Comparative clinical evaluation of acellular dermal matrix allograft and connective tissue graft for the treatment of gingival recession

AIMS: "Gingival recession is a condition reported to occur due to abnormal periodontal anatomy, poor hygiene, excessive occlusal forces, toothbrush abrasion, and even iatrogenic or factitious causes. Though various surgical techniques are available to treat this problem, the most common is the palatal soft tissue autograft. Recently, an acellular dermal matrix allograft (ADMA) has been available as a substitute for the palatal tissue harvest. The aim of this study is to compare the ADMA with the conventional subepithelial connective tissue graft (SCTG) in the treatment of gingival recession." METHODS AND MATERIALS: Fourteen patients with 20 gingival recessions of Miller's grade I and II were selected and randomized in two groups of control (SCTG ) and test (ADMA). In each group ten recession defects were treated. The following parameters were measured at baseline and then at six months post surgery: recession height (RH), recession width (RW), probing depth (PD), attached gingiva (AG), keratinized gingiva (KG), and clinical attachment level (CAL). All parameters were analyzed using the two-sample t-test. Data analysis was performed using SPSS (version 11) software. RESULTS: The following mean changes (mm) occurred in SCTG and ADMA, respectively: 2.60+/-0.97 and 2.90+/-0.81 decrease in RH; 1.70+/-1.01 and 1.65+/-0.67 decrease in RW; 2.50+/-0.97 and 2.95+/-0.69 increase in KG; 2.25+/-0.92 and 2.65+/-0.85 increase in AG; 2.60+/-1.08 and 2.75+/-0.92 decrease in CAL; and finally 0.05+/-0.50 and 0.10+/-0.46 decrease in PD for the SCTG and ADMA groups, respectively. The percentage of root coverage for the two groups was 70.12%+/-22.81% and 72.08%+/-14.12%, respectively. The changes from baseline to the six-month visit were significant for both groups in terms of all parameters but PD. However, the differences in mean changes were not significant between the two groups in any of the parameters. CONCLUSION: These findings imply the ADMA and SCTG techniques could produce the same results when used for the successful treatment of gingival recessions. In addition the ADMA could be used as an adequate alternative treatment modality for conventional techniques.     

Use of acellular dermal matrix graft in the treatment of gingival recessions: a case report

Case presentation in which a 12-years-old boy presented with two large gingival recessions on the maxillary central incisors, secondary to a lateral luxation. In the surgical procedure, an acellular dermal matrix graft (ADMG) was placed as a substitute for a free gingival graft. Twelve months later, complete root coverage was achieved, showing that ADMG, a biomaterial recently developed for mucogingival surgery, can be successfully used in the treatment of gingival recessions in pediatric patients.     

Ridge augmentation with a folded acellular dermal matrix allograft: a case report

Deformities of the dentoalveolar ridge are usually the result of developmental defects, periodontal disease, trauma, or surgical insult. Various techniques are available to correct ridge defects. In this case presentation, ridge augmentation was achieved utilizing an acellular dermal matrix allograft in lieu of an autograft. This report demonstrated an acceptable esthetic result with a significant improvement in the bucco-lingual dimension of the dental ridge. Color match was judged to be excellent. Furthermore, there was no post-surgical loss in papillae height. This case report illustrates an innovative soft tissue surgical technique for clinicians attempting to correct dentoalveolar ridge defects.     

Root coverage of advanced gingival recession: a comparative study between acellular dermal matrix allograft and subepithelial connective tissue grafts

BACKGROUND: Acellular dermal matrix allograft (ADMA) has successfully been applied as a substitute for free connective tissue grafts (CTG) in various periodontal procedures, including root coverage. The purpose of this study was to clinically compare the efficiency of ADMA and CTG in the treatment of gingival recessions > or = 4 mm. METHODS: Seven patients with bilateral recession lesions participated. Fourteen teeth presenting gingival recessions > or = 4 mm were randomly treated with ADMA or CTG covered by coronally advanced flaps. Recession, probing depth, and width of keratinized tissue were measured preoperatively and 12 months postoperatively. Changes in these clinical parameters were calculated within and compared between groups and analyzed statistically. RESULTS: Baseline recession, probing depth, and keratinized tissue width were similar for both groups. At 12 months, root coverage gain was 4.57 mm (89.1%) versus 4.29 mm (88.7%) (P = NS), and keratinized tissue gain was 0.86 mm (36%) versus 2.14 mm (107%) (P < 0.05) for ADMA and CTG, respectively. Probing depth remained unchanged (0.22 mm/0 mm), with no difference between the groups. CONCLUSIONS: Recession defects may be covered using ADMA or CTG, with no practical difference. However, CTG results in significantly greater gain of keratinized gingiva.     

