Xenogeneic collagen matrix for the treatment of multiple gingival recessions in esthetics areas: a case series with 24-month follow-up
Keywords:Biomaterials; Esthetics; Gingival recession; Periodontal disease; Case series; Periodontics.
Introduction: Multiple gingival recessions (GR) are often associated with high hypersensitivity and esthetics concerns due to exposed roots. The collagen matrix (CM) associated with coronally advanced flap (CAF) may be a suitable treatment for multiple GR in esthetic areas. However, there is a lack of long term follow up investigations. Objective: To evaluate a 24-month follow-up of the CM + CAF treatment for multiple RT1 GRs in esthetics areas. Materials and Methods: Six patients presenting 6 adjacent Cairo’s gingival recessions type 1 (RT1) in the anterior maxilla were treated with CM + CAF, and based on these patients a brief statistical analysis was conduct. The evaluated parameters included gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), gingival thickness (GT), and mean root coverage (MRC). Patient-related outcomes measurements (PROMs) were assessed using an oral health impact profile (OHIP-14) questionnaire and visual analogue scale (VAS). Results: There was significant improvement in GRD, GRW, and CAL measurements at 3 months postoperatively (p<0.05). Besides, CAL also increased from 12 months to 24 months’ follow-up (p=0.0023). The MRC percentage was 82%. PD, GT, and KTW presented no statistical difference. PROMs revealed a high score for esthetics (82.2%) and a significant reduction in hypersensitivity and surgical pain/discomfort. Conclusions: Considering the limitations of a case series, the use of CM + CAF on RT1 multiple gingival recessions in esthetic areas demonstrated positive outcomes after 24 months.
AlSarhan, M. A., Al Jasser, R., Tarish, M. A., AlHuzaimi, A. I., & Alzoman, H. (2019). Xenogeneic collagen matrix versus connective tissue graft for the treatment of multiple gingival recessions: A systematic review and meta-analysis. Clinical and experimental dental research, 5(5), 566–579. https://doi.org/10.1002/cre2.210
Armitage G. C. (1999). Development of a classification system for periodontal diseases and conditions. Annals of periodontology, 4(1), 1–6. https://doi.org/10.1902/annals.19188.8.131.52
Aroca, S., Molnár, B., Windisch, P., Gera, I., Salvi, G. E., Nikolidakis, D., & Sculean, A. (2013). 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. Journal of clinical periodontology, 40(7), 713–720. https://doi.org/10.1111/jcpe.12112
Baldi, C., Pini-Prato, G., Pagliaro, U., Nieri, M., Saletta, D., Muzzi, L., & Cortellini, P. (1999). Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. Journal of periodontology, 70(9), 1077–1084. https://doi.org/10.1902/jop.19184.108.40.2067
Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., & Pagliaro, U. (2011). The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. Journal of clinical periodontology, 38(7), 661–666. https://doi.org/10.1111/j.1600-051X.2011.01732.x
Cairo F. (2017). Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontology 2000, 75(1), 296–316. https://doi.org/10.1111/prd.12186
Chambrone, L., Ortega, M., Sukekava, F., Rotundo, R., Kalemaj, Z., Buti, J., & Prato, G. (2019). Root coverage procedures for treating single and multiple recession-type defects: An updated Cochrane systematic review. Journal of periodontology, 90(12), 1399–1422. https://doi.org/10.1002/JPER.19-0079
Fu, J. H., Su, C. Y., & Wang, H. L. (2012). Esthetic soft tissue management for teeth and implants. The journal of evidence-based dental practice, 12(3 Suppl), 129–142. https://doi.org/10.1016/S1532-3382(12)70025-8
