Clinical comparison of coronally-advanced flap plus amniotic membrane or subepithelial connective tissue in the treatment of Miller's class I and II gingival recessions: A split-mouth study

Ardeshir Lafzi, Nader Abolfazli, Masoumeh Faramarzi, Masoumeh Eyvazi, Amir Eskandari, Fariba Salehsaber, Ardeshir Lafzi, Nader Abolfazli, Masoumeh Faramarzi, Masoumeh Eyvazi, Amir Eskandari, Fariba Salehsaber

Abstract

Background. The aim of the present study was to compare coronally advanced flap (CAF) plus amniotic membrane (AM) to CAF with connective tissue graft (CTG) in the treatment of Miller's class I and II gingival recessions. Methods. Eleven healthy subjects with thirty Miller's class І and ІІ gingival recessions ≥3 mm, were selevted for this research and randomly assigned to two groups in a split-mouth design. In the control group gingival recessions were treated with CAF and CTG; however, in the test group the lesions were treated with (AM) and CAF. The clinical parameters, including recession depth (RD), recession width (RW), keratinized tissue width (WKT), probing depth (PD) and clinical attachment level (CAL), were measured at baseline and 1, 3 and 6 months postoperatively. Statistical significance was set at P < 0.01. Results. Position changes of RD, RW, CAL, and MGJ were significant between baseline and one month after surgery (P < 0.01) in both the test and control groups and these values remained unchanged at 3- and 6-month follow-ups. There were no statistically significant differences in PD and WKT between baseline and 1-, 3- and 6-months intervals postoperatively. The mean root coverage values after 6 months were 75.5% and 63.1% for two groups, respectively. The mean recession depth reductions were 2.63±0.63 mm and 2±1.4 mm in the test and control groups, respectively. Conclusion. The results of this research showed that application of AM instead of connective tissue decreased surgical operation time and patient discomfort but the amount of root coverage was not significantly different between the two methods.

Keywords: Amniotic membrane; connective tissue; gingival recession.

