Efficacy of acellular dermal matrix and subepithelial connective tissue flap on gingival recession: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

XU Ruonan ^1,2 , XU Jun ^1,2 , GUO Xin ^1,2 , XU Jingjing ^1,2 , JILA Palidan ^1,2 ,  AWUTI Gulinuer ^1,2

1. Department of Periodontal Mucosa, The First Affiliated Hospital of Xinjiang Medical University (Affiliated Stomatological Hospital), Urumqi, 830054, P.R.China;
2. Xinjiang Oral Medical Research Institute, Urumqi, 830011, P.R.China;

Corresponding author：

AWUTI Gulinuer, Email: guawuti@sina.com

Keywords：

Acellular dermal matrix; Subepithelial connective tissue flap; Gingival recession; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201908091

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Objective To systematically review the efficacy of acellular dermal matrix (ADM) and subepithelial connective tissue flap (sCTG) on patients with gingival recession (GR).Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) about the efficacy of ADM and sCTG on patients with GR from inception to August 11^st, 2019. Two reviewers indepeudently screened literature, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.3 software and Stata 12.1 software.Results A total of 9 RCTs were included. The results of meta-analysis showed that: there were no significant differences in probing depth (PD) (MD_3m=−0.04, 95%CI −0.18 to 0.11, P=0.63; MD_6m=−0.01, 95%CI −0.13 to 0.12, P=0.90) and GR degree (MD_3m=−0.10, 95%CI −0.37 to 0.18, P=0.48; MD_6m=−0.02, 95%CI −0.33 to 0.29, P=0.89) in 3 and 6 months after operative between two groups. But the clinical attachment loss (CAL) in 3 months after operation (MD=0.33, 95%CI 0.00 to 0.66, P=0.05) and width of keratinized tissue (KTW) in 6 months after operation (MD=−0.48, 95%CI −0.76 to −0.20, P=0.000 7) of sCTG group were superior to ADM group, the differences were statistically significant.Conclusion Current evidence shows that there are no differences in PD and GR degree in 3 months and 6 months after operation between ADM and sCTG group. But the CAL in 3 months after operation and KTW in 6 months after operation of sCTG group is superior to ADM group. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.

Citation： XU Ruonan, XU Jun, GUO Xin, XU Jingjing, JILA Palidan, AWUTI Gulinuer. Efficacy of acellular dermal matrix and subepithelial connective tissue flap on gingival recession: a systematic review. Chinese Journal of Evidence-Based Medicine, 2020, 20(2): 168-173. doi: 10.7507/1672-2531.201908091 Copy

