Abstract
Objective: The purpose of this study was to assess the clinical effectiveness of using a combination of enamel matrix protein derivative and acellular dermal matrix in comparison to acellular dermal matrix alone for treating gingival recessions. Methods: The Cochrane Library (Wiley), PubMed by Medline (NLM), Medline (EBSCO), and Embase (Ovid) databases were searched for entries up to April 2020. Only clinical trials were included. Primary outcomes were root coverage (%), changes in keratinized tissue width and recession (mm). Meta-analysis was conducted for root coverage, changes in keratinized tissue width, recession, clinical attachment level and probing depth. Results: Four studies were selected for the analysis. In primary outcomes, root coverage, change in keratinized tissue width and recession analysis showed a mean difference of 4.99% (p = 0.11), 0.20 mm (p = 0.14) and 0.13 mm (p = 0.23) respectively between the two groups. Secondary outcomes analysis also exhibited a statistically insignificant difference between the test and control group with mean difference of 0.11 mm (p = 0.32) in clinical attachment level gain and -0.03 mm (p = 0.29) in probing depth reduction analysis. Conclusions: Within the limits of this study, enamel matrix protein derivative combined with acellular dermal matrix used for treating gingival recession defects resulted in no beneficial effect clinically than acellular dermal matrix only.
Highlights
Gingival recession and pathological loss of keratinized tissues are the most prevalent mucogingival deformities demanding surgical treatment to restore the lost supportive tissues [1]
root coverage (RC), change in keratinized tissue width (KTW) and REC analysis showed a mean difference of 4.99% (p = 0.11; 95% confidence intervals of differences (95% CI) −1.16–11.14), 0.20 mm (p = 0.14; 95% CI −0.06–0.47) and 0.13 mm (p = 0.23; 95% CI −0.08–0.35) respectively between the experimental group and control group, indicating no beneficial effect of enamel matrix protein derivative (EMD) + acellular dermal matrix (ADM) than ADM
Enamel matrix protein derivative and acellular dermal matrix are commonly explored for gingival recessions regenerative therapy
Summary
Gingival recession and pathological loss of keratinized tissues are the most prevalent mucogingival deformities demanding surgical treatment to restore the lost supportive tissues [1]. Autogenous tissue grafts, CTG, unquestionably remain the gold standard for root coverage treatments and soft tissue augmentation [5,6]. Some of the obvious drawbacks of harvesting autogenous tissue, includes post-operative bleeding and discomfort or pain at the donor site, a limited tissue supply, enhanced morbidity, much lengthier duration of surgery, and further proficiency of the surgeon [8]. To overcome such issues, various allograft substitutes (non-vital) have been investigated for plastic periodontal surgery. A histometric evaluation at 6-months post-operatively showed an enhanced thickness of marginal tissue, corresponding to a palatal tissue graft [20,21]
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