title: Root coverage with a coronally positioned flap used in combination with enamel matrix derivative: 18-month clinical evaluation.
abstract: BACKGROUND
  Ginigival recession can be successfully treated with coronally positioned flaps. Twelve-month data failed to demonstrate that topical application of enamel matrix derivative (EMD) used in combination with the coronally positioned flap enhances clinical outcomes of the surgical technique used alone. This study was designed to examine the effects of EMD combined with the coronally positioned flap over an 18-month postoperative period.
  
  
  METHODS
  Thirty patients presenting with Miller Class I or II gingival recessions on single-rooted teeth participated in this parallel-design clinical study. Six weeks after phase I therapy, recession areas were surgically treated with a coronally positioned flap for root coverage. Teeth in the experimental group received EMD treatment of the exposed root, whereas control teeth did not. Clinical parameters evaluated at baseline and 18 months postoperatively included gingival recession, clinical attachment level, probing depth, and the apico-coronal dimension of the keratinized tissue.
  
  
  RESULTS
  Compared to baseline, 18-month measurements showed a significant reduction in probing depth, gain in attachment level, and decrease in gingival recession for control and experimental groups. When the results of the two treatment groups were compared, the experimental group presented with significantly greater root coverage than the control group (2.66 +/- 0.61 mm versus 1.73 +/- 0.70 mm, respectively), more gain in clinical attachment than the control group (2.80 +/- 0.76 mm versus 2.06 +/- 0.70 mm, respectively), and a greater gain in the apico-coronal dimension of the keratinized tissue than the control group (0.13 +/- 0.06 mm versus -0.06 +/- 0.01 mm, respectively).
  
  
  CONCLUSIONS
  The results of this study indicate that topical application of EMD is beneficial in augmenting the effects of the coronally positioned flap in terms of amount of root coverage, gain in clinical attachment, and in increasing the apico-coronal dimension of the keratinized tissue.
authors.affiliation: School of Dentistry, University of Rome, La Sapienza, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pilloni
authors.forename: Michele
authors.initials: M
authors.lastname: Paolantonio
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Camargo
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D053523:Amelogenin / Q000008:administration & dosage / Q000502:physiology*; D003131:Combined Modality Therapy; D005260:Female; D005782:Gels; D005889:Gingival Recession / Q000601:surgery* / Q000628:therapy; D005893:Gingivoplasty / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000601:surgery* / Q000628:therapy; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000628:therapy; D013524:Surgical Flaps / Q000502:physiology*; D014092:Tooth Root / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D053523:Amelogenin; D005782:Gels