involved in data collection and data analysis. RM, MFM, DCP, and JCJ have been involved in data interpretation. MFM and RM have been involved in drafting the manuscript. All the authors critically revised and approved the final version of the manuscript to be published.

Corresponding author

Correspondence to Julio Cesar Joly.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the institutional and/or national research committee’s ethical standards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

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

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Online Resource 1

(PDF 180 kb)

Online Resource 2

(PDF 111 kb)

Online Resource 3

(PDF 112 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maluta, R., Monteiro, M.F., Peruzzo, D.C. et al. Root coverage of multiple gingival recessions treated with coronally advanced flap associated with xenogeneic acellular dermal matrix or connective tissue graft: a 6-month split-mouth controlled and randomized clinical trial. Clin Oral Invest 25, 5765–5773 (2021). https://doi.org/10.1007/s00784-021-03879-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-021-03879-8

Keywords

Search

Navigation