Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of multiple Class III-IV recessions in lower anterior teeth: A 3-year randomized clinical trial.

Abstract

This study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of multiple Class III-IV Miller periodontal recession (REC) defects on mandibular anterior teeth. This randomized clinical study evaluated 41 patients at 3 years follow-up. One hundred and fifty-six teeth were divided into two groups: test (CTG-EMD, 79 teeth) and control (CTG only, 77 teeth). Clinical REC, keratinized tissue (KT) width, percentage of root coverage, patient-centered outcomes were compared between the two groups. At 36 months follow-up, patient level analysis showed that REC in the test group reduced significantly (5.71 ± 0.58mm to 1.57 ± 0.85mm) compared with the control group (5.94 ± 0.46mm to 2.51 ± 0.62mm) (P<0.001), while KT width increased in the test group (1.51 ± 0.26mm to 4.18 ± 0.34mm) and was significantly greater than the control group (1.65 ± 0.21mm to 2.90 ± 0.20mm) (P<0.001). At 36 months, tooth level analysis (Class III and Class IV groups) found less residual REC and increased KT in the test group compared with the control group (P<0.01). Significantly less pain was reported at 2, 7, and 14 days follow-up post-surgery in the test group (P<0.001). The addition of EMD to CTG results in improved root coverage outcomes and higher amounts of KT width 36 months after treatment of Class III-IV REC on mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days post-surgery.