Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue: Comparison of clinical parameters at 10 years

Michael K. McGuire, E. Todd Scheyer, Martha E. Nunn

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: The effective treatment of gingival recession (GR) defects is crucial for predictable outcomes. The most common treatment is the subepithelial connective tissue graft (CTG), but good outcomes have also been obtained using enamel matrix derivative (EMD). A split-mouth, randomized controlled trial was previously performed during a 12-month period to evaluate primary and secondary outcomes in Miller Class I and II GR defects treated with CTG or EMD, both in combination with coronally advanced flap (CAF). The purpose of the current study is to examine the major qualitative and quantitative parameters of this study after a 10-year follow-up. Methods: Nine of 17 original patients were available for follow-up evaluation 10 years after the original surgery. The parameters measured were: 1) GR depth; 2) probing depth (PD); 3) clinical attachment level; 4) width of keratinized tissue (wKT); 5) percentage of root coverage; 6) root dentin hypersensitivity; 7) color, texture, and contour of treatment sites; and 8) patient satisfaction at 10 years. Results at 1 and 10 years of these nine patients (nine test and nine control teeth) were compared to original baseline values. In addition, results within treatment groups between 1 and 10 years and between treatment groups (i.e., EMD versus CTG) at the same time points were examined. Results: At 10 years, all quantitative parameters except PD for both treatment protocols showed statistically significant improvements from baseline values, including wKT in the EMD group, which at 1 year was not significantly improved compared with baseline wKT. In addition, at 10 years, there were no statistically significant differences between EMD + CAF and CTG + CAF for any measured parameter. The only statistically significant finding in this study was the difference in wKT found at 1 year (EMD, 3.00 mm; CTG, 3.89 mm; P = 0.031). Qualitative parameters at 10 years demonstrated similar stability. The only major qualitative difference was the marginal tissue contour, which was similar to adjacent tissues at EMD-treated sites but greater than adjacent tissues at all CTG sites except one. Esthetically, both EMD- and CTG-mediated treatments were similar at 10 years. However, given the choice, six of nine patients would choose EMD over CTG treatment to avoid a secondary harvesting procedure. Conclusions: This paper highlights the importance of long-term data as it relates to procedural effectiveness in selecting optimally effective protocols to treat gingival recession. Based on the results of this 10-year follow-up investigation, treatment with either EMD + CAF or CTG + CAF for Miller Class I and II GR defects appears stable, clinically effective, and similar to each other on all measured parameters. J Periodontol 2012;83: 1353-1362.

Original languageEnglish
Pages (from-to)1353-1362
Number of pages10
JournalJournal of Periodontology
Volume83
Issue number11
DOIs
StatePublished - Nov 2012

Fingerprint

Dental Enamel
Connective Tissue
Gingival Recession
Transplants
Therapeutics
Dentin Sensitivity
Clinical Protocols
Patient Satisfaction
Mouth
Tooth
Randomized Controlled Trials
Color

All Science Journal Classification (ASJC) codes

  • Periodontics

Cite this

@article{38014abcdbb8422a853d28e1c904db20,
title = "Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue: Comparison of clinical parameters at 10 years",
abstract = "Background: The effective treatment of gingival recession (GR) defects is crucial for predictable outcomes. The most common treatment is the subepithelial connective tissue graft (CTG), but good outcomes have also been obtained using enamel matrix derivative (EMD). A split-mouth, randomized controlled trial was previously performed during a 12-month period to evaluate primary and secondary outcomes in Miller Class I and II GR defects treated with CTG or EMD, both in combination with coronally advanced flap (CAF). The purpose of the current study is to examine the major qualitative and quantitative parameters of this study after a 10-year follow-up. Methods: Nine of 17 original patients were available for follow-up evaluation 10 years after the original surgery. The parameters measured were: 1) GR depth; 2) probing depth (PD); 3) clinical attachment level; 4) width of keratinized tissue (wKT); 5) percentage of root coverage; 6) root dentin hypersensitivity; 7) color, texture, and contour of treatment sites; and 8) patient satisfaction at 10 years. Results at 1 and 10 years of these nine patients (nine test and nine control teeth) were compared to original baseline values. In addition, results within treatment groups between 1 and 10 years and between treatment groups (i.e., EMD versus CTG) at the same time points were examined. Results: At 10 years, all quantitative parameters except PD for both treatment protocols showed statistically significant improvements from baseline values, including wKT in the EMD group, which at 1 year was not significantly improved compared with baseline wKT. In addition, at 10 years, there were no statistically significant differences between EMD + CAF and CTG + CAF for any measured parameter. The only statistically significant finding in this study was the difference in wKT found at 1 year (EMD, 3.00 mm; CTG, 3.89 mm; P = 0.031). Qualitative parameters at 10 years demonstrated similar stability. The only major qualitative difference was the marginal tissue contour, which was similar to adjacent tissues at EMD-treated sites but greater than adjacent tissues at all CTG sites except one. Esthetically, both EMD- and CTG-mediated treatments were similar at 10 years. However, given the choice, six of nine patients would choose EMD over CTG treatment to avoid a secondary harvesting procedure. Conclusions: This paper highlights the importance of long-term data as it relates to procedural effectiveness in selecting optimally effective protocols to treat gingival recession. Based on the results of this 10-year follow-up investigation, treatment with either EMD + CAF or CTG + CAF for Miller Class I and II GR defects appears stable, clinically effective, and similar to each other on all measured parameters. J Periodontol 2012;83: 1353-1362.",
author = "McGuire, {Michael K.} and Scheyer, {E. Todd} and Nunn, {Martha E.}",
year = "2012",
month = "11",
doi = "10.1902/jop.2012.110373",
language = "English",
volume = "83",
pages = "1353--1362",
journal = "Journal of Periodontology",
issn = "0022-3492",
publisher = "American Academy of Periodontology",
number = "11",

}

TY - JOUR

T1 - Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue

T2 - Comparison of clinical parameters at 10 years

AU - McGuire, Michael K.

