Xenogeneic Collagen Matrix Research Articles

VESTIBULOPLASTY IN AN EXTREMELY ATROPHIC EDENTULOUS MANDIBLE USING A COMBINATION OF STRIP PALATAL GRAFT AND XENOGENEIC COLLAGEN MATRIX: A CASE REPORT

Purpose: The aim of this research was to evaluate the cumulative effect of using both epithelial autograft and xenogeneic collagen matrix as an alternative to single keratinized epithelial palatal autografts, which can prove beneficial for its reduced morbidity. Materials and methods: This study includes one female patient with an extremely atrophic mandible who requires deepening of the vestibulum in the anterior region in order to improve the stability of the removable denture. The surgical procedure included local anesthesia, one horizontal incision and a partial-thickness flap elevation. The exposed periosteum was covered by a small keratinized epithelial autograft from the hard palate at its apical aspect and a xenogeneic collagen matrix at its coronal portion. Follow up of the healing process was performed on the 7th, 14th, 30th day, after three and six months. Results: The postoperative period underwent without any complications in all areas. The healing process resulted in the formation of an additional area of keratinized mucosa - a mean gain value of 2.92 mm after six months, which led to a significant improvement of denture stability. Conclusion: The final result suggested that this technique shows great promise in compensating the disadvantages of using single grafting materials: the increased morbidity caused by the additional surgical site on the palate in the case of autografts and the greater shrinkage of the area of keratinized mucosa in a six months period when collagen matrixes are applied as a single grafting material in large edentulous areas.

Healing of Post-Extraction Sockets Filled with Anorganic Bovine Bone and Covered with a Xenogeneic Collagen Matrix. Radiological 2D and 3D Results of a Pilot Study to Assess Dimensional Stability.

Analysis of short-term results regarding dimensional stability of post-extraction sockets managed via a preservation protocol using deproteinized bovine bone matrix and a xenogeneic collagen matrix. Materials and methods Fifteen patients needing extraction of one single-rooted premolar tooth were treated in a pilot study. Five patients were treated in each centre. After tooth extraction, sockets were filled with anorganic bovine bone matrix and covered with a xenogeneic collagen matrix. Six months later, implants were placed. Dimensional changes in the treated sites were digitally evaluated using the best-fit superimposition of pre-and post-socket preservation models. Results After six months of healing, the vertical reduction of the grafted sites was 0.31 ± 0.24 mm (p < 0.001). Volumetric analysis of superimposed models showed an average palatal-lingual contraction of 0.33 ± 0.51 mm3 (p = 0.02). At the vestibular level, the average contraction was found to be 0.8 ± 0.3 mm3 (p < 0.001). Finally, the analysis of linear variations in the treated sites on a single sagittal section at the crystal level, and at 3 and 7 mm apically respect to the crest, both towards the vestibule and palate, generally showed more marked resorption at the crestal level compared to apical measurements. Conclusion: The clinical protocol herein employed for socket preservation showed a positive effect in preventing the physiological post-extraction remodeling.

Clinical and radiographic evaluation of jumping distance management using a collagen matrix in flapless immediate implant placement.

Improvement in implant design has made implant dentistry a challenging treatment modality worldwide. This study aimed to investigate the efficacy of a xenogeneic collagen matrix in managing 3-4-millimeter gaps in flapless immediate implant placement. Twenty-two patients received 39 immediate implants via the flapless approach. Patients with intact bony walls, buccal bone thickness ≥2 mm and a jumping distance of 3-4 mm were included in this study. The gap between the implant and the socket walls was filled with a xenogeneic collagen matrix (Collacone®). The final clinical and radiographic evaluations were performed at least 24 months following functional loading. There was no early or late failure, and the implants showed a 100% survival rate. The mean mesial (0.28 ±0.39 mm) and distal (0.28 ±0.39 mm) marginal bone loss (MBL) at the site of incisors was not significantly different from the values at the site of premolars and molars (0.30 ±0.42 mm and 0.34 ±0.48 mm, respectively). The evaluation of the implant success index (ISI) score revealed no difference between the mandible and the maxilla (p = 0.700), or incisors compared with premolars and molars (p = 0.420). The only significant difference was in terms of distal MBL, which was higher in the maxilla (0.39 ±0.49 mm) than in the mandible (0.12 ±0.23 mm) (p = 0.040). Within the limitations of this study, it seems that the application of a xenogeneic collagen matrix to manage 3-4-millimeter gaps in carefully selected cases may bring promising outcomes.