A patient-centered clinical evaluation of acellular dermal matrix graft in the treatment of gingival recession defects

BACKGROUND: The present randomized controlled trial was conducted to evaluate acellular dermal matrix (ADM) graft in terms of patient satisfaction and its effectiveness and efficiency in the treatment of gingival recession. METHODS: Fourteen patients (seven males and seven females) with Miller Class I and II recessions > or =3 mm participated in this 6-month clinical study. They were assigned randomly to the ADM group (ADM graft and coronally positioned flap [CPF]) or the CPF group (CPF alone). Results were evaluated based on parameters measuring patient satisfaction and clinical outcomes associated with the two treatment procedures. Significance was set at P <0.05. RESULTS: The mean recession was 4.0 +/- 1.0 mm and 3.7 +/- 0.7 mm for the ADM and CPF groups, respectively. For the ADM group, the defect coverage was 3.85 +/- 0.89 mm or 97.14% compared to the CPF group, in which the defect coverage was 2.85 +/- 0.89 mm or 77.42%. The difference between the two groups was statistically significant (P <0.05). There were no statistically significant differences between the two groups in the remaining clinical parameters and overall patient satisfaction except in criteria related to patient comfort and cost effectiveness, in which CPF alone produced significantly better results (P <0.03). CONCLUSIONS: ADM graft is significantly superior with regard to effectiveness and efficiency in the treatment of gingival recession than CPF alone. CPF emerges as a better option than ADM graft in terms of cost effectiveness and patient comfort.     

Comparative 6-month clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recession.

BACKGROUND: Different techniques have been proposed for the treatment of gingival recessions. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft. METHODS: Nine patients with bilateral Miller Class I or II gingival recessions were selected. A total of 30 recessions were treated and randomly assigned to the test group and the contralateral recession to the control group. In the control group, the exposed root surfaces were treated by the placement of a connective tissue graft in combination with a coronally positioned flap; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured 2 weeks prior to surgery and 3 and 6 months postsurgery. RESULTS: There were no statistically significant differences between the test group and the control group in terms of recession reduction, clinical attachment gain, and reduction in probing depth. The control group had a statistically significant increased area of keratinized tissue after 3 months compared to the test group. Both procedures, however, produced an increase in keratinized tissue after 6 months, with no statistically significant difference. CONCLUSION: The acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures.     

脱细胞真皮基质在牙龈退缩治疗中的应用评价

目的评价脱细胞真皮基质（acellular dermal matrix,ADM）代替上皮下结缔组织瓣在Ⅰ类牙龈退缩治疗中的应用效果。方法在犬尖牙上制造Ⅰ类牙龈退缩模型,实验组用ADM加冠向复位瓣治疗,对照组用单纯冠向复位瓣治疗。观察和测量比较基线和术后8周时牙龈退缩高度、临床附着水平、角化龈的宽度和厚度等。结果术后8周,实验组治疗牙龈退缩的根面覆盖率为52.53%,明显高于对照组的15.89%,差异有高度显著性（P〈0.01）;实验组的角化龈宽度和高度比基线时分别增加1.06mm和0.18mm,而对照组则比基线时分别减少1.19mm和0.27mm,两者比较,差异也有高度显著性（P〈0.01）。结论 ADM代替上皮下结缔组织瓣治疗Ⅰ类牙龈退缩,能比单纯冠向复位瓣获得更高的根面覆盖率,并显著增加角化龈的宽度和厚度。     

Esthetic correction of gingival recession using a modified tunnel technique and an acellular dermal connective tissue allograft

Esthetic correction of gingival recession is an important goal of periodontal therapy. This article describes a surgical technique that combines a modified tunnel technique and an acellular dermal connective tissue allograft. With the aid of vertical incisions, a tunnel is created under the buccal mucosa of the affected tooth. These incisions enable easy access for graft placement and create mobility for gingival coronal positioning. The use of an acellular dermal connective tissue allograft eliminates the need for a surgical palatal donor site. This minimizes postsurgical complications.

CLINICAL SIGNIFICANCE

The combination of a modified tunnel technique and an acellular dermal connective tissue allograft permits esthetic root coverage in a manner that reduces postsurgical complications.     

Root coverage with an acellular dermal allograft: a three-month case report

Treatment of gingival recession has been a common practice in periodontics for years. As esthetic demands of periodontal patients increase, more root coverage procedures will be performed to satisfy esthetic demands. Often patients present with multiple areas requiring treatment. Palatal anatomy may limit the amount of autogenous tissue that can be harvested, limiting the number of procedures that can be performed. A patient may not desire to have additional tissue transplanted from the palate, due to increased pain and morbidity associated with multiple transplant procedures. The following is a case presentation of multiple adjacent recession defects. The patient presented with a shallow palate from which one side would not yield an adequate quantity of connective tissue. Furthermore, the patient declined to have both sides of his palate harvested simultaneously. As an alternative, an acellular dermal matrix allograft was utilized to correct these gingival defects negating the requirement for a second palatal surgical procedure.     

