Complete Root Coverage for Miller Class I and II – Recession Type Defects: Meta-Analysis of CAF+EMD Versus CAF+FCTG

Year 2016, Volume: 2 Issue: 2, 1 - 21, 01.05.2016

Rüdiger Junker Andreas Leıner Daniela Zıtsch Thomas Ulrıch Wilhelm Frank Adrian Kasaj

Abstract

Background: To the best of our knowledge, the equality of CAF + EMD and CAF + FCTG regarding complete root coverage in Miller class I and II recession-type defects is still uncertain. Aim: The aim of the current paper is to compare the effect of CAF + EMD versus CAF + FCTG regarding complete root recession coverage. Thereby, equality on the longer term of both therapeutic options is hypothesized (H0- hypothesis).Materials and methods: Three reviewers searched independently within the electronic database Pubmed/Medline. Only RCTs reporting quantitative data for the outcome variable percentage complete root coverage (%CRC) for the therapeutic options CAF + EMD or CAF + FCTG were considered. Additionally a manual search in the reference lists of all included publications was accomplished.Results: After electronical and manual search for relevant studies, the three independent reviewers (DZ, TU, AL) screened 552 titles, resulting in 102 abstracts and 41 full-texts. Eventually, twenty-five papers could be included for meta-analysis. By comprehensively comparing data from RCTs for the outcome variable “percentage complete root coverage”, statistically significant weighted mean differences in favor of CAF + FCTG were found at 6, 12 and 24 months. Conclusion: Regarding percentage complete root coverage, CAF + EMD is not as effective as CAF + FCTG for Miller class I and II recession- type defects

Keywords

Miller class I and II recession-type defects, root coverage, coronally advanced flap, free connective tissue graft, enamel matrix derivative