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References

    1. Sangnes G. Traumatization of teeth and gingiva related to habitual tooth cleaning procedures. J Clin Periodontol. 1976;3:94–103. doi: 10.1111/j.1600-051X.1976.tb01855.x.
    1. Murtomaa H, Meurman JH, Rytömaa I, Turtola L. Periodontal status in university students. J Clin Periodontol. 1987;14:462–5. doi: 10.1111/j.1600-051X.1987.tb02252.x.
    1. Löe H, Anerud A, Boysen H. The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. J Periodontol. 1992;63:489–95. doi: 10.1902/jop.1992.63.6.489.
    1. Woofter C. The prevalence and etiology of gingival recession. Periodontal Abstr. 1969;17:45–50.
    1. Lafzi A, Abolfazli N, Eskandari A. Assessment of the etiologic factors of gingival recession in a group of patients in northwest Iran. J Dent Res Dent Clin Dent Prospects. 2009;3(3):90–3. doi: 10.5681/joddd.2009.023.
    1. Miller PD Jr. Regenerative and reconstructive periodontal plastic surgery. Dent Clin North Am. 1988;32:287–306.
    1. Harris RJ. The connective tissue and partial thickness double pedicle graft: a predictable method of obtaining root coverage. J Periodontol. 1992;63:477–86. doi: 10.1902/jop.1992.63.5.477.
    1. Sullivan HC, Atkins JC. Free autogenous gingival grafts, IIIUtilization of grafts in the treatment of gingival recessions. Periodontics. 1968;6:121–129.
    1. Pini Prato G, Tinti C, Vincenzi G, Magnani C, Cortellini P, Clauser C. Guided Tissue Regeneration Versus Mucogingival Surgery in the Treatment of Human Buccal Gingival Recession. J Periodontol. 1992;63:919–28. doi: 10.1902/jop.1992.63.11.919.
    1. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol. 1985;56:715. doi: 10.1902/jop.1985.56.12.715.
    1. Moslemi N, Heidari M, Mousavi Jazi M, Daneshmonfared M. Application of an acellular dermal matrixallograft (CenoDerm) for treatment of multiple gingival recession defects: A case report with one-year follow-up. J Dent Res Dent Clin Dent Prospects. 2014;8(3):180–3. doi: 10.5681/joddd.2014.033.
    1. Wennström JL. Mucogingival therapy. Annals of Periodontology. 1996;1:671–701. doi: 10.1902/annals.1996.1.1.671.
    1. Aichelmann-Reidy ME, Yukna RA, Evans GH, Nasr HF, Mayer ET. Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession. J Periodontol. 2001;72:998–1005. doi: 10.1902/jop.2001.72.8.998.
    1. Burgos H. Angiogenic factor from human term placentaPurification and partial characterization. Eur J Clin Invest. 1986;16:486–93. doi: 10.1111/j.1365-2362.1986.tb02166.x.
    1. Talmi YP, Sigler L, Inge E, Finkelstein Y, Zohar Y. Antibacterial properties of human amniotic membranes. Placenta. 1991;12:285–8.
    1. Solomon A, Wajngarten M, Alviano F, Anteby I, Elchalal U, Pe'er J, Levi-Schaffer F. Suppression of inflammatory and fibrotic responses in allergic inflammation by the amniotic membrane stromal matrix. Clin Exp Allergy. 2005;35:941–8. doi: 10.1111/j.1365-2222.2005.02285.x.
    1. Koizumi NJ, Inatomi TJ, Sotozono CJ, Fullwood NJ, Quantock AJ, Kinoshita S. Growth factor mRNA and protein in preserved human amniotic membrane. Curr Eye Res. 2000;20:173–7. doi: 10.1076/0271-3683%28200003%292031-9FT173.
    1. Alviano F, Fossati V, Marchionni C, Arpinati M, Bonsi L, Franchina M, etal etal. Term amniotic membrane is a high throughput source for multipotentmesenchymal stem cells with the ability to differentiate into endothelial cells in vitro. BMC Dev Biol. 2007;7:11.
    1. Toda A, Okabe M, Yoshida T, Nikaido T. The potential of amniotic membrane/ amnion-derived cells for regeneration of various tissues. J Pharmacol Sci. 2007;105:215–28. doi: 10.1254/jphs.cr0070034.
    1. Trelford-Sauder M, Dawe EJ, Trelford JD. Use of allograft amniotic membrane for control of intra-abdominal adhesions. J Med. 1978;9:273–84.
    1. Tancer ML, Katz M, Veridiano NP. Vaginal epithelialization with human amnion. Obstet Gynecol. 1979;54:345–9.
    1. Paridaens D, Beekhuis H, Van Den Bosch W, Remeyer I, Melles G. Amniotic membrane transplantation in the management of conjunctiva malignant melanoma and primary acquired melanosis with atypia. Br J Ophthalmol. 2001;85:658–61. doi: 10.1136/bjo.85.6.658.
    1. Branski LK, Herndon DN, Celis MM, Norbury WB, Masters OE, JeschkeMG JeschkeMG. Amnion in the treatment of pediatric partial-thickness facial burns. Burns. 2008;34:393–9. doi: 10.1016/j.burns.2007.06.
    1. Kothiwale SV, Anuroopa P, Gajiwala AL. A clinical and radiological evaluation of DFDBA with amniotic membrane versus bovine derived xenograft with amniotic membrane in human periodontal grade II furcation defects. Cell Tissue Bank. 2009;10:317–26. doi: 10.1007/s10561-009-9126-3.
    1. Velez I, Parker WB, Siegel MA, Hernandez M. Cryopreserved amniotic membrane for modulation of periodontal soft tissue healing: a pilot study. J Periodontol. 2010;81:1797–804. doi: 10.1902/jop.2010.100060.
    1. Ghahroudi AA, Khorsand A, Rokn AR, Sabounchi SS, Shayesteh YS, Soolari A. Comparison of amnion allograft with connective tissue graft for root coverage procedures: a double-blind, randomized, controlled clinical trial. J Int Acad Periodontol. 2013;15:101–12.
    1. Allen EP, Miller PO. Coronal positioning of existing gingivaShort term results in the treatment of shallow marginal tissue recession. J Periodontol. 1989;60:316–9. doi: 10.1902/jop.1989.60.6.316.
    1. O'Leary TJ, Drake RB, Naylor JE . The plaque control record. J Periodontol. 1972;43:38. doi: 10.1902/jop.1972.43.1.38.
    1. Leo H. The gingival index, the plaque index and the retention index systems. J Periodontol. 1967;38:610–6. doi: 10.1902/jop.1967.38.6.610.
    1. Harris RJ. Connective tissue grafts combined with either double pedicle grafts or coronally positioned pedicle grafts: results of 266 consecutively treated defects in 200 patients. Int J Periodontics Restorative Dent. 2002;22:463–71.
    1. Saletta D, Pini Prato GP, Pagliro V, Baldi C, Mauri M, NieriM NieriM. Coronally advanced flap procedure. Is the interdental papilla a prognostic factor for root coverage? J Periodontol. 2001;72:760–6. doi: 10.1902/jop.2001.72.6.760.
    1. Zuchelli G, Amore C, Sforza NM, Montebugnoli L, De Sanctis M. Bilaminar techniques for the treatment of recession defectsA comparative clinical study. J Clin Periodontol. 2003;30:862–70. doi: 10.1034/j.1600-051x.2003.00397.x.
    1. Paolantonio M, Di Murro C, Cattabriga A, Cattabriga M. Subpedicle connective tissue graft versus free gingival graft in the coverage of exposed root surfacesA 5year- clinical study. J Clin Periodontol. 1997;24:51–6. doi: 10.1111/j.1600-051x.1997.tb01184.x.
    1. Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root-coverage procedures for the treatment of localized recession-type defects: A Cochrane systematic review. J Periodontol. 2010;81:452–78. doi: 10.1902/jop.2010.090540.
    1. Romanos GE, Bernimoulin JP, Marggraf F. The double lateral bridging flap for root coverage of denuded root surfaces: longitudinal study and clinical evaluation after 5 to 8 years. J Periodontol. 1993;64:683–8. doi: 10.1902/jop.1993.64.8.683.
    1. Wennstrom JL, Zucchelli G. Increased gingival dimensionsA significant factor for successful outcome of root coverage procedures?A 2-year prospective clinical study. J Clin Periodontol. 1996;23:770–7. doi: 10.1111/j.1600-051x.1996.tb00608.x.
    1. Huang LH, Nieva RF, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol. 2005;76:1729–34. doi: 10.1902/jop.2005.76.10.1729.
    1. Wang HL, Bunyaratavej P, Labadie M, Shyr Y, MacNeil RL. Comparison of 2 clinical techniques for treatment of gingival recession. J Periodontol. 2001;72:1301–11. doi: 10.1902/jop.2001.72.10.1301.
    1. Harris RJ. Root coverage with connective tissue grafts: an evaluation of short and long-term results. J Periodontol. 2002;73(9):1054–9. doi: 10.1902/jop.2002.73.9.1054.
    1. Borghetti A, Gardella JP. Thick gingival autograft for the coverage of gingival recession: A clinical evaluation. Int J Periodontics Restorative Dent. 1990;10:216–29.
    1. Hwang D, Wang HL. Flap thickness as a predictor of root coverage: a systematic review. J Periodontol. 2006;77:1625–34. doi: 10.1902/jop.2006.060107.

Source: PubMed

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