Effect of enamel matrix derivative on collagen guided tissue regeneration-based root coverage procedure.
BACKGROUND
Enamel matrix derivative (EMD) has been shown to promote periodontal wound healing and/or regeneration when applied to tooth root surfaces in soft tissue dehiscence models. In addition, guided tissue regeneration (GTR)-based root coverage using collagen membrane (GTRC) has shown promising results. However, limited information is available regarding how EMD may influence GTRC outcome.


METHODS
Twenty-six patients with Miller's Class I or II gingival recession defects of 2.5 mm were recruited for the study. Subjects were randomly assigned to receive either EMD + collagen (EMDC; test group) or collagen membrane (GTRC; control group). Clinical parameters, including plaque index (PI), gingival index (GI), relative clinical attachment levels (RCAL) to the stent, recession depth (RD), recession width (RW), probing depth (PD), gingival tissue thickness (GTT), and width of keratinized gingiva (KG) were assessed at baseline, and 3 and 6 months after surgery. A repeated measure of analysis of variance (ANOVA) was used to determine differences between treatment groups and time effect.


RESULTS
Both treatments (GTRC and EMDC) resulted in a statistically significant decrease in RD and RW between baseline and 6 months (P <0.05). However, no difference was noted between treatment groups. The percent of root coverage after 6 months was 75% for GTRC and 63% for EMDC. Complete 100% root coverage was achieved in five patients in the GTRC group, compared to only one patient in the EMDC group. There was a statistically significant gain (P <0.05) in the clinical attachment level (CAL) between baseline and 6 months in both groups, as reflected on the RCAL data. No other significant differences were noted on other clinical parameters (PD, GTT, KG, GI, and PI).


CONCLUSIONS
GTR-based root coverage utilizing collagen membrane, with or without enamel matrix derivative, can be successfully used in obtaining gingival recession coverage. The application of EMD during GTRC procedures did not add additional benefit to the final clinical outcome.
Trabulsi
Manal
M
Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
Oh
Tae-Ju
TJ
Eber
Robert
R
Weber
Daniel
D
Wang
Hom-Lay
HL
D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001672:Biocompatible Materials / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D005260:Female; D005889:Gingival Recession / Q000145:classification / Q000601:surgery*; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps
D001672:Biocompatible Materials; D003746:Dental Enamel Proteins; C109069:enamel matrix proteins; D003094:Collagen