Autologous connective tissue graft or xenogenic collagen matrix with coronally advanced flaps for coverage of multiple adjacent gingival recession. 36-month follow-up of a randomized multicentre trial.

To report the 36-month follow-up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed-up for 36months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. No differences were observed between the randomized and the follow-up population. Average baseline recession was 2.6±1.0mm. 3-year root coverage was 1.5±1.5mm for CMX and 2.0±1.0mm for CTG (difference of 0.32mm, 95% CI from -0.02 to 0.65mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25mm. No treatment differences in position of the gingival margin were observed between 6- and 36-month follow-up (difference 0.06mm, 95% CI -0.17 to 0.29mm). CMX was not non-inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision-making.

Wound Closure and Simultaneous Soft Tissue Augmentation at Fresh Extraction Sockets: A Simplified Technique Adopting a Xenogeneic Collagen Matrix

A simplified surgical technique is presented for closure and soft tissue augmentation of fresh extraction sockets that utilizes a xenogeneic collagen matrix as a substitute for a combined onlay-interpositional connective tissue graft. Ten alveoli receiving a socket preservation procedure (n = 5) or an immediate submerged implant (n = 5) were sealed with a xenogeneic collagen matrix, stabilized under small palatal and buccal full-thickness envelope flaps. Eight weeks after surgery, full wound closure was achieved in 9 out of 10 sites with satisfactory esthetic integration (mean ΔE score: 3.76). Results from this descriptive observational study suggest that this technique may represent a valuable and minimally invasive solution to simplify closure and soft tissue augmentation of fresh extraction sockets.

Alveolar Ridge Preservation with Deproteinized Bovine Bone Mineral and Xenogeneic Collagen Matrix: A 12-Month Clinical and Histomorphometric Case Series.

The aim of the present study was to evaluate the efficacy of alveolar ridge preservation (ARP) protocol using deproteinized bovine bone mineral (DBBM) covered with a collagen matrix (CM), as well as to clinically and histologically analyze the alveolar bone healing at 12 months, prior to implant placement. Six patients had bone biopsy samples harvested and underwent implant placement at 12 months following ARP. At 12 months, DBBM granules represented a mean 29.52% ± 6.09% of the specimens and were embedded in the newly formed bone, which represented a mean 27.72% ± 5.64% of the sample. Data suggest that 12 months of ARP using DBBM granules covered with a CM may be considered a predictable technique providing favorable conditions for implant placement in the anterior maxilla.

Clinical Efficacy of Gingival Thickening Following the Use of Allogeneic Acellular and Xenogeneic Collagen Matrix: A 12-Month Randomized Clinical Trial.

This randomized controlled clinical trial with a 1-year follow-up evaluated gingival thickness changes around teeth after use of dermal allograft and xenograft matrix. A total of 116 teeth (19 patients) were separated into two groups. One group received xenogeneic collagen matrix (n = 48), while the other received allogeneic acellular dermal matrix (n = 68) via a coronally advanced flap (CAF). Gingival thickness (GT), keratinized gingival width (KGW), pocket depth (PD), and clinical attachment loss (CAL) were measured on the day of surgery (baseline) and at 3 weeks, 2 months, 6 months, and 1 year postoperative. The two groups were compared using repeated-measures ANOVA (P < .05). The mean GT at 1 year was 1.59 ± 0.31 mm in the xenogeneic group and 1.63 ± 0.33 mm in the allogeneic group (P = .60). The mean change in GT was 1.08 mm in the xenogeneic group and 1.13 mm in the allogeneic group, which was clinically relevant and statistically significant compared to baseline values (P < .001). However, changes in GT were not significantly different between the two groups at any time point (P > .05). The GT increased in all cases treated with allogeneic and xenogeneic enriched collagen matrix. Both soft tissue substitutes were equally effective in acheiving optimal GT.

