New surgical approach for root coverage of localized gingival recession with acellular dermal matrix: a 12-month comparative study.
Background: An acellular dermal matrix graft (ADMG) has been used as an advantageous substitute for an autogenous subepithelial connective tissue graft (SCTG). However, the surgical techniques used were primarily developed for the SCTG, and they may not be adequate for the ADMG since it has a different healing process than SCTG owing to its different vascular and cellular structures. This study compared the 1-year clinical outcome of a new surgical approach with the outcome of a conventional procedure for the treatment of localized gingival recessions, both performed using the ADMG. Materials and Methods: The clinical parameters—probing, depth, relative clinical attachment level, gingival recession (GR), and width of keratinized tissues—of 32 bilateral Miller Class I or II gingival recessions were assessed at baseline and 12 months postoperatively. Results: Significant clinical changes for both surgical techniques were achieved after this period, including GR reduction from 3.4 mm presurgery to 1.2 mm 1 year after the conventional technique and from 3.9 mm presurgery to 0.7 mm at 1 year for the new technique. The percentage of root coverage was 62.3% and 82.5% for the conventional and new techniques, respectively. Comparisons between groups after this period by Mann-Whitney rank sum test revealed a statistically significant greater reduction of GR favoring the new procedure (p = .000)
Gingival recession is a common occurrence. For patients it can lead to root hypersensitivity, root caries, and an unsatisfactory esthetic appearance. This study investigated a new technique using an acellular dermal matrix after 1 year, comparing it to a conventional root coverage technique. This is a power�ful research report. Unlike many case reports that we read every month for the treatment of 1 patient, this study evaluated 14 patients with 16 pairs of gingival recession that were treated and then reevaluated at 1 year. Not only was the data presented but excellent clinical photographs were included in the paper that demonstrated the level of success that was seen. The new technique was superior to conventional root coverage. The clinical significance of this study is that for the general dentist referring their patient for evaluation for root coverage, a more predictable technique is available for treatment. This also has implications when recession adjacent to existing crowns or veneers is present that the patient finds esthetically unpleasing.
The techniques described also highlight the importance of not only using periodontal treatment for improved periodontal health but also consideration for periodontal plastic surgical procedures to enhance other esthetic results. In some circumstances the reshaping and removal of marginal gingival will place the height of the free margin of the gingival of adjacent teeth at a more esthetic, matching height. For placing an anterior implant or a fixed partial denture where there is bone loss and discrepancies in height at the edentulous ridge where the gingival aspect of the restoration will be placed, consideration should be given to the placement of a graft to reshape the gingival tissues first. We should not limit our view of how the soft tissue frames our restorations but rather expand treatment to provide our patients with healthy, better functioning restorations.
Howard E. Strassler, DMD