Graziani, F., Gennai, S., Roldán, S., Discepoli, N., Buti, J., Madianos, P., & Herrera, D. (2014). Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. Journal of clinical periodontology, 41 Suppl 15, S63–S76. https://doi.org/10.1111/jcpe.12172
Huang, J. P., Liu, J. M., Wu, Y. M., Chen, L. L., & Ding, P. H. (2019). Efficacy of xenogeneic collagen matrix in the treatment of gingival recessions: A systematic review and meta-analysis. Oral diseases, 25(4), 996–1008. https://doi.org/10.1111/odi.12949
Jepsen, K., Stefanini, M., Sanz, M., Zucchelli, G., & Jepsen, S. (2017). Long-Term Stability of Root Coverage by Coronally Advanced Flap Procedures. Journal of periodontology, 88(7), 626–633. https://doi.org/10.1902/jop.2017.160767
McGuire, M. K., & Scheyer, E. T. (2010). Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. Journal of periodontology, 81(8), 1108–1117. https://doi.org/10.1902/jop.2010.090698
McGuire, M. K., & Scheyer, E. T. (2016). Long-Term Results Comparing Xenogeneic Collagen Matrix and Autogenous Connective Tissue Grafts with Coronally Advanced Flaps for Treatment of Dehiscence-Type Recession Defects. Journal of periodontology, 87(3), 221–227. https://doi.org/10.1902/jop.2015.150386
Moraschini, V., de Almeida, D., Sartoretto, S., Bailly Guimarães, H., Chaves Cavalcante, I., & Diuana Calasans-Maia, M. (2019). Clinical efficacy of xenogeneic collagen matrix in the treatment of gingival recession: a systematic review and meta-analysis. Acta odontologica Scandinavica, 77(6), 457–467. https://doi.org/10.1080/00016357.2019.1588372
Nahas, R., Gondim, V., Carvalho, C. V., Calderero, L. M., Rosa, E. F., Sakiyama, T., César Neto, J. B., Pannuti, C. M., & Romito, G. A. (2020). Treatment of multiple recessions with collagen matrix versus connective tissue: a randomized clinical trial. Brazilian oral research, 33, e123. https://doi.org/10.1590/1807-3107bor-2019.vol33.0123
Oates, T. W., Robinson, M., & Gunsolley, J. C. (2003). Surgical therapies for the treatment of gingival recession. A systematic review. Annals of periodontology, 8(1), 303–320. https://doi.org/10.1902/annals.2003.8.1.303
Oliveira, B. H., & Nadanovsky, P. (2005). Psychometric properties of the Brazilian version of the Oral Health Impact Profile-short form. Community dentistry and oral epidemiology, 33(4), 307–314. https://doi.org/10.1111/j.1600-0528.2005.00225.x
Palmer, R. M., Cortellini, P., & Group B of European Workshop on Periodontology (2008). Periodontal tissue engineering and regeneration: Consensus Report of the Sixth European Workshop on Periodontology. Journal of clinical periodontology, 35(8 Suppl), 83–86. https://doi.org/10.1111/j.1600-051X.2008.01262.x
Pelekos, G., Lu, J. Z., Ho, D., Graziani, F., Cairo, F., Cortellini, P., & Tonetti, M. S. (2019). Aesthetic assessment after root coverage of multiple adjacent recessions with coronally advanced flap with adjunctive collagen matrix or connective tissue graft: Randomized clinical trial. Journal of clinical periodontology, 46(5), 564–571. https://doi.org/10.1111/jcpe.13103
Rotundo, R., Genzano, L., Patel, D., D'Aiuto, F., & Nieri, M. (2019). Adjunctive benefit of a xenogenic collagen matrix associated with coronally advanced flap for the treatment of multiple gingival recessions: A superiority, assessor-blind, randomized clinical trial. Journal of clinical periodontology, 46(10), 1013–1023. https://doi.org/10.1111/jcpe.13168
Sangiorgio, J., Neves, F., Rocha Dos Santos, M., França-Grohmann, I. L., Casarin, R., Casati, M. Z., Santamaria, M. P., & Sallum, E. A. (2017). Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part I: Clinical Outcomes. Journal of periodontology, 88(12), 1309–1318. https://doi.org/10.1902/jop.2017.170126
Santamaria, M. P., Neves, F., Silveira, C. A., Mathias, I. F., Fernandes