Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/1807-2577.19515
Revista de Odontologia da UNESP
Original Article

Coverage of Miller class I and II gingival recessions treated with subepithelial connective tissue graft, acellular dermal matrix, and enamel matrix proteins. Pilot study

Recobrimento de recessões gengival classe I e II de Miller com enxerto de tecido conjuntivo subepitelial, matriz dérmica acelular, e proteína derivada da matriz do esmalte. Estudo piloto

Aroni, Mauricio Andrés Tinajero; Oliveira, Guilherme José Pimentel Lopes de; Changoluisa, George; Camacho, Fausto Maurício Tinajero

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Abstract

Objective: The aim of this study was to compare clinical findings obtained in the treatment of gingival recessions using subepithelial connective tissue graft (SECT), acellular dermal matrix (ADM), and enamel matrix proteins (EMP). Material and method: Twelve patients with Miller class I and II recession in the canines or upper premolars were randomly divided into groups to receive treatments using SECT, ADM, or EMP. Clinical measurements were performed before and three months after surgical procedures. The data evaluated were as follows: percentage of root coverage, height and width of gingival recession, probe depth, clinical attachment level, and height and thickness of keratinized gingiva. The Kruskal-Wallis test complemented by Dunn’s test was used to perform the between-group, analysis and the Wilcoxon test was used to perform the within-groups analysis. The tests were applied at the 95% confidence level. Result: The SECT and ADM groups had a higher percentage of root coverage and greater reduction in the height and width of gingival recessions compared to the EMP group (p<0.05). Conclusion: The SECT and ADM are more effective in treating gingival recessions than EMP.

Keywords

Oral surgery, gingival recession, gingival retraction techniques.

Resumo

Objetivo: O objetivo desse estudo foi de comparar os achados clínicos obtidos no tratamento de recessões gengivais utilizando o enxerto de tecido conjuntivo subepitelial (SECT), a matriz dérmica acelular (ADM) e as proteínas derivadas da matriz do esmalte (EMP). Material e método: Doze pacientes que apresentavam recessões gengival classe I e II de Miller nos caninos e pré-molares superiores foram randomicamente alocados para receber o SECT, ADM ou EMP. Análises clínicas foram executadas antes e 3 meses após os procedimentos cirúrgicos. Foram avaliados os seguintes parâmetros: porcentagem de recobrimento radicular, altura e comprimento da recessão gengival, profundidade de bolsa a sondagem, nível clínico de inserção, altura e espessura da gengiva queratinizada. O teste de Kruskal-Wallis complementado pelo teste de Dunn foram usados para avaliar as diferenças entre os grupos em cada período enquanto que o teste de Wilcoxon foi utilizado para avaliar as diferenças dentro de cada grupo variando-se o período de avaliação. Os teste foram aplicados com nível de confiança de 95%. Resultado: Os grupos SECT e ADM apresentaram maior porcentagem de recobrimento radicular e maior redução da altura e comprimento das recessões do que o grupo EMP (p<0,05). Conclusão: O SECT e a ADM são mais efetivos no tratamento de recessões gengivais que o EMP.

Palavras-chave

Cirurgia oral, retração gengival, técnicas de retração gengival.

References

1. Rios FS, Costa RS, Moura MS, Jardim JJ, Maltz M, Haas AN. Estimates and multivariable risk assessment of gingival recession in the population of adults from Porto Alegre, Brazil. J Clin Periodontol. 2014 Nov;41(11):1098-107. http://dx.doi.org/10.1111/jcpe.12303. PMid:25164479.

2. Matas F, Sentís J, Mendieta C. Ten-year longitudinal study of gingival recession in dentists. J Clin Periodontol. 2011 Dec;38(12):1091-8.http://dx.doi.org/10.1111/j.1600-051X.2011.01799.x. PMid:22092502.

3. Salhi L, Lecloux G, Seidel L, Rompen E, Lambert F. Coronally advanced flap versus the pouch technique combined with a connective tissue graft to treat Miller’s class I gingival recession: a randomized controlled trial. J Clin Periodontol. 2014 Apr;41(4):387-95. http://dx.doi.org/10.1111/jcpe.12207. PMid:24720640.

4. Moslemi N, Mousavi Jazi M, Haghighati F, Morovati SP, Jamali R. Acellular dermal matrix allograft versus subepithelial connective tissue graft in treatment of gingival recessions: a 5-year randomized clinical study. J Clin Periodontol. 2011 Dec;38(12):1122-9.http://dx.doi.org/10.1111/j.1600-051X.2011.01789.x. PMid:22092784.

5. Rosetti EP, Marcantonio E Jr, Zuza EP, Marcantonio RA. Root coverage stability of the subepithelial connective tissue graft and guided tissue regeneration: a 30-month follow-up clinical trial. J Dent. 2013 Feb;41(2):114-20.http://dx.doi.org/10.1016/j.jdent.2012.05.008. PMid:22652007.

6. Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, et al. Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: a comparative short- and long-term controlled randomized clinical trial. J Clin Periodontol. 2014 Apr;41(4):396-403. http://dx.doi.org/10.1111/jcpe.12224. PMid:24382170.

7. Papageorgakopoulos G, Greenwell H, Hill M, Vidal R, Scheetz JP. Root coverage using acellular dermal matrix and comparing a coronally positioned tunnel to a coronally positioned flap approach. J Periodontol. 2008 Jun;79(6):1022-30. http://dx.doi.org/10.1902/jop.2008.070546. PMid:18533779.