1.	Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc, 2003, 134(2): 220-225.
2.	Santamaria MP, Queiroz LA, Mathias IF, et al. Resin composite plus connective tissue graft to treat single maxillary gingival recession associated with non-carious cervical lesion: randomized clinical trial. J Clin Periodontol, 2016, 43(5): 461-468.
3.	Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol, 2008, 35(8 Suppl): 136-162.
4.	Chambrone L, Sukekava F, Araújo MG, et al. Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol, 2010, 81(4): 452-478.
5.	Karam PS, Sant'Ana AC, de Rezende ML, et al. Root surface modifiers and subepithelial connective tissue graft for treatment of gingival recessions: a systematic review. J Periodontal Res, 2016, 51(2): 175-185.
6.	Roccuzzo M, Bunino M, Needleman I, et al. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol, 2002, 29(3): 178-194.
7.	Rasperini G, Acunzo R, Pellegrini G, et al. Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9 years results of a randomized controlled clinical trial. J Clin Periodontol, 2018, 45(9): 1107-1117.
8.	Amine K, El Amrani Y, Chemlali S, et al. Alternatives to connective tissue graft in the treatment of localized gingival recessions: a systematic review. J Stomatol Oral Maxillofac Surg, 2018, 119(1): 25-32.
9.	Allen EP. AlloDerm: an effective alternative to palatal donor tissue for treatment of gingival recession. Dent Today, 2006, 25(1): 48-50.
10.	Griffin TJ, Cheung WS, Zavras AI, et al. Postoperative complications following gingival augmentation procedures. J Periodontol, 2006, 77(12): 2070-2079.
11.	de Resende DRB, Greghi SLA, Siqueira AF, et al. Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial. Clin Oral Investig, 2019, 23(2): 539-550.
12.	Kroiss S, Rathe F, Sader R, et al. Acellular dermal matrix allograft versus autogenous connective tissue grafts for thickening soft tissue and covering multiple gingival recessions: a 5-year preference clinical study. Quintessence Int, 2019, 50(4): 278-285.
13.	Rahmani ME, Lades MA. Comparative clinical evaluation of acellular dermal matrix allograft and connective tissue graft for the treatment of gingival recession. J Contemp Dent Pract, 2006, 7(2): 63-70.
14.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
15.	Taiyeb Ali TB, Shapeen IM, Ahmed HB, et al. Efficacy of acellular dermal matrix and autogenous connective tissue grafts in the treatment of gingival recession defects among Asians. J Investig Clin Dent, 2015, 6(2): 125-132.
16.	Shori T, Kolte A, Kher V, et al. A comparative evaluation of the effectiveness of subpedicle acellular dermal matrix allograft with subepithelial connective tissue graft in the treatment of isolated marginal tissue recession: a clinical study. J Indian Soc Periodontol, 2013, 17(1): 78-81.
17.	Thomas LJ, Emmadi P, Thyagarajan R, et al. A comparative clinical study of the efficacy of subepithelial connective tissue graft and acellular dermal matrix graft in root coverage: 6-month follow-up observation. J Indian Soc Periodontol, 2013, 17(4): 478-483.
18.	Koudale SB, Charde PA, Bhongade ML. A comparative clinical evaluation of acellular dermal matrix allograft and sub-epithelial connective tissue graft for the treatment of multiple gingival recessions. J Indian Soc Periodontol, 2012, 16(3): 411-416.
19.	Goyal N, Gupta R, Pandit N, et al. Analysis of patient acceptance following treatment of Miller's class II gingival recession with acellular dermal matrix and connective tissue graft. J Indian Soc Periodontol, 2014, 18(3): 352-356.
20.	Sadat Mansouri S, Ayoubian N, Eslami Manouchehri M. A comparative 6-month clinical study of acellular dermal matrix allograft and subepithelial connective tissue graft for root coverage. J Dent (Tehran), 2010, 7(3): 156-164.
21.	Thakare P, Baliga V, Bhongade ML. Comparative evaluation of the effectiveness of acellular dermal matrix allograft and subepithelial connective tissue to coronally advanced flap alone in the treatment of multiple gingival recessions: a clinicala study. J Indian Soc Periodontol, 2015, 19(5): 537-544.
22.	Moslemi N, Mousavi Jazi M, Haghighati F, et al. Acellular dermal matrix allograft versus subepithelial connective tissue graft in treatment of gingival recessions: a 5-year randomized clinical study. J Clin Periodontol, 2011, 38(12): 1122-1129.
23.	Novaes AB Jr, Grisi DC, Molina GO, et al. Comparative 6-month clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recession. J Periodontol, 2001, 72(11): 1477-1484.
24.	Thoma DS, Buranawat B, Hämmerle CH, et al. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol, 2014, 41 Suppl 15: S77-S91.
25.	Cairo F, Cortellini P, Pilloni A, et al. Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol, 2016, 43(10): 849-856.
26.	Pabst AM, Lehmann KM, Walter C, et al. Influence of porcine-derived collagen matrix on endothelial progenitor cells: an in vitro study. Odontology, 2016, 104(1): 19-26.
27.	Tavelli L, Barootchi S, Cairo F, et al. The effect of time on root coverage outcomes: a network meta-analysis. J Dent Res, 2019, 98(11): 1195-1203.
28.	Tavelli L, Barootchi S, Di Gianfilippo R, et al. Acellular dermal matrix and coronally advanced flap or tunnel technique in the treatment of multiple adjacent gingival recessions. A 12-year follow-up from a randomized clinical trial. J Clin Periodontol, 2019, 46(9): 937-948.

1. Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc, 2003, 134(2): 220-225.
2. Santamaria MP, Queiroz LA, Mathias IF, et al. Resin composite plus connective tissue graft to treat single maxillary gingival recession associated with non-carious cervical lesion: randomized clinical trial. J Clin Periodontol, 2016, 43(5): 461-468.
3. Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol, 2008, 35(8 Suppl): 136-162.
4. Chambrone L, Sukekava F, Araújo MG, et al. Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol, 2010, 81(4): 452-478.
5. Karam PS, Sant'Ana AC, de Rezende ML, et al. Root surface modifiers and subepithelial connective tissue graft for treatment of gingival recessions: a systematic review. J Periodontal Res, 2016, 51(2): 175-185.
6. Roccuzzo M, Bunino M, Needleman I, et al. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol, 2002, 29(3): 178-194.
7. Rasperini G, Acunzo R, Pellegrini G, et al. Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9 years results of a randomized controlled clinical trial. J Clin Periodontol, 2018, 45(9): 1107-1117.
8. Amine K, El Amrani Y, Chemlali S, et al. Alternatives to connective tissue graft in the treatment of localized gingival recessions: a systematic review. J Stomatol Oral Maxillofac Surg, 2018, 119(1): 25-32.
9. Allen EP. AlloDerm: an effective alternative to palatal donor tissue for treatment of gingival recession. Dent Today, 2006, 25(1): 48-50.
10. Griffin TJ, Cheung WS, Zavras AI, et al. Postoperative complications following gingival augmentation procedures. J Periodontol, 2006, 77(12): 2070-2079.
11. de Resende DRB, Greghi SLA, Siqueira AF, et al. Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial. Clin Oral Investig, 2019, 23(2): 539-550.
12. Kroiss S, Rathe F, Sader R, et al. Acellular dermal matrix allograft versus autogenous connective tissue grafts for thickening soft tissue and covering multiple gingival recessions: a 5-year preference clinical study. Quintessence Int, 2019, 50(4): 278-285.
13. Rahmani ME, Lades MA. Comparative clinical evaluation of acellular dermal matrix allograft and connective tissue graft for the treatment of gingival recession. J Contemp Dent Pract, 2006, 7(2): 63-70.
14. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
15. Taiyeb Ali TB, Shapeen IM, Ahmed HB, et al. Efficacy of acellular dermal matrix and autogenous connective tissue grafts in the treatment of gingival recession defects among Asians. J Investig Clin Dent, 2015, 6(2): 125-132.
16. Shori T, Kolte A, Kher V, et al. A comparative evaluation of the effectiveness of subpedicle acellular dermal matrix allograft with subepithelial connective tissue graft in the treatment of isolated marginal tissue recession: a clinical study. J Indian Soc Periodontol, 2013, 17(1): 78-81.
17. Thomas LJ, Emmadi P, Thyagarajan R, et al. A comparative clinical study of the efficacy of subepithelial connective tissue graft and acellular dermal matrix graft in root coverage: 6-month follow-up observation. J Indian Soc Periodontol, 2013, 17(4): 478-483.
18. Koudale SB, Charde PA, Bhongade ML. A comparative clinical evaluation of acellular dermal matrix allograft and sub-epithelial connective tissue graft for the treatment of multiple gingival recessions. J Indian Soc Periodontol, 2012, 16(3): 411-416.
19. Goyal N, Gupta R, Pandit N, et al. Analysis of patient acceptance following treatment of Miller's class II gingival recession with acellular dermal matrix and connective tissue graft. J Indian Soc Periodontol, 2014, 18(3): 352-356.
20. Sadat Mansouri S, Ayoubian N, Eslami Manouchehri M. A comparative 6-month clinical study of acellular dermal matrix allograft and subepithelial connective tissue graft for root coverage. J Dent (Tehran), 2010, 7(3): 156-164.
21. Thakare P, Baliga V, Bhongade ML. Comparative evaluation of the effectiveness of acellular dermal matrix allograft and subepithelial connective tissue to coronally advanced flap alone in the treatment of multiple gingival recessions: a clinicala study. J Indian Soc Periodontol, 2015, 19(5): 537-544.
22. Moslemi N, Mousavi Jazi M, Haghighati F, et al. Acellular dermal matrix allograft versus subepithelial connective tissue graft in treatment of gingival recessions: a 5-year randomized clinical study. J Clin Periodontol, 2011, 38(12): 1122-1129.
23. Novaes AB Jr, Grisi DC, Molina GO, et al. Comparative 6-month clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recession. J Periodontol, 2001, 72(11): 1477-1484.
24. Thoma DS, Buranawat B, Hämmerle CH, et al. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol, 2014, 41 Suppl 15: S77-S91.
25. Cairo F, Cortellini P, Pilloni A, et al. Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol, 2016, 43(10): 849-856.
26. Pabst AM, Lehmann KM, Walter C, et al. Influence of porcine-derived collagen matrix on endothelial progenitor cells: an in vitro study. Odontology, 2016, 104(1): 19-26.
27. Tavelli L, Barootchi S, Cairo F, et al. The effect of time on root coverage outcomes: a network meta-analysis. J Dent Res, 2019, 98(11): 1195-1203.
28. Tavelli L, Barootchi S, Di Gianfilippo R, et al. Acellular dermal matrix and coronally advanced flap or tunnel technique in the treatment of multiple adjacent gingival recessions. A 12-year follow-up from a randomized clinical trial. J Clin Periodontol, 2019, 46(9): 937-948.

Chinese Journal of Evidence-Based Medicine

Efficacy of acellular dermal matrix and subepithelial connective tissue flap on gingival recession: a systematic review

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