Keratinized mucosa augmentation guided by double xenogeneic collagen matrix membranes around implants in the posterior mandible

Rationale:Traditional free gingival graft (FGG) technique is usually used for patients with insufficient peri-implant keratinized mucosa. However, this technique often requires a second surgical area which increases the pain as well as the risk of infection in patients. Xenogeneic collagen matrix (XCM) membrane technique can obtain good results for keratinized mucosa increment.Patient concerns:The patient was a 66-year-old healthy female with loss of left mandibular first molar and second molar (FDI #36, #37) for 5 years. Two implants were placed submucosally for 3 months with no interference, while a stage II surgery was needed.Diagnosis:Probing depth measurements suggested that the mesial, medial, and distal widths of buccal keratinized mucosa within the edentulous area were 0.5, 0.5, and 1 mm, respectively, which were insufficient to maintain the health of peri-implant tissues.Interventions:Keratinized mucosa augmentation guided by XCM membranes was performed to increase the inadequate buccal keratinized mucosa.Outcomes:After 2 months of healing, the widths of mesial, medial, and distal buccal keratinized mucosa were 4, 3, and 3 mm, respectively, and the thickness of the augmented mucosa was 4 mm. Then a stage II surgery was followed. The patient was satisfied with the outcomes of keratinized mucosa augmentation.Lessons:Keratinized mucosa augmentation guided by double XCM membrane technique can be applied to cases with keratinized mucosa width within 2 mm around implants.

Randomized, controlled, clinical trial to evaluate a xenogeneic collagen matrix as an alternative to free gingival grafting for oral soft tissue augmentation: A 6- to 8-year follow-up.

The purpose of this follow up study was to determine if a xenogeneic collagen matrix (CMX) is as effective as free gingival graft (FGG) in preventing further recession 6+ years following vestibuloplasty. This study was a single-blind (examiner), randomized, controlled, split-mouth study of 30 subjects with insufficient zones of KT(<2mm), associated with at least two, paired teeth. The study utilized a within subject treatment comparison to examine non-inferiority according to primary and secondary endpoints 6+ years after therapy. The original study primary efficacy endpoint was keratinized tissue width (KTw); however, in this report, prevention of recession (Rec) was also examined, along with traditional, secondary clinical measures, histopathology of mucosal biopsies and exploratory, patient reported outcomes (PROs) for pain and satisfaction. A total of 23 of the 30 original, study patients were available for 6 to 8-year postoperative assessment, and these patients were representative of the original patient population. For preventing further Rec, CMX was not inferior to FGG (ΔRec=-0.07 ± 1.26mm for CMX and -0.17 ± 0.78mm for FGG, P=0.710). There were no adverse results observed, and histological assessment indicated normal, keratinized gingiva for both therapies. Tissue texture and color match to surrounding, native tissues were significantly better for CMX, and patients preferred CMX over FGG therapy. CMX appears to be a suitable substitute for FGG 6+ years after therapy.

Influence of Immediate Implant Placement and Provisionalization with or without Soft Tissue Augmentation on Hard and Soft Tissues in the Esthetic Zone: A One-Year Retrospective Study.

The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment (P > 0.05), while the NG group presented a significant difference (P < 0.05). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group (P < 0.05). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.

Engaging a polylactide copolymer in oral tissue regeneration: first validation of Suprathel® for guided epithelial and osseous healing.

The present study investigated the capacity of Suprathel® (a copolymer membrane, so far validated for skin regeneration) to also regenerate oral tissue – mucosa and bone, by comparing this biomaterial, in a split-mouth rabbit model, to Mucoderm®, a xenogeneic collagen matrix certified for keratinized oral mucosa healing. The clinical reason behind this experimental animal model was to determine whether the benefits of this advanced skin regeneration product (Suprathel®) could be conveyed for future evaluation in clinical trials of oral tissue regeneration in humans. The outcomes of this study validated the use of Suprathel®, a terpolymer of polylactide with trimethylene carbonate and ε-caprolactone, for stimulation of oral epithelium and alveolar bone regeneration in rabbits. Both Suprathel® and Mucoderm® exhibited comparable results and the null hypothesis stating a comparable regenerating effect of these two materials could not be rejected.

Dynamic navigation guided surgery and prosthetics for immediate loading of complete-arch restoration.