AU - Scheyer, E. Todd

AU - Nunn, Martha E.

PY - 2012/11

Y1 - 2012/11

N2 - Background: The effective treatment of gingival recession (GR) defects is crucial for predictable outcomes. The most common treatment is the subepithelial connective tissue graft (CTG), but good outcomes have also been obtained using enamel matrix derivative (EMD). A split-mouth, randomized controlled trial was previously performed during a 12-month period to evaluate primary and secondary outcomes in Miller Class I and II GR defects treated with CTG or EMD, both in combination with coronally advanced flap (CAF). The purpose of the current study is to examine the major qualitative and quantitative parameters of this study after a 10-year follow-up. Methods: Nine of 17 original patients were available for follow-up evaluation 10 years after the original surgery. The parameters measured were: 1) GR depth; 2) probing depth (PD); 3) clinical attachment level; 4) width of keratinized tissue (wKT); 5) percentage of root coverage; 6) root dentin hypersensitivity; 7) color, texture, and contour of treatment sites; and 8) patient satisfaction at 10 years. Results at 1 and 10 years of these nine patients (nine test and nine control teeth) were compared to original baseline values. In addition, results within treatment groups between 1 and 10 years and between treatment groups (i.e., EMD versus CTG) at the same time points were examined. Results: At 10 years, all quantitative parameters except PD for both treatment protocols showed statistically significant improvements from baseline values, including wKT in the EMD group, which at 1 year was not significantly improved compared with baseline wKT. In addition, at 10 years, there were no statistically significant differences between EMD + CAF and CTG + CAF for any measured parameter. The only statistically significant finding in this study was the difference in wKT found at 1 year (EMD, 3.00 mm; CTG, 3.89 mm; P = 0.031). Qualitative parameters at 10 years demonstrated similar stability. The only major qualitative difference was the marginal tissue contour, which was similar to adjacent tissues at EMD-treated sites but greater than adjacent tissues at all CTG sites except one. Esthetically, both EMD- and CTG-mediated treatments were similar at 10 years. However, given the choice, six of nine patients would choose EMD over CTG treatment to avoid a secondary harvesting procedure. Conclusions: This paper highlights the importance of long-term data as it relates to procedural effectiveness in selecting optimally effective protocols to treat gingival recession. Based on the results of this 10-year follow-up investigation, treatment with either EMD + CAF or CTG + CAF for Miller Class I and II GR defects appears stable, clinically effective, and similar to each other on all measured parameters. J Periodontol 2012;83: 1353-1362.

AB - Background: The effective treatment of gingival recession (GR) defects is crucial for predictable outcomes. The most common treatment is the subepithelial connective tissue graft (CTG), but good outcomes have also been obtained using enamel matrix derivative (EMD). A split-mouth, randomized controlled trial was previously performed during a 12-month period to evaluate primary and secondary outcomes in Miller Class I and II GR defects treated with CTG or EMD, both in combination with coronally advanced flap (CAF). The purpose of the current study is to examine the major qualitative and quantitative parameters of this study after a 10-year follow-up. Methods: Nine of 17 original patients were available for follow-up evaluation 10 years after the original surgery. The parameters measured were: 1) GR depth; 2) probing depth (PD); 3) clinical attachment level; 4) width of keratinized tissue (wKT); 5) percentage of root coverage; 6) root dentin hypersensitivity; 7) color, texture, and contour of treatment sites; and 8) patient satisfaction at 10 years. Results at 1 and 10 years of these nine patients (nine test and nine control teeth) were compared to original baseline values. In addition, results within treatment groups between 1 and 10 years and between treatment groups (i.e., EMD versus CTG) at the same time points were examined. Results: At 10 years, all quantitative parameters except PD for both treatment protocols showed statistically significant improvements from baseline values, including wKT in the EMD group, which at 1 year was not significantly improved compared with baseline wKT. In addition, at 10 years, there were no statistically significant differences between EMD + CAF and CTG + CAF for any measured parameter. The only statistically significant finding in this study was the difference in wKT found at 1 year (EMD, 3.00 mm; CTG, 3.89 mm; P = 0.031). Qualitative parameters at 10 years demonstrated similar stability. The only major qualitative difference was the marginal tissue contour, which was similar to adjacent tissues at EMD-treated sites but greater than adjacent tissues at all CTG sites except one. Esthetically, both EMD- and CTG-mediated treatments were similar at 10 years. However, given the choice, six of nine patients would choose EMD over CTG treatment to avoid a secondary harvesting procedure. Conclusions: This paper highlights the importance of long-term data as it relates to procedural effectiveness in selecting optimally effective protocols to treat gingival recession. Based on the results of this 10-year follow-up investigation, treatment with either EMD + CAF or CTG + CAF for Miller Class I and II GR defects appears stable, clinically effective, and similar to each other on all measured parameters. J Periodontol 2012;83: 1353-1362.

UR - http://www.scopus.com/inward/record.url?scp=84867143891&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867143891&partnerID=8YFLogxK

U2 - 10.1902/jop.2012.110373

DO - 10.1902/jop.2012.110373

M3 - Article

C2 - 22348698

AN - SCOPUS:84867143891

VL - 83

SP - 1353

EP - 1362

JO - Journal of Periodontology

JF - Journal of Periodontology

SN - 0022-3492

IS - 11

ER -