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DOI: 10.1055/s-0043-1772778
Allogenic Acellular Dermal Matrix and Xenogeneic Dermal Matrix as Connective Tissue Graft Substitutes for Long-Term Stability Gingival Recession Therapy: A Systematic Review and Meta-Analysis
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Abstract
Connective tissue graft (CTG) serves as a gold standard for gingival recession therapy. Yet the availability of CTG is limited, and it increases patient morbidity. Allogenic acellular dermal matrix (AADM) and xenogeneic dermal matrix (XDM) have been proven to be effective substitutes of CTG although the long-term stability is unclear. The aim of this study was to analyze the long-term stability outcome of gingival recession therapy using AADM and XDM compared to CTG. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted independently from several online databases (PubMed, Scopus, and Embase). Five of 233 publications were included for final qualitative analysis and meta-analysis focusing on the mean difference of clinical parameters such as recession depth (RD), recession width (RW), probing depth (PD), clinical attachment loss (CAL), tissue thickness (TT), keratinized tissue width (KTW), and mean root coverage (MRC). Meta-analyses of RD, RW, CAL, TT, KTW, and MRC display an overall mean of 0.2 mm (95% confidence interval [CI]: –0.45 to –0.05), 0.29 mm (95% CI: –0.65 to 0.08), 0.2 mm (95% CI: –0.69 to 0.29), 0.25 mm (95% CI: –0.53 to 0.03), 0.26 mm (95% CI: –0.5 to 0.02), and 9.19% (95% CI: –13.95 to –4.43]), respectively, favoring the CTG. PD was the only parameter that favored the AADM or XDM with an overall mean of 0.03 mm (95% CI: –0.05 to 0.11). In all, if the long-term stability is the goal, the CTG is considered superior for gingival recession therapy. However, if it is contraindicated, the AADM and XDM might be considered as alternatives.
Keywords
allogeneic acellular dermal matrix - xenogeneic dermal matrix - connective tissue graft - gingival recessionPublication History
Article published online:
17 October 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000 2015; 68 (01) 333-368
- 2 Pini-Prato G, Baldi C, Pagliaro U. et al. Coronally advanced flap procedure for root coverage. Treatment of root surface: root planning versus polishing. J Periodontol 1999; 70 (09) 1064-1076
- 3 Marini MG, Greghi SL, Passanezi E, Sant'ana AC. Gingival recession: prevalence, extension and severity in adults. J Appl Oral Sci 2004; 12 (03) 250-255
- 4 Barootchi S, Tavelli L, Di Gianfilippo R. et al. Soft tissue phenotype modification predicts gingival margin long-term (10-year) stability: longitudinal analysis of six randomized clinical trials. J Clin Periodontol 2022; 49 (07) 672-683
- 5 Kasaj A. Etiology and prevalence of gingival recession. In: Gingival Recession Management. Cham, Switzerland: Springer International Publishing; 2018: 19-31
- 6 Imber JC, Kasaj A. Treatment of gingival recession: when and how?. Int Dent J 2021; 71 (03) 178-187
- 7 Zalkind M, Hochman N. Alternative method of conservative esthetic treatment for gingival recession. J Prosthet Dent 1997; 77 (06) 561-563
- 8 Zucchelli G, Tavelli L, McGuire MK. et al. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction. J Periodontol 2020; 91 (01) 9-16
- 9 Barootchi S, Tavelli L, Zucchelli G, Giannobile WV, Wang HL. Gingival phenotype modification therapies on natural teeth: a network meta-analysis. J Periodontol 2020; 91 (11) 1386-1399
- 10 Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 2015; 86 (2, Suppl): S8-S51
- 11 Harris RJ. Root coverage with connective tissue grafts: an evaluation of short- and long-term results. J Periodontol 2002; 73 (09) 1054-1059
- 12 Tavelli L, Barootchi S, Di Gianfilippo R. et al. Patient experience of autogenous soft tissue grafting has an implication for future treatment: a 10- to 15-year cross-sectional study. J Periodontol 2021; 92 (05) 637-647
- 13 Tavelli L, McGuire MK, Zucchelli G. et al. Extracellular matrix-based scaffolding technologies for periodontal and peri-implant soft tissue regeneration. J Periodontol 2020; 91 (01) 17-25
- 14 Moraschini V, Calasans-Maia MD, Dias AT. et al. Effectiveness of connective tissue graft substitutes for the treatment of gingival recessions compared with coronally advanced flap: a network meta-analysis. Clin Oral Investig 2020; 24 (10) 3395-3406
- 15 Dadlani S. Porcine acellular dermal matrix: an alternative to connective tissue graft—a narrative review. Int J Dent 2021; 2021: 1652032
- 16 Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns 1995; 21 (04) 243-248
- 17 Novaes Jr AB, Grisi DC, Molina GO, Souza SL, Taba Jr M, Grisi MF. 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
- 18 Harris RJ. A short-term and long-term comparison of root coverage with an acellular dermal matrix and a subepithelial graft. J Periodontol 2004; 75 (05) 734-743
- 19 Al-Hamdan K. Long-term predictability of allogenic dermal matrix for root coverage: Three years observation period on 15 consecutive cases. Saudi Dent J 2021; 33 (02) 99-104
- 20 de Resende DRB, Greghi SLA, Siqueira AF, Benfatti CAM, Damante CA, Ragghianti Zangrando MS. Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial. Clin Oral Investig 2019; 23 (02) 539-550
- 21 Rothamel D, Benner M, Fienitz T. et al. Biodegradation pattern and tissue integration of native and cross-linked porcine collagen soft tissue augmentation matrices: an experimental study in the rat. Head Face Med 2014; 10 (01) 10