To assess clinical and radiological performance of novel digital workflow integrating dynamic guided surgery, to streamline execution of implant placement, soft and bone tissue sculpturing, and immediate delivery of navigation guided complete-arch prosthesis. This proof of concept prospective single cohort study investigated 10 consecutive patients (three males, seven females; mean age 62.5 ± 8.9 years; range, 48-75) requiring at least one complete-arch fixed dental prostheses (FDP) in both jaws, treated between January and August 2019. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications. Secondary outcomes were marginal bone loss (MBL), implant stability quotient (ISQ), periodontal parameters (plaque and bleeding indexes). Sixty implants (32 NobelParallel TiUltra and 28 NobelActive TiUltra, Nobel Biocare) were placed and 14 complete-arch FDPs immediately loaded (mean follow-up 16.2 ± 1.7 months, 14-18). One implant failed and was immediately replaced. No other surgical or biological complications occurred, accounting for a cumulative success rate of 98.3%. No prosthetic complication occurred, leading to 100% prosthetic success rate. Mean ISQ at implant placement was 71 ± 2.8 (65-78). The mean MBL was -0.53 ± 0.28 mm (-0.22 to -1.12 mm). Plaque and bleeding scores were 14.4 ± 8.18 and 7.15 ± 4.4, respectively. Within the limitations of this proof-of-concept dynamic navigation was effective to deliver in the planned coordinates both implants and prosthesis and guide bone and soft tissue sculpturing. Immediate loading of digitally prefabricated esthetically driven complete-arch FDP was facilitated, resulting in high implant and prosthetic success rates. The investigated digital workflow integrating dynamic navigation may overcome the difficulties related to immediate positioning and loading of digitally prefabricated complete-arch FDP. The navigation guided soft and bone tissues sculpturing, associated to xenogeneic collagen matrix grafting, represented a predictable technique to achieve the digitally planned interface, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health.

Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.

Which type of soft tissue augmentation at dental implant sites is best supported by evidence?

Data sources PubMed, the Cochrane Oral Health Group Trials Register and Embase. Additionally, issues of the following journals between 2000 and April 2019 were hand-searched: Journal of Clinical Periodontology, Journal of Periodontology, International Journal of Periodontology and Restorative Dentistry, European Journal of Oral Implantology, Journal of Oral and Maxillofacial Surgery, Clinical Implant Dentistry and Related Research, and Clinical Oral Implants Research.Study selection Only randomised controlled trials (RCTs) involving soft tissue augmentation at dental implant sites were considered for inclusion. The selection was restricted to RCTs published in English language with at least ten patients per group and a minimum follow-up period of three months. A PICO method was used to organise the inclusion criteria and soft tissue augmentations were clustered into three groups; that is, before prosthetic treatment, after prosthetic treatment and at immediate implant placement.Data extraction and synthesis The screening of titles and abstracts was carried out by two reviewers and disagreements were moderated by a third reviewer. Eligibility was determined using full texts and data were extracted using purposefully designed forms. The Cochrane handbook for systematic reviews of interventions toolkit was used to assess the risk of bias. The studies were grouped according to the type of intervention and subjected to quantitative data synthesis. Continuous outcome measures were assessed using random-effects meta-analyses and pooled estimates were expressed as weighted mean differences (MDs) along with 95% confidence intervals (CIs).Results Following initial electronic and hand-searches, 2,119 studies were screened for title and abstract, and 32 studies were considered for full-text screening. Only 14 RCTs met the inclusion criteria and the remaining 18 studies were excluded from the systematic review. The included studies described soft tissue augmentation for 538 implants placed in 475 patients. Three studies (68 patients; 78 implants) reported improved soft tissue thickness with xenogenic collagen matrix (XCM) augmentation compared to no augmentation at the implant sites before prosthetic treatment (high/unclear risk of bias). One study (28 patients; 41 implants) reported improved height of keratinised tissue (KT) and marginal bone levels (MBLs) with free gingival graft (FGG) compared to no augmentation at the implant sites after prosthetic treatment (unclear risk of bias). Three RCTs (126 patients; 126 implants) focused on connective tissue grafting (CTG) and bone grafting versus no grafting in conjunction with immediate implant placement after tooth extraction (unclear risk of bias). There was no difference in MBLs in any of the studies, while one study showed superior soft tissue thickness (STT). Four RCTs (129 patients; 133 implants) compared different augmentation techniques before prosthetic treatment. Only one study showed improved STT with CTG compared to XCM (low risk of bias). Finally, three RCTs (124 patients; 160 implants) compared different augmentation techniques after prosthetic treatment (high/unclear risk of bias). FGG was observed to be superior to acellular dermal matrix (ADM) and vestibuloplasty to improve KT. Meta-analyses did not favour CTG to improve MBLs at extraction sites but CTG was superior to XCM to improve STT before prosthetic treatment.Conclusions Notwithstanding the limitations of the systematic review, soft tissue augmentation significantly enhances the amount of soft tissue at the implant site. CTG at the extraction site also improves subsequent bone level of the implants. Moreover, CTG before prosthetic treatment is superior to XCM to improve thickness of peri-implant soft tissues. However, these findings are based on short-term follow-up and future studies with improved methodology are required to establish the long-term benefits of soft tissue augmentation at the dental implant sites.

