title: A multicenter comparative study of two root coverage procedures: coronally advanced flap with addition of enamel matrix proteins and subpedicle connective tissue graft.
abstract: BACKGROUND
  Free grafts, pedicle flaps, and barrier membranes have been used to cover exposed root surfaces. The aim of the present study was to evaluate the clinical efficacy of a coronally advanced flap procedure with the additional use of enamel matrix protein derivative (EMD) to treat gingival recession and to compare it to the subpedicle connective tissue graft procedure (CTG).
  
  
  METHODS
  The study was conducted in six different periodontal clinics. Miller Class I or II buccal recession type defects in the anterior or premolar teeth were treated in 70 consecutive patients, 30 with EMD and 40 with CTG. At baseline and 6 and 12 months post-surgical treatment, vertical recession defect, defined as the distance from cemento-enamel junction to gingival margin; width of keratinized tissue; and probing depth were recorded and the percentage of coverage of the original defect was calculated. Statistical analyses consisted of t-test, analysis of variance, and analysis of covariance.
  
  
  RESULTS
  At 6 months, percent of root coverage was 77.4% +/- 11.92% in EMD and 84.1% +/- 11.97% in CTG (statistically significant at P = 0.024). At 12 months, percent of root coverage in EMD was 71.7% +/- 16.14% and 87.0% +/- 12.22% in CTG; again, differences between groups were statistically significant (P < 0.001). Differences between the 6- and 12-month vertical recession defect and percent of root coverage recordings within each group were also statistically significant.
  
  
  CONCLUSIONS
  The connective tissue graft procedure was superior to the coronally positioned flap with the addition of enamel matrix proteins derivative in percentage of coverage and increase in width of keratinized tissue. The EMD procedure is a predictable treatment for root coverage that is relatively easy to perform and presents low patient morbidity, and is appropriate especially where a substantial increase in the width of keratinized tissue is not of prime importance.
authors.affiliation: Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. carlos@post.tau.ac.il
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Nemcovsky
authors.forename: Zvi
authors.initials: Z
authors.lastname: Artzi
authors.forename: Haim
authors.initials: H
authors.lastname: Tal
authors.forename: Avital
authors.initials: A
authors.lastname: Kozlovsky
authors.forename: Ofer
authors.initials: O
authors.lastname: Moses
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D003238:Connective Tissue / Q000637:transplantation; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D005260:Female; D005889:Gingival Recession / Q000188:drug therapy* / Q000601:surgery*; D005893:Gingivoplasty / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D013524:Surgical Flaps
chemical_list: D003746:Dental Enamel Proteins; C109069:enamel matrix proteins