Connective tissue-bone onlay graft with enamel matrix derivative for treatment of gingival recession: a case report

We describe a case of gingival recession in which root coverage and coronal bone regrowth were achieved after treatment with a connective tissue-bone graft and enamel matrix derivative. The connective tissue-bone graft was harvested from a maxillary edentulous area and then curved to fit the root surfaces of the maxillary left central and lateral incisors. Enamel matrix derivative was applied to the root surfaces, and the connective tissue-bone graft was fixed to the interdental bone by a titanium screw. Six months later, the exposed roots were covered with thick gingiva, and coronal regrowth of thick bone was evident at reentry surgery. This technique is useful for esthetic restoration placement with an intracrevicular margin on teeth with a thin, receding gingiva.     

牙龈退缩根面覆盖治疗1例

目的 牙龈退缩常常导致根面敏感、菌斑控制不良和牙龈美学等问题,影响患者的口腔健康和颜面美观。本病例采用根面覆盖术治疗牙龈退缩,以改善患者牙齿敏感问题。诊治经过：手术采用冠向复位瓣联合结缔组织移植瓣双层技术治疗退缩类型（recession type,RT）为1类的牙龈退缩。结果 术后2周,受区龈缘略水肿;术后12个月复诊,龈缘位置趋于稳定,根面覆盖率达100%,角化龈宽度及临床附着水平增加。患者无牙齿敏感、系带牵拉和瘢痕形成等不适症状,牙龈美学效果良好。结论 冠向复位瓣联合结缔组织移植瓣双层技术治疗RT 1类牙龈退缩效果良好,不仅能够获得完全根面覆盖、牙龈美学效果良好,而且增加了术区角化牙龈的宽度和临床附着水平。     

Free gingival graft and acellular dermal matrix for gingival augmentation: a 15-year clinical study

This study evaluated clinical outcomes of acellular dermal matrix (ADM) allograft compared with autogenous free gingival graft (FGG) for gingival augmentat     

Combined periodontal and restorative approach to the treatment of gingival recessions with noncarious cervical lesions: a case treated with acellular dermal matrix allograft and compomer restorations

Treatment of gingival recessions has become one of the most challenging procedures in periodontal plastic surgery. Various surgical options with predictable outcomes are available, but in cases with cervical lesions or restorations, optimal functional and esthetic results may require the combination of periodontal and restorative procedures. In this case report, one patient treated with acellular dermal matrix allograft and a coronally positioned flap in combination with compomer cervical restorations is presented. Clinical parameters were recorded immediately prior to surgery and after 12 months. Postoperatively, significant root coverage, reductions in probing depths, and gains in clinical attachment were observed. The final clinical results, esthetics, color match, and tissue contours were acceptable to both the patient and clinicians.     

Healing of gingival recession following orthodontic treatment: a 30-year case report

This case report describes the healing of gingival recessions on mandibular incisors resulting from orthodontic treatment of a deep bite malocclusion at a 30-year follow-up observation. The marked improvement in the severe recessions was a consequence of the elimination of the direct trauma, orthodontic intrusion of the affected teeth, and subsequent creeping attachment over time. No periodontal treatment was performed before or after orthodontic treatment.     

Ridge expansion with acellular dermal matrix and deproteinized bovine bone: a case report

Reduction of the original height and width of the alveolar bone of an edentulous site precludes optimal positioning of implant fixtures and may esthetically compromise the prosthesis. Ridge expansion at the time of extraction can prevent the need for ridge reduction and reduces the number of surgical interventions.A patient with a narrow ridge with buccal deformity was treated for the staged placement of an implant. The tooth was extracted. The socket was expanded with an osteotome and an acellular dermal matrix graft was applied as a barrier membrane. The underlying bone showed good healing with maturity and the acellular dermal matrix had the potential to increase the keratinized tissue in the extraction area.     

Gingival augmentation with an acellular dermal matrix revisited: surgical technique for gingival grafting.

Acellular dermal matrix grafts have become popular in gingival augmentation procedures as they eliminate the disadvantages of autogenous graft materials. Since the healing dynamics of acellular dermal matrix grafts are different from those of autogenous grafts, the surgical technique developed for the autograft may not be adequate for the allograft. This article demonstrates a simple and predictable surgical technique involving an acellular dermal matrix for gingival augmentation, using graft stretching to facilitate tissue adaptation and the development of an early blood supply. Learning Objectives: This article discusses a simple surgical technique for the use of an acellular dermal matrix for gingival augmentation surgery. Upon reading this article, the reader should: Understand how an acellular dermal matrix can be used as a functional equivalent for gingival grafting. Become familiar with graft stretching as a means to facilitate tissue adaptation and the development of an early blood supply.