- 22 Pabst AM, Wagner W, Kasaj A. et al. Synchrotron-based X-ray tomographic microscopy for visualization of three-dimensional collagen matrices. Clin Oral Investig 2015; 19 (02) 561-564
- 23 Lin Z, Nica C, Sculean A, Asparuhova MB. Enhanced wound healing potential of primary human oral fibroblasts and periodontal ligament cells cultured on four different porcine-derived collagen matrices. Materials (Basel) 2020; 13 (17) 3819
- 24 Lu W, Qi G, Ding Z, Li X, Qi W, He F. Clinical efficacy of acellular dermal matrix for plastic periodontal and implant surgery: a systematic review. Int J Oral Maxillofac Implants 2020; 49 (08) 1057-1066
- 25 Sterne JAC, Savović J, Page MJ. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898
- 26 Meza-Mauricio J, Cortez-Gianezzi J, Duarte PM, Tavelli L, Rasperini G, de Faveri M. Comparison between a xenogeneic dermal matrix and connective tissue graft for the treatment of multiple adjacent gingival recessions: a randomized controlled clinical trial. Clin Oral Investig 2021; 25 (12) 6919-6929
- 27 Vincent-Bugnas S, Laurent J, Naman E, Charbit M, Borie G. Treatment of multiple gingival recessions with xenogeneic acellular dermal matrix compared to connective tissue graft: a randomized split-mouth clinical trial. J Periodontal Implant Sci 2021; 51 (02) 77-87
- 28 Gürlek Ö, Gümüş P, Nizam N, Buduneli N. Coronally advanced flap with connective tissue graft or xenogeneic acellular dermal matrix in the treatment of multiple gingival recessions: a split-mouth randomized clinical trial. J Esthet Restor Dent 2020; 32 (04) 380-388
- 29 Rakasevic DL, Milinkovic IZ, Jankovic SM, Soldatovic IA, Aleksic ZM, Nikolic-Jakoba NS. The use of collagen porcine dermal matrix and connective tissue graft with modified coronally advanced tunnel technique in the treatment of multiple adjacent type I gingival recessions: a randomized, controlled clinical trial. J Esthet Restor Dent 2020; 32 (07) 681-690
- 30 Barros RR, Macedo GO, de Queiroz AC, Novaes Jr AB. A modified surgical flap for root coverage in association with grafting materials. J Esthet Restor Dent 2015; 27 (02) 84-91
- 31 Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. eds. Cochrane Handbook for Systematic Reviews of Interventions. version 6.3. Chichester, UK: Wiley-Blackwell; 2019
- 32 Atieh MA, Alsabeeha N, Tawse-Smith A, Payne AG. Xenogeneic collagen matrix for periodontal plastic surgery procedures: a systematic review and meta-analysis. J Periodontal Res 2016; 51 (04) 438-452
- 33 Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M. Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. J Clin Periodontol 2009; 36 (10) 868-876
- 34 Tavelli L, Barootchi S, Rodriguez MV. et al. Recombinant human platelet-derived growth factor improves root coverage of a collagen matrix for multiple adjacent gingival recessions: a triple-blinded, randomized, placebo-controlled trial. J Clin Periodontol 2022; 49 (11) 1169-1184
- 35 Zhang M, Wang M, Zhang C. Efficacy and safety of acellular dermal matrix versus connective tissue graft for root coverage of Miller's class I and II gingival recession: a systematic review and meta-analysis. Ann Palliat Med 2022; 11 (07) 2478-2491
- 36 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 (09) 937-948
- 37 Chambrone L, Salinas Ortega MA, Sukekava F. et al. Root coverage procedures for treating localised and multiple recession-type defects. Cochrane Database Syst Rev 2018; 10 (10) CD007161
- 38 Ahmedbeyli C, Dirikan Ipçi S, Cakar G, Yılmaz S, Chambrone L. Coronally advanced flap and envelope type of flap plus acellular dermal matrix graft for the treatment of thin phenotype multiple recession defects. A randomized clinical trial. J Clin Periodontol 2019; 46 (10) 1024-1029
- 39 Stefanini M, Marzadori M, Aroca S, Felice P, Sangiorgi M, Zucchelli G. Decision making in root-coverage procedures for the esthetic outcome. Periodontol 2000 2018; 77 (01) 54-64
- 40 Sumana SZ, Lelyati S, Lessang R. Root coverage using the subepithelial connective tissue graft or the acellular dermal matrix for the treatment of gingival recession: a clinical study. Int J App Pharm 2017; 9 (02) 20-23
- 41 Toledano-Osorio M, Muñoz-Soto E, Toledano M. et al. Treating gingival recessions using coronally advanced flap or tunnel techniques with autografts or polymeric substitutes: a systematic review and meta-analysis. Polymers (Basel) 2022; 14 (07) 1453
- 42 Tavelli L, Barootchi S, Nguyen TVN, Tattan M, Ravidà A, Wang HL. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: a systematic review and meta-analysis. J Periodontol 2018; 89 (09) 1075-1090
- 43 AlSarhan MA, Al Jasser R, Tarish MA, AlHuzaimi AI, Alzoman H. Xenogeneic collagen matrix versus connective tissue graft for the treatment of multiple gingival recessions: a systematic review and meta-analysis. Clin Exp Dent Res 2019; 5 (05) 566-579
- 44 Gallagher SI, Matthews DC. Acellular dermal matrix and subepithelial connective tissue grafts for root coverage: a systematic review. J Indian Soc Periodontol 2017; 21 (06) 439-448
- 45 Lissek M, Boeker M, Happe A. How thick is the oral mucosa around implants after augmentation with different materials: a systematic review of the effectiveness of substitute matrices in comparison to connective tissue grafts. Int J Mol Sci 2020; 21 (14) 5043