Advances in Clinical and Experimental Medicine
2016, vol. 25, nr 3, May-June, p. 587–598
Publication type: review article
A Preliminary Clinical Comparison of the Use of Fascia Lata Allograft and Autogenous Connective Tissue Graft in Multiple Gingival Recession Coverage Based on the Tunnel Technique
1 Specialistic Outpatient Medical Clinic MEDIDENT, Gorlice, Poland
2 Specialist Medical Practice, Tarnowskie Góry, Poland
3 Dresden University of Technology, Germany
4 Department of Oral Surgery, Wroclaw Medical University, Poland
Background. The most effective method for treating gingival recessions (GR) is with an autogenous connective tissue graft (CTG) via flap surgery. Often, however, the amount of CTG that can be grafted is insufficient to cover all of a patient’s gingival recessions at one time.
Objectives. The objective of this study was to provide a 6-month comparative assessment of the results of covering multiple Miller Class I and II gingival recessions with a Fascia Lata Allograft (FL) and a CTG harvested from palatal mucosa.
Material and Methods. The study comprised a total of 30 people who underwent multiple gingival recession (GR) procedures using a modified, coronally advanced tunnel technique (MCAT). The patients were divided into two groups of 15 according to the type of materials used for gingival augmentation purposes: FL for the test group and CTG for the control group. A clinical assessment was made at baseline, as well as 3 and 6 months following surgery. The following factors were assessed: recession depth, recession width, probing depth, clinical attachment level, height of keratinized tissue (HKT), distance between the cemento-enamel junction and the muco-gingival junction (CEJ-MGJ), API, SBI. The following values were calculated: average root coverage (ARC), complete root coverage (CRC).
Results. No statistically significant differences were observed between the groups in terms of clinical parameters assessed after 6 months, apart from CRC, which was 94.87 ± 0.14 mm in the control group and 94.24 ± 0.20 mm in the study group (p = 0.034). The average HKT in the control group after 6 months amounted to 2.86 ± 1.60 mm, and in the test group to 3.09 ± 0.95 mm, which translates into an increase in comparison to the baseline values of 0.73 mm (p < 0.001) and 0.48 mm (p = 0.017), respectively.
Conclusion. FL Allografts may serve as an alternative to autogenous CTG in multiple gingival recession coverage procedures based on the tunnel technique.
gingival recession, connective tissue, autograft, allograft, fascia lata
- Dominiak M, Gedrange T: New perspectives in the diagnostic of gingival recession. Adv Clin Exp Med 2014, 23, 6, 857–863.
- Dominiak M, Konopka T, Lompart H, Kubasiewicz P: Comparative research concerning clinical efficiency of three surgical methods of periodontium recessions treatment in five-year observations. Adv Med Sci 2006, 51, Suppl 1, 18–25.
- Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L: Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: A comparative shortand long-term controlled randomized clinical trial. J Clin Periodontol 2014, 41, 396–403.
- Hofmänner P, Alessandri R, Laugisch O, Aroca S, Salvi GE, Stavropoulos A, Sculean A: Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions. A systematic review. Quintessence Int 2012, 43, 545–554.
- Benninger B, Andrews K, Carter W: Clinical measurements of hard palate and implications for subepithelial connective tissue grafts with suggestions for palatal nomenclature. J Oral Maxillofacial Surg 2012, 70, 149–153.
- Harris RJ: Histologic Evaluation of Connective Tissue Grafts in Humans. Int J Periodontics Restorative Dent 2003, 23, 575–583.
- Harris RJ: Formation of a cyst-like area after a connective tissue graft for root coverage. J Periodontol 2002, 73, 340–345.
- Wei P-Ch, Geivelis M: A gingival Cul-de-Sac following a root coverage procedure with a subepithelial connective tissue submerged graft. J Periodontol 2003, 74, 1376–1380.
- Harris RJ: Gingival augmentation with an acellular dermal matrix: Human histologic evaluation of a case-placement of the graft on periosteum. Int J Periodontics Restorative Dent 2004, 24, 378–385.
- Mahn DH: Use of the tunnel technique and an acellular dermal matrix in the treatment of multiple adjacent teeth with gingival recession in the esthetic zone. Int J Periodontics Restorative Dent 2010, 30, 593–599.
- Schlee M, Esposito M: Human dermis graft versus autogenous connective tissue grafts for thickening soft tissue and covering multiple gingival recessions: 6-month results from a preference clinical trial. Eur J Oral Implant 2011, 4, 119–125.