Soft Tissue Grafting Around Implants: Why, When, and How?

This paper discusses the role of soft tissue grafting around dental implants. The aim of this review is to present pertinent literature on peri-implant soft tissue including its role, indications for augmentation, techniques used to enhance the quality and/or quantity of the soft tissue, and corresponding timing of those procedures. Most reviewed soft tissue grafting studies in this paper were published in the last 5 years. However, the review also included older articles to mitigate the lack of recent randomized controlled trials or even case series on the reviewed soft tissue graft types. Soft tissue management with custom healing abutments or temporary restorations should be considered whenever possible. Soft tissue grafting to increase the width of keratinized mucosa (KM) seems to result in greater reduction of inflammation signs and a greater maintenance of crestal bone levels. The use of soft tissue grafts to increase soft tissue thickness tends to have a positive effect on maintaining crestal bone levels, especially when used to increase vertical thickness. Apically positioned flaps (APFs) in combination with free gingival grafts (FGGs), subepithelial connective tissue grafts (SCTGs), or xenogenic collagen matrix (XCM) can significantly increase the KM width. Grafts to enhance facial tissue thickness lack evidence to support their long-term impact on mucosal marginal levels. Nonetheless, soft tissue manipulation is frequently performed at second-stage surgery to improve the facial thickness and esthetics. No clear advantages for the timing of soft tissue grafting with regard to clinical outcomes can be delineated when grafting is performed to increase KM or tissue thickness in simultaneous or staged approaches. The decision and timing to treat soft tissue defects should be based on risk assessment at the site and patient levels.

Labial Strip Gingival Graft for the Reconstruction of Severely Distorted Mucogingival Defects: A Prospective Case Series.

Several techniques involving the harvesting of a soft tissue graft from the palate have been proposed for regenerating keratinized mucosa (KM) at implant sites. However, patient morbidity and poor esthetic outcomes are considered the main drawbacks of these approaches. Therefore, the aim of this study was to describe and evaluate a new technique for harvesting keratinized tissue from the adjacent labial site (labial gingival graft [LGG]), in combination with a xenogeneic collagen matrix (XCM) or a connective tissue graft (CTG). Eighteen patients were enrolled and participated in this case series. The primary outcomes were KM gain after 12 months and patient-reported satisfaction, esthetics, and morbidity using a visual analog scale (VAS). All treated sites healed uneventfully, showing a mean KM gain of 6.8 ± 2 mm. The average VAS score for patient satisfaction and the self-reported esthetic outcomes were 95.6 ± 6.9 and 93.4 ± 9.2, respectively, and the score for morbidity was 22.8 ± 22.3. However, the VAS score for morbidity dropped to 8.7 ± 8.4 when CTG-treated subjects were excluded. Higher esthetic results were observed when XCM was used instead of CTG and when LGG was harvested from the anterior region of the implant site (P < .05 for both comparisons). LGG with XCM or CTG is a viable technique for regenerating KM at implant sites with high patient satisfaction and esthetics and low morbidity outcomes.

Digital assisted soft tissue sculpturing (DASS) technique for immediate loading pink free complete arch implant prosthesis.

