Comparative evaluation of free gingival graft and AlloDerm(®) in enhancing the width of attached gingival: A clinical study

Chitra Agarwal, A B Tarun Kumar, Dhoom Singh Mehta, Chitra Agarwal, A B Tarun Kumar, Dhoom Singh Mehta

Abstract

Background: The presence of an adequate width of keratinized tissue is important to maintain a healthy dentogingival junction. In case of inadequate width of attached gingiva, the gingival augmentation procedure has been performed classically using the patient's own masticatory mucosa and more recently, using an acellular dermal allograft as the donor material.

Aims: The aim of the clinical study was to evaluate and compare the effectiveness of free gingival graft (FGG) and acellular dermal matrix (ADM) allograft in the ability to increase the zone of attached gingiva.

Materials and methods: Fifteen patients with 30 sites showing the inadequate width of attached gingiva (≤1 mm) were enrolled for the split-mouth study. The width of keratinized gingiva and other clinical parameters were recorded at baseline and 12(th) month postoperatively.

Statistical analysis: The difference in clinical parameters within the group was assessed by Wilcoxon signed rank test. However, Mann-Whitney U-test was used to analyze the differences between test and control groups.

Results: The width of attached gingiva increased significantly (P < 0.01) following both the treatments but comparatively lesser gain with ADM allograft (2.13 mm vs. 4.8 mm). ADM site had significantly more shrinkage (76.6%) than FGG site (49.7%). Though FGG was found to be more effective, clinicians can prefer ADM allograft because of its certain advantages over the FGG.

Conclusion: ADM allograft has resulted in sufficient increase in width of attached gingiva although lesser than FGG. Considering the disadvantages of FGG, it can be concluded that ADM allograft can be used as an alternative to FGG in increasing width of attached gingival in certain clinical situations.

Keywords: Acellular dermal matrix; allograft; autograft; comparison studies; gingival grafts; soft tissue grafts.

Figures

Figure 1
Figure 1
(a-d) Intraoperative view of free gingival graft procedure
Figure 2
Figure 2
(a-d) Intraoperative view of AlloDerm® graft procedure
Figure 3
Figure 3
(a and b) Postoperative view 15 days and 9 months at free gingival graft site
Figure 4
Figure 4
(a and b) Postoperative view 15 days and 9 months at AlloDerm® site

References

    1. Nevins M, Nevins ML, Kim SW, Schupbach P, Kim DM. The use of mucograft collagen matrix to augment the zone of keratinized tissue around teeth: A pilot study. Int J Periodontics Restorative Dent. 2011;31:367–73.
    1. Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972;43:623–7.
    1. Wennström JL. Mucogingival therapy. Ann Periodontol. 1996;1:671–701.
    1. Wilson RD. Marginal tissue recession in general dental practice: A preliminary study. Int J Periodontics Restorative Dent. 1983;3:40–53.
    1. Dorfman HS, Kennedy JE, Bird WC. Longitudinal evaluation of free autogenous gingival grafts. J Clin Periodontol. 1980;7:316–24.
    1. Nevins M. Attached gingiva – Mucogingival therapy and restorative dentistry. Int J Periodontics Restorative Dent. 1986;6:9–27.
    1. Wei PC, Laurell L, Geivelis M, Lingen MW, Maddalozzo D. Acellular dermal matrix allografts to achieve increased attached gingiva. Part 1. A clinical study. J Periodontol. 2000;71:1297–305.
    1. Scarano A, Barros RR, Iezzi G, Piattelli A, Novaes AB., Jr Acellular dermal matrix graft for gingival augmentation: A preliminary clinical, histologic, and ultrastructural evaluation. J Periodontol. 2009;80:253–9.
    1. Carnio J, Camargo PM. The modified apically repositioned flap to increase the dimensions of attached gingiva: The single incision technique for multiple adjacent teeth. Int J Periodontics Restorative Dent. 2006;26:265–9.
    1. Mohammadi M, Shokrgozar MA, Mofid R. Culture of human gingival fibroblasts on a biodegradable scaffold and evaluation of its effect on attached gingiva: A randomized, controlled pilot study. J Periodontol. 2007;78:1897–903.
    1. Nevins M, Nevins ML, Camelo M, Camelo JM, Schupbach P, Kim DM. The clinical efficacy of DynaMatrix extracellular membrane in augmenting keratinized tissue. Int J Periodontics Restorative Dent. 2010;30:151–61.
    1. Nevins ML. Tissue-engineered bilayered cell therapy for the treatment of oral mucosal defects: A case series. Int J Periodontics Restorative Dent. 2010;30:31–9.
    1. Bjorn H. Free transplantation of gingiva propria. Symposium in Periodontology in Malmö. Odontol Revy. 1963;14:323.
    1. Nabers JM. Free gingival grafts. Periodontics. 1966;4:243–5.
    1. Nabers JM. Extension of the vestibular fornix utilizing a gingival graft – Case history. Periodontics. 1966;4:77–9.
    1. Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics. 1968;6:121–9.
    1. Silverstein LH, Callan DP. An acellular dermal matrix allograft substitute for palatal donor tissue. Postgrad Dent. 1996;3:14–21.
    1. Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns. 1995;21:243–8.
    1. Wainwright D, Madden M, Luterman A, Hunt J, Monafo W, Heimbach D, et al. Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns. J Burn Care Rehabil. 1996;17:124–36.
    1. Shulman J. Clinical evaluation of an acellular dermal allograft for increasing the zone of attached gingiva. Pract Periodontics Aesthet Dent. 1996;8:201–8.
    1. Callan DP, Silverstein LH. Use of acellular dermal matrix for increasing keratinized tissue around teeth and implants. Pract Periodontics Aesthet Dent. 1998;10:731–4.
    1. Achauer BM, VanderKam VM, Celikoz B, Jacobson DG. Augmentation of facial soft-tissue defects with Alloderm dermal graft. Ann Plast Surg. 1998;41:503–7.
    1. Jhaveri HM, Chavan MS, Tomar GB, Deshmukh VL, Wani MR, Miller PD., Jr Acellular dermal matrix seeded with autologous gingival fibroblasts for the treatment of gingival recession: A proof-of-concept study. J Periodontol. 2010;81:616–25.
    1. Han TJ, Klokkevold PR, Takei HH. Strip gingival autograft used to correct mucogingival problems around implants. Int J Periodontics Restorative Dent. 1995;15:404–11.
    1. Adell R, Lekholm U, Rockler B, Brånemark PI, Lindhe J, Eriksson B, et al. Marginal tissue reactions at osseointegrated titanium fixtures (I). A 3-year longitudinal prospective study. Int J Oral Maxillofac Surg. 1986;15:39–52.
    1. Wennström JL, Bengazi F, Lekholm U. The influence of the masticatory mucosa on the peri-implant soft tissue condition. Clin Oral Implants Res. 1994;5:1–8.
    1. Miller PD, Jr, Allen EP. The development of periodontal plastic surgery. Periodontol 2000. 1996;11:7–17.
    1. Vieira Ede O, Fidel Junior RA, Figueredo CM, Fischer RG. Clinical evaluation of a dermic allograft in procedures to increase attached gingiva width. Braz Dent J. 2009;20:191–4.
    1. Harris RJ. Clinical evaluation of 3 techniques to augment keratinized tissue without root coverage. J Periodontol. 2001;72:932–8.

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