- Thombre V, Somnath B, Koudale SB, Manohar L, Bhongade ML: Comparative evaluation of the effectiveness of coronally positioned flap with or without Acellular Dermal Matrix Allograft in the treatment of multiple marginal gingival recession defects. Int J Periodontics Restorative Dent 2013, 33, e88–e94.
- Gholami GA, Saberi A, Kadkhodazadeh M, Amid R, Karami D: Comparison of the clinical outcomes of connective tissue and acellular dermal matrix in combination with double papillary flap for root coverage: A 6 month trial. Dent Res J 2013, 10, 506–513.
- Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L: Treatment of gingival recession defects using coronally advanced flap with a porcine collagen matrix compared to coronally advanced flap with connective tissue graft: A randomized clinical trial. J Periodontol 2012, 83, 321–328.
- Aroca, S, Molnar B, Windisch P, Gera I, Salvi GE, Nikolidakis D, Sculean A: Treatment of multiple adjacent Miller class I and II gingival recessions with a modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: A randomized, controlled clinical trial. J Clin Periodontol 2013, 40, 713–720.
- Jepsen K, Jepsen S, Zucchelli, G, Stefanini M, deSanctis M, Baldini N, Greven B, Heinz B, Wennström J, Cassel B, Vignoletti F, Sanz M: Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: A multicenter randomized clinical trial. J Clin Periodontol 2013, 40, 82–89.
- Dominiak M, Mierzwa-Dudek D, Puzio M, Gedrange T: Clinical evaluation of the effectiveness of using collagen matrix (Mucograft® prototype) in gingival recession coverage – a pilot study. J Stomat 2012, 65, 188–202.
- Ahmedbeyli C, İpçi SD, Cakar G, Kuru BE, Yılmaz S: Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype. J Clin Periodontol 2014, 41, 303–310.
- Defrere J, Franckart A: Freeze-dried fascia lata allografts in the reconstruction of anterior cruciate ligament defects. A twoto seven-year follow-up study. Clin Orthop Relat Res 1994, 303, 56–66.
- Dufrane D, Cornu O, Delloye C, Schneider YJ: Physical and chemical processing for a human dura mater substitute. Biomaterials 2002, 23, 2979–2988.
- Kamiński A, Gut G, Marowska J, Lada-Kozłowska M, Biwejnis W, Zasacka M: Mechanical properties of radiation – sterilised human Bone-Tendon-Bone grafts preserved by different methods. Cell Tissue Bank 2009, 10, 215–219.
- Graziani F, Gennai S, Roldan S, Discepoli N, Buti J, Madianos P, Herrera D: Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. J Clin Periodontol 2014, 41, Suppl 15, 63–76.
- Dembowska E, Drozdzik A: Subepithelial connective tissue graft in the treatment of multiple gingival recession. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007, 104, e1–e7.
- Modaressi M, Wang HL: Tunneling procedure for root coverage using acellular dermal matrix: A case series. Int J Periodontics Restorative Dent 2009, 29, 395–403.
- Azzi R, Etienne D, Takei H, Fenech P: Surgical thickening of the existing gingiva and interdental papillae around imlant-supported restorations. Int J Periodontics Rest Dent 2002, 22, 71–77.
- Ayub LG, Ramos UD, Reino DM, Grisi MFM, Taba Jr M, Souza SLS, Palioto DB, Novaes Jr AB: A Randomized comparative clinical ctudy of two surgical procedures to improve root coverage with the acellular dermal matrix graft. J Clin Periodontol 2012, 39, 871–878.
- Koudale SB, Pretti A, Charde PA, Bhongade ML: A comparative clinical evaluation of acellular dermal matrix allograft and subepithelial connective tissue graft for the treatment of multiple gingival recessions. J Indian Soc Periodontol 2012, 16, 411–416.
- Gapski R, Parks CA, Wang HL: Acellular dermal matrix for mucogingival surgery: A meta-analysis. J Periodontol 2005, 76, 1814–1822.
- Rahmani ME, Mohammed A, Rigi Lades ME, Lades MA: Comparative clinical evaluation of Acellular Dermal Matrix Allograft and connective tissue graft for the treatment of gingival recession. J Contemp Dent Prac 2006, 2, 63–70.
- Hirsch A, Goldstein M, Goultschin J, Boyan BD, Schwartz Z: A 2-year follow-up of root coverage using subpedicle acellular dermal matrix allograft and subepithelial connective tissue graft autograft. J Periodontol 2005, 76, 1323–1328.