To introduce a digitally assisted technique to achieve the ideal soft and bone tissue interface for anatomic-driven pink free implant supported fixed prosthesis, and prefabricate an interim prosthesis to be used the day of the surgery as a prosthetic scaffold to condition the healing. The digital assisted soft tissue sculpturing (DASS) technique allows the previsualization of the ideal soft and bone tissue interface and fabricate a computer aided design computer aided manufacturing (CAD-CAM) anatomic-driven pink free complete arch interim prosthesis for the immediate loading. Bone and soft tissue interface as well as the interim prosthesis design are performed in a segmented multiple standard tessellation language (STL) file embedding the bone anatomy, the intraoral surface anatomy (dental and soft tissue), the digital wax-up and the implant positioning. The interim prosthesis is used as a prosthetic scaffold to guide the soft and bone tissue surgical sculpturing and regeneration. The DASS technique is a predictable integrated digital workflow that simplifies the achievement of a scalloped tissue interface for pink free fixed implant prosthesis, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health. The surgical sculpturing and maturation of the soft and bone tissue is driven and enhanced by the xenogeneic collagen matrix grafting and prosthetic scaffold effect of the digitally prefabricated interim prosthesis delivered the day of the surgery.

The use of a xenogenic collagen matrix (Mucograft®) in the treatment of the implant site: a literature review

The use of a xenogenic collagen matrix (Mucograft®) in the treatment of the implant site: a literature review

Effectiveness of connective tissue graft substitutes for the treatment of gingival recessions compared with coronally advanced flap: a network meta-analysis.

This study aimed to conduct a network comparison of the clinical effect of connective tissue graft (CTG) substitutes on the treatment of gingival recessions using coronally advanced flap. An electronic search without language or dates restrictions was performed in five databases and in Grey literature for articles published until May, 2020. The eligibility criteria comprised randomized controlled trials (RCTs) that analyzed the clinical outcomes of CTG substitutes when compared with coronally advanced flap (CAF) for the treatment of Miller class I and II (Cairo RT I) gingival recessions. A pairwise and network meta-analysis were conducted for each periodontal parameters to assess and compare the outcomes among different treatment arms for the primary and secondary outcomes. This systematic review (SR) was registered in INPLASY under number INPLASY202060075. Twenty-seven studies were included in the present SR. All analyzed CTG substitutes showed superior results when comparing with CAF alone for all periodontal parameters. However, when compared in a network, the acellular dermal matrix (ADM) demonstrated the best treatment ranking of probability results, followed by platelet-rich fibrin (PRF), enamel matrix derivative (EMD), and xenogeneic collagen matrix (XCM) for root coverage (RC). This SR observed that the association of biomaterials increases the effectiveness of RC in comparison with CAF alone. Based on the treatment ranking, although all the biomaterials analyzed showed a positive effect for RC, the ADM demonstrated the best results. To know the effectiveness of CTG substitutes for the treatment of gingival recessions.

Clinical efficacy of xenogeneic and allogeneic 3D matrix in the management of gingival recession: a systematic review and meta-analysis.

A systematic review and meta-analysis was thus conducted to answer the following focused question based on PICO strategy: Is there any 3D matrix biomaterial used for root coverage of human Miller class I and II defects equivalent with the connective tissue graft in localized defects of at least 2mm and 3mm? The search on electronic database included MEDLINE, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, Web of Science, and New Zealand/Australian Clinical Trials. Only randomized clinical trials (RCTs) that compared connective tissue graft (CTG) with at least one 3D matrix alone for root coverage in Class I and II Miller localized defects of at least 2mm, with at least 6months follow-up, were included in this systematic review. A total of 14 studies were included for meta-analysis (12 compared CTG with acellular dermal matrix allograft and 2 compared CTG with Xenogenic Collagen Matrix). Relative root coverage showed no significant difference among the materials, for either 2 or 3mm minimal recessions. For keratinized tissue width, on 2mm recessions, CTG showed superiority above other biomaterials, but on 3mm recessions, it seemed to have the same results. The percentage of recessions with complete root coverage for both 2 and 3mm recessions showed similar results for all biomaterials. With their limits, the present data concluded that CTG, acellular dermal matrix allograft, and xenogenic collagen matrix provided similar results for root coverage. To know if there is a 3D matrix with equivalent predictable results for root coverage, that we could avoid the morbidity of the connective tissue graft for these cases.