References

• Abolfazli N, Saleh-Saber F, Eskandari A, Lafzi A. A comparative study of the long term results of root coverage with connective tissue graft or enamel matrix protein: 24-month results. Medicina oral, patología oral y cirugía bucal 2009;14;304–309.
• Academy Report. Oral reconstrucitve and corrective considerations in periodontal therapy. J Periodontol 2005;76;1588-1600.
• Alkan EA, Parlar A. EMD or subepithelial connective tissue graft for the treatment of single gingival recessions: A pilot study. J Periodontol Res 2011; 46;637–642.
• Alkan EA, Parlar A. Enamel matrix derivative (emdogain) or subepithelial connective tissue graft for the treatment of adjacent multiple gingival recessions: a pilot study. Int J Perio Rest Dent 2013;33;619–25.
• Allen E, Miller P. Coronal positioning of existing Gingiva : Short term results in the treatment of shallow marginal tissue recession. J Periodontol 1989;60;316–319.
• Aroca S, Molnár B, Windisch P, Gera I, Salvi GE, Nikolidakis D, Sculean A. Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: A randomized, controlled clinical trial. J Clin Periodontol 2013;40;713–720.
• Boyd RL. Mucogingival considerations and their relationship to orthodontics. J Periodontol 1978;49;67–76.
• Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Cincinelli S, Pini- Prato G.
• Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of interdental attachment. A randomized controlled clinical trial. J Clin Periodontol, 2012;39;760–768.
• Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 2014;41;44–62.
• Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: A systematic review. J Clin Periodontol 2008; 35 Suppl. 8;136–162.
• Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L. Treatment of gingival recession defects using coronally advanced flap with a porcine collagen matrix compared to coronally advanced flap with connective tissue graft: A randomized controlled clinical trial. J Periodontol 2012;83;321–328.
• Castellanos A, de la Rosa M, de la Garza M, Caffesse RG. Enamel matrix derivative and coronal flaps to cover marginal tissue recessions. J Periodontol 2006;77;7–14.
• Chambrone L, Sukekava F, Araşjo M, Pustiglioni F, Chambrone L, Lima, L. Root coverage procedures for the treatment of localized recession- type defects: A Cochrane Systematic Review. J Periodontol 2009;81;452–78.
• Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 2015;86;8-51.
• Cheng GL, Fu E, Tu YK, Shen EC, Chiu HC, Huang RJ, Yuh DY, Chiang CY. 2014. Root coverage by coronally advanced flap with connective tissue graft and/or enamel matrix derivative : a meta-analysis. J Periodont Res 2014;501-11.
• Cordaro L, di Torresanto VM, Torsello F. Split-mouth comparison of a coronally advanced flap with or without enamel matrix derivative for coverage of multiple gingival recession defects: 6- and 24-month follow-up. Int J Perio Rest Dent 2012;32;10–20.
• Cortellini P, Tonetti M, Baldi C, Francetti L, Rasperini G, Rotundo R, Nieri M, Franceschi D, Labriola A, Pini Prato G. Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi-centre, randomized, double- blind, clinical trial. J Clin Periodontol 2009;36;68–79.
• Cueva M, Boltchi FE, Hallmon WW, Nunn ME, Rivera-Hidalgo F, Rees T. A comparative study of coronally advanced flaps with and without the addition of enamel matrix derivative in the treatment of marginal tissue recession. J Periodontol 2004;75;949–956.
• Gorman W. Prevalence and etiology of ginigival recession. J Periodontol 1967; 38;316–322.
• Grupe H, Warren R. Repair of gingival defects by a sliding flap operation. J Periodontol 1956;27;92–95.
• Hägewald S, Spahr A, Rompola E, Haller B, Heijl L, Bernimoulin JP. Comparative study of Emdogain and coronally advanced flap technique in the treatment of human gingival recessions. A prospective controlled clinical study. J Clin Periodontol 2002;29;35–41.
• Higgins JP, Green S. 2011. Cochrane Handbook at http://handbook. cochrane.org/.
• Hofmänner P, Alessandri R, Laugisch O, Sculean A. Predictability of surgical techniques used for coverage of multiple adjacent ginigval recessions. A systematic review. Quintessence International 2012;43;545–554.
• Jaiswal G, Khatri P, Bhongade M, Kumar R, Jaiswal S. The effectiveness of enamel matrix protein (Emdogain®) in combination with coronally advanced flap in the treatment of multiple marginal tissue recession: A clinical study. Journal of Indian Society of Periodontol 2012;16;224-230.
• Kuis D, Sciran I, Lajnert V, Snjaric D, Prpic J, Pezelj-Ribaric S, Bosnjak A. Coronally advanced flap alone or with connective tissue graft in the treatment of single gingival recession defects: a long-term randomized clinical trial. J Periodontol 2013;84;1576–85.
• Kumar GNV, Murthy KRV. A comparative evaluation of subepithelial connective tissue graft (SCTG) versus platelet concentrate graft (PCG) in the treatment of gingival recession using coronally advanced flap technique: A 12-month study. Journal of Indian Society of Periodontology 2013;17;771–776.
• Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol 1985;56;715–720.
• McGuire MK, Scheyer ET. Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. J Periodontol 2010;81;1108–1117.
• McGuire MK, Scheyer ET, Snyder MB. Evaluation of recession defects treated with coronally advanced flaps and either recombinant human platelet-derived growth factor-BB plus Beta Tricalcium Phosphate or Connective Tissue: Comparison of clinical parameters at 5 Years. J Periodontol 2014;85;1361-1370.
• McGuire, Nunn. Evaluation of human recession defects treated with coronally advanced flaps. J Periodontol 2003;74;1126–1135.
• Miller PD. A classification of marginal tissue recession. Int J Periodont Rest Dent 1985;5;8–13.
• Miller PD, Allen EP. The development of periodontal plastic surgery. J Periodontol 1996;11;7-17.
• Modica F, Del Pizzo M, Roccuzzo M, Romagnoli R. Coronally advanced flap for the treatment of buccal gingival recessions with and without enamel matrix derivative. A split-mouth study. J Periodontol 2000;71;1693–1698.
• Oates TW, Robinson M, Gunsolley GC. Surgical therapies for the treatment of gingival recessions: A systematic review. Ann Periodontol 2003;8;303-320.
• Pini-Prato G, Nieri M, Pagliaro U, Giorgi TS, La Marca M, Franceschi D, Buti J, Giani M, Weiss JH, Padeletti L, Cortellini P, Chambrone L, Barzagli L, Defraia E, Rotundo R. Surgical treatment of single gingival recessions: clinical guidelines. European journal of oral implantology 2014;7;9–43.
• Del Pizzo M, Zucchelli G, Modica F, Villa R, Debernardi C. Coronally advanced flap with or without enamel matrix derivative for root coverage: A 2-year study. J Clin Periodontol 2005;32;1181–1187.
• Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 2002a; 29 Suppl 3;178–196.
• Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized ginigval recessions: a systematic review. J Clin Periodontol 2002b;29;178–194.
• Roman, Soancǎ, Kasaj, Stratul SI. 2013. Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of Miller class I and II gingival recessions: A controlled randomized clinical trial. J Periodontol Res 2013;48;563–572.
• Sagnes G, Gjermo P. Prevalence of oral soft and hard tissue lesions related to mechanical tooth cleaning procedures. Community Dent Oral Epidemiol 1976;4;77–83.
• Salhi L, Lecloux G, Seidel L, Rompen E, Lambert F. Coronally advanced flap versus the pouch technique combined with a connective tissuegraft to treat Miller’s class I gingival recession: A randomized controlled trial. J Clini Periodontol 2014;41;387–395.
• Sayar F, Akhundi N, Gholami S. Connective tissue graft vs. emdogain: A new approach to compare the outcomes. J Dent Res 2013;10;38–45.
• Sculean A, Cosgarea R, Stähli A, Katsaros C, Arweiler N, Brecx M, Deppe H. The modified coronally advanced tunnel combined with an enamel matrix derivative and subepithelial connective tissue graft for the treatment of isolated mandibular Miller Class I and II gingival recessions: A report of 16 cases. Quintessence International 2014;10;829–835.
• da Silva RC, Joly JC, de Lima AFM, Tatakis DN. Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. J Periodontol 2004;75;413–419.
• Spahr A, Haegewald S, Tsoulfidou F, Rompola E, Heijl L, Bernimoulin J, Ring C, Sander S, Haller B. 2005. Proteins versus coronally advanced flap technique : A 2-year report. J Periodontol 2005;76;1871–1880.
• Sullivan H, Atkins J. Free autogenous ginigval grafts. I. Principles of successful grafting. J Periodontics 1968;6;121–129.
• Tarnow DP. Semilunar coronally repositioned flap. J Clin Periodontol 1986;13;182–185.
• Tinti C, Vincenzi G, Cortellini P, Pini Prato G, Clauser C. Guided tissue regeneration in the treatment of human facial recession. A 12-case report. J Periodontol 1992;63;554–60.
• Wennström J. Mucogingival therapy. Annals of periodontology 1996;1;671–701.
• Wolf HF, Rateitschak EM, Rateitschak KH. Farbatlanten der Zahnmedizin 1, Parodontologie. 3. Auflage, Georg Thieme Verlag, 2004.
• Zucchelli G, Marzadori M, Mounssif I, Mazzotti C, Stefanini M. Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors. A controlled randomized clinical trial. J Clin Periodontol 2014;41;806–813.
• Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L. 2014. 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;41;396–403.
• Zuhr, Hürzeler. Plastisch- ästhetische Parodontal- Implantatchirurgie. 1. Auflage, Quintessenz Verlags- GmbH 2011.