title: A comparative study of coronally advanced flaps with and without the addition of enamel matrix derivative in the treatment of marginal tissue recession.
abstract: BACKGROUND
  The primary aim of this randomized, controlled, clinical investigation was to evaluate the differences in clinical parameters of root coverage procedures utilizing coronally advanced flaps (CAF) with and without enamel matrix derivative (EMD). Another aim was to evaluate if EMD can influence keratinization of tissues utilizing these procedures.
  
  
  METHODS
  Fifty-eight contralateral sites in 17 patients with > or = 2 mm of Miller Class I, II, and III buccal marginal tissue recession were treated. Test sites received CAF plus EMD while control sites were treated with CAF only, with each patient serving as his own control. Patients were followed for 3 and 6 months. All data were analyzed using the method of generalized estimating equations. A P value <0.05 was considered significant (alpha = 0.05).
  
  
  RESULTS
  There was a mean increase in keratinized tissue of 0.60 mm for test sites and a mean decrease of 0.05 mm for control sites. Test sites demonstrated significantly better root coverage (P<0.001), 89.7% and 92.9% root coverage after 3 months and 6 months, respectively, while control sites had 56.6% and 66.8% root coverage after 3 months and 6 months, respectively. There was significantly more root coverage among test sites compared to control sites, regardless of arch or Miller classification.
  
  
  CONCLUSIONS
  Based on the results of this study, the application of enamel matrix derivative to denuded root surfaces receiving coronally advanced flaps significantly increased the percentage of root coverage compared to CAF without EMD. In addition, EMD application was accompanied by a significant increase in keratinized tissue 6 months after surgery.
authors.affiliation: Department of Periodontics, Baylor College of Dentistry--The Texas A&M University System Health Science Center, Dallas, TX 75246, USA. mcueva@tambcd.edu
authors.forename: Marco A
authors.initials: MA
authors.lastname: Cueva
authors.forename: Farhad E
authors.initials: FE
authors.lastname: Boltchi
authors.forename: William W
authors.initials: WW
authors.lastname: Hallmon
authors.forename: Martha E
authors.initials: ME
authors.lastname: Nunn
authors.forename: Francisco
authors.initials: F
authors.lastname: Rivera-Hidalgo
authors.forename: Terry
authors.initials: T
authors.lastname: Rees
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003131:Combined Modality Therapy; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D004955:Esthetics, Dental; D005260:Female; D005889:Gingival Recession / Q000188:drug therapy* / Q000601:surgery*; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D003746:Dental Enamel Proteins; C109069:enamel matrix proteins