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Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation

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Abstract

Objectives

The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2 weeks).

Materials and methods

Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6 months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1β, IL-6, IL-8, FGF, MIP-1α and β, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14 days after procedures.

Results

The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14 days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side.

Conclusion

The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process.

Clinical relevance

EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.

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Funding

The work was supported by the Department of Periodontology of Rio de Janeiro State University, in Rio de Janeiro, Brazil.

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Authors and Affiliations

  1. Department of Periodontology, Dental School, Rio de Janeiro State University, Rio de Janeiro, Brazil

    Alexandra Tavares Dias, Sergio Kahn & Ricardo Guimarães Fischer

  2. Department of Periodontology, Faculty of Dentistry at Universidade do Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil

    Claudia Callegaro de Menezes

  3. School of Dentistry and Oral Health and Menzies, Griffith University, Gold Coast, Australia

    Carlos Marcelo da Silva Figueredo

  4. Periodontics and Biomaterials, Faculty of Dental Medicine at the Universidade Católica Portuguesa, Viseu, Portugal

    Gustavo Vicentis de Oliveira Fernandes

  5. Centre for Interdisciplinary Research in Health (CIIS), Viseu, Portugal

    Gustavo Vicentis de Oliveira Fernandes

  6. Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro–UERJ, Pavilhão Mario Franco Barroso, 2º andas – Salas 09 e 10, Av. 28 de Setembro, 157 – Vila Isabel, Rio de Janeiro, Brazil

    Gustavo Vicentis de Oliveira Fernandes

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  1. Alexandra Tavares Dias
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Correspondence to Gustavo Vicentis de Oliveira Fernandes.

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

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Dias, A.T., de Menezes, C.C., Kahn, S. et al. Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation. Clin Oral Invest 26, 1453–1463 (2022). https://doi.org/10.1007/s00784-021-04119-9

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