8. Pilloni A, Paolantonio M, Camargo PM. Root coverage with a coronally positioned flap used in combination with enamel matrix derivative: 18-month clinical evaluation. J Periodontol. 2006 Dec;77(12):2031-9. http://dx.doi.org/10.1902/jop.2006.050390. PMid:17209788.

9. Hammarström L. Enamel matrix, cementum development and regeneration. J Clin Periodontol. 1997 Sep;24(9):658-68. http://dx.doi.org/10.1111/j.1600-051X.1997.tb00247.x. PMid:9310870.

10. Nemcovsky CE, Zahavi S, Moses O, Kebudi E, Artzi Z, Beny L, et al. Effect of enamel matrix protein derivative on healing of surgical supra-infrabony periodontal defects in the rat molar: a histomorphometric study. J Periodontol. 2006 Jun;77(6):996-1002. http://dx.doi.org/10.1902/jop.2006.050317. PMid:16734574.

11. Hakki SS, Berry JE, Somerman MJ. The effect of enamel matrix protein derivative on follicle cells in vitro. J Periodontol. 2001 May;72(5):679-87. http://dx.doi.org/10.1902/jop.2001.72.5.679. PMid:11394405.

12. Kémoun P, Laurencin-Dalicieux S, Rue J, Farges JC, Gennero I, Conte-Auriol F, et al. Human dental follicle cells acquire cementoblast features under stimulation by BMP-2/-7 and enamel matrix derivatives (EMD) in vitro. Cell Tissue Res. 2007 Aug;329(2):283-94. http://dx.doi.org/10.1007/s00441-007-0397-3. PMid:17443352.

13. Ramis JM, Rubert M, Vondrasek J, Gayà A, Lyngstadaas SP, Monjo M. Effect of enamel matrix derivative and of proline-rich synthetic peptides on the differentiation of human mesenchymal stem cells toward the osteogenic lineage. Tissue Eng Part A. 2012 Jun;18(11-12):1253-63. http://dx.doi.org/10.1089/ten.tea.2011.0404. PMid:22429009.

14. Gruber R, Stähli A, Miron RJ, Bosshardt DD, Sculean A. Common target genes of palatal and gingival fibroblasts for EMD: the microarray approach. J Periodontal Res. 2015 Feb;50(1):103-12. http://dx.doi.org/10.1111/jre.12186. PMid:24824040.

15. Alkan EA, Parlar A. EMD or subepithelial connective tissue graft for the treatment of single gingival recessions: a pilot study. J Periodontal Res. 2011 Dec;46(6):637-42. http://dx.doi.org/10.1111/j.1600-0765.2011.01381.x. PMid:21631510.

16. Nemcovsky CE, Artzi Z, Tal H, Kozlovsky A, Moses O. A multicenter comparative study of two root coverage procedures: coronally advanced flap with addition of enamel matrix proteins and subpedicle connective tissue graft. J Periodontol. 2004 Apr;75(4):600-7. http://dx.doi.org/10.1902/jop.2004.75.4.600. PMid:15152826.

17. McGuire MK, Cochran DL. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 2: histological evaluation. J Periodontol. 2003 Aug;74(8):1126-35. http://dx.doi.org/10.1902/jop.2003.74.8.1126. PMid:14514225.

18. Tal H, Moses O, Zohar R, Meir H, Nemcovsky C. Root coverage of advanced gingival recession: a comparative study between acellular dermal matrix allograft and subepithelial connective tissue grafts. J Periodontol. 2002 Dec;73(12):1405-11. http://dx.doi.org/10.1902/jop.2002.73.12.1405. PMid:12546089.

19. Harris RJ. A short-term and long-term comparison of root coverage with an acellular dermal matrix and a subepithelial graft. J Periodontol. 2004 May;75(5):734-43. http://dx.doi.org/10.1902/jop.2004.75.5.734. PMid:15212356.

20. Karring T, Lang NP, Löe H. The role of gingival connective tissue in determining epithelial differentiation. J Periodontal Res. 1975 Feb;10(1):1-11. http://dx.doi.org/10.1111/j.1600-0765.1975.tb00001.x. PMid:124329.

21. McGuire MK, Nunn M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: comparison of clinical parameters. J Periodontol. 2003 Aug;74(8):1110-25. http://dx.doi.org/10.1902/jop.2003.74.8.1110. PMid:14514224.

22. Alves LB, Costa PP, Souza SLS, Grisi MFM, Palioto DB, Taba M Jr, et al. Acellular dermal matrix graft with or without enamel matrix derivative for root coverage in smokers: a randomized clinical study. J Clin Periodontol. 2012 Apr;39(4):393-9. http://dx.doi.org/10.1111/j.1600-051X.2012.01851.x. PMid:22409423.

23. Henriques PS, Pelegrine AA, Nogueira AA, Borghi MM. Application of subepithelial connective tissue graft with or without enamel matrix derivative for root coverage: a split-mouth randomized study. J Oral Sci. 2010 Sep;52(3):463-71. http://dx.doi.org/10.2334/josnusd.52.463. PMid:20881341.

24. Shin SH, Cueva MA, Kerns DG, Hallmon WW, Rivera-Hidalgo F, Nunn ME. A comparative study of root coverage using acellular dermal matrix with and without enamel matrix derivative. J Periodontol. 2007 Mar;78(3):411-21. http://dx.doi.org/10.1902/jop.2007.060170. PMid:17335405.

25. Rasperini G, Roccuzzo M, Francetti L, Acunzo R, Consonni D, Silvestri M. Subepithelial connective tissue graft for treatment of gingival recessions with and without enamel matrix derivative: a multicenter, randomized controlled clinical trial. Int J Periodontics Restorative Dent. 2011 Apr;31(2):133-9. PMid:21491012.

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