Treatment of Recessions with Acellular Dermal Matrix in Thick and Thin Biotype Populations
Abstract: ABSTRACT Aim and Hypothesis: Gingival recession is a common periodontal defect where lost gingival attachment on tooth surface results in exposed dentin and predisposes patients to dentin sensitivity, esthetic concerns and root caries. Recession repair is often treated using connective tissue graft (CTG), however availability of donor tissue may limit the number of teeth treated with CTG ... read moreduring surgery. To bypass limitations of donor tissue availability, acellular dermal matrix (ADM) is introduced as a substitute. Literature shows predictable root coverage in using ADM as a substitute for CTG in recession therapy. However, literature reporting long-term outcome is scarce. The present controlled clinical trial aims to investigate the impact of periodontal biotypes on the healing of root coverage procedures performed with ADM H: Level of root coverage in Miller class I or class II defects using CAF + ADM is different in patients with thick biotype compared to patients with thin biotype. Materials and Methods: 10 patients with thick (gingival thickness ≥0.8mm) and 9 with thin biotypes (gingival thickness <0.8mm), each with Miller class I or II defects involving two adjacent teeth. Coronally positioned flaps were advanced over ADM and exposed roots. Stents were made to standardize reference points for measuring recession height (RH) and width (RW), keratinized tissue width (KTW), probing depth (PD), gingival thickness (GT) and clinical attachment level (CAL) at baseline, three, six, and twelve month follow-up visits (FUVs). Repeated measures ANOVA and Friedman's test were used to detect within-group changes, whereas independent samples t-test and Mann-Whitney U test were used for between-group comparisons. Results: Both groups achieved statistically significant reduction in RH from baseline to 3, 6 and 12 month follow (TkB: RHBL=2.68±0.49mm, RH3MO= -0.14±1.63mm, RH6MO=-0.13±1.95mm, RH12MO=0.10±0.99mm; TnB: RHBL=2.63±0.41mm, RH3MO=0.16±1.25, RH6MO=0.79±1.13mm, RH12MO=0.39±0.83mm, p<0.01), but no statistically significant change is observed in between the FUVs during the healing period. Similar reduction in CAL and RW from baseline to all FUVs is observed in both biotypes, but no statistically significant change is observed in between each FUVs. %RC (TkB: %RC6MO=106.46±42.75%, %RC12MO=97.11±33.2%; TnB: %RC6MO=68.18±44.93%, %RC12MO=85.01±28.83%), RH reduction and KTW among the FUVs were statistically not significant. Between group comparison revealed that differences in RH, %RC, CAL, RW and PD were statistically not significant. Increase in GT were statistically significant at the 3-month FUV (p<0.0083) for both groups (TkB: GTBL= 0.96±0.08mm, GT3MO=1.66±0.28mm, GT6MO=1.27±0.16mm, GT12MO=1.12±0.49mm; TnB: GTBL=0.57±0.12mm, GT3MO=1.13±0.28mm, GT6MO=0.91±0.15mm, GT3MO=1.02±0.44mm). At the following FUVs, significant reduction in GT was detected in the TkB group from baseline to 3 month and 6 month FUV (p=0.01). Between thick and thin biotype, statistically significant differences were found for GT at all time points except at 12-month. Conclusions: At 12 month follow up, clinical measurements suggest that no significant difference in outcome is present in between thick and thin biotype treated with CAF + ADM. Both groups achieved statistically significant reduction in recession height, recession width and percent root coverage with no statistically significant difference between the two biotypes. RES assessment confirms similar aesthetic outcome in both groups at 12 month follow up, further confirming the results of from clinical measurement.
Thesis (M.S.)--Tufts University, 2018.
Submitted to the Dept. of Periodontology.
Advisor: Wai Cheung.
Keyword: Dentistry.read less
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