A Comparative Study of Root Coverage between Subepithelial Connective Tissue Graft and Dynamatrix Plus® Collagen Membrane.
Abstract: Background Gingival recession (GR) is the apical migration of the free gingival margin from the CEJ of the tooth. It is associated with attachment loss and its etiology is multifactorial. Different surgical techniques are used to treat GR. Subepithelial connective tissue graft (SCTG) combined with coronally advanced flap (CAF) is well documented in dental literature to predictably achieve ... read moreacceptable results which are stable long term. The need for a second surgical site and possible anatomical variations in the palate are potential limitations of this technique. Non-autogenous soft tissue scaffolds that obviate the second surgical site have been compared to SCTG/CAF technique with promising results. DPCM is an extracellular matrix soft tissue scaffold, porcine derived, that has been introduced to dentistry for gingival augmentation procedures. The aim of this randomized controlled clinical trial is to compare the clinical outcomes 3 months after root coverage procedures, using DPCM or SCTG combined with CAF in a split-mouth design, to treat Miller class I and II recession defects. Materials and Methods Sixteen subjects received 18 bilateral surgical procedures using DPCM + CAF (experimental group) and SCTG + CAF (control group) at contralateral sides. Vertical recession depth (VRD), clinical attachment level (CAL), keratinized tissue width (KTW), probing depth (PD), plaque index (PI), bleeding on probing index (BOP) were measured at baseline and at 3 months after surgery. Differences from baseline to 3 months measurements were calculated for both groups as VRDreduction, CALgain, KTWincrease, PIreduction and BOPreduction. The percentage of root coverage (%RC) and the percentage of complete root coverage (%CRC) were also calculated. Post-surgical discomfort levels (PSD) and differences between the groups (PSDdif) were evaluated at 1 week, 2 weeks and 1 month after surgery. Three independent examiners evaluated the esthetic outcomes 3 months after surgery. Descriptive statistics, mixed effects models, Wilcoxon signed-rank tests and generalized estimating equations were used to detect statistically significant differences between the groups at different time points (a=0.05). Results Baseline VRD was 2.45mm ± 0.47mm for the experimental and 2.51mm ± 0.48mm for the control group (p=0.604). At 3 months re-evaluation, there was statistically significant more recession reduction in the control group 2.17mm ± 0.43mm than the experimental group 1.77mm ± 0.71mm (p=0.003) with %RC of 87.48% ± 14.43% and 73.07% ± 26.72% respectively. There was no statistically significant difference in CRC identified between the groups (p=0.256). 28.1% of the experimental group sites achieved CRC, which was less than the control group, 46.7%. No statistically significant differences were found in CALgain, KTWincrease, PIreduction and BOPreduction between the two groups. The experimental group presented statistically significant less PSD at 1 and 2 weeks and no differences between the groups at 1 month. Esthetic evaluation of tissue contour revealed statistically significant better scores for DPCM group. There were no statistically significant differences identified between the groups, when color match and tissue texture were evaluated. Conclusions DMPM may be an alternative to SCTG for root coverage procedures, associated with less amount of root coverage, but less post-operative discomfort and better esthetic results 3 months after surgery.
Thesis (M.S.)--Tufts University, 2012.
Submitted to the Dept. of Periodontology.
Advisor: James Hanley.
Committee: Charles Hawley, Yong Hur, and Matthew Finkelman.
Keyword: Dentistry.read less