title: Acellular dermal matrix graft for gingival augmentation: a preliminary clinical, histologic, and ultrastructural evaluation.
abstract: BACKGROUND
  The aim of this study was to evaluate clinically, histologically, and ultrastructurally the integration process of the acellular dermal matrix used to increase the band of keratinized tissue while achieving gingival inflammation control.
  
  
  METHODS
  Ten patients exhibiting a mucogingival problem with bands of keratinized tissue <or=1 mm and gingival inflammation of the related teeth were included in the study. The surgical procedures were performed to augment the gingival tissue using acellular dermal matrix. Clinical measurements were assessed at baseline and after 3 months. A specimen of the allograft and surrounding tissues was obtained immediately before the surgery and 4 minutes and 1, 2, 3, 4, 6, and 10 weeks after grafting.
  
  
  RESULTS
  Clinically, a gain of keratinized tissue of 2.92 +/- 0.65 mm was observed after 3 months. Histologically and ultrastructurally, many macrophages were observed phagocytosing preexisting collagen fibers in the first weeks. From week 2 on, fibroblasts synthesizing new collagen, epithelial cells colonizing the graft surface, and revascularization were noticed. After 6 weeks it was difficult to find the acellular dermal matrix preexisting collagen fibers. This process of substitution was completed after 10 weeks, when the reepithelialization of the entire graft throughout a well-structured basement membrane was achieved.
  
  
  CONCLUSIONS
  The acellular dermal matrix graft seemed to be an easily handled material for use in keratinized tissue augmentation that, in humans, was substituted and completely reepithelialized in 10 weeks according to histologic and ultrastructural results.
authors.affiliation: School of Dentistry, University of Chieti-Pescara, Chieti, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Scarano
authors.forename: Raquel R M
authors.initials: RR
authors.lastname: Barros
authors.forename: Giovanna
authors.initials: G
authors.lastname: Iezzi
authors.forename: Adriano
authors.initials: A
authors.lastname: Piattelli
authors.forename: Arthur B
authors.initials: AB
authors.lastname: Novaes
mesh_terms: D000328:Adult; D001485:Basement Membrane / Q000648:ultrastructure; D020219:Chondrogenesis; D003094:Collagen; D004847:Epithelial Cells / Q000648:ultrastructure; D005260:Female; D005881:Gingiva / Q000166:cytology / Q000502:physiology / Q000648:ultrastructure; D005889:Gingival Recession / Q000601:surgery*; D005891:Gingivitis / Q000601:surgery; D005893:Gingivoplasty / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012038:Regeneration; D017768:Skin, Artificial; D014727:Vestibuloplasty / Q000379:methods*; D055815:Young Adult
chemical_list: C440568:Alloderm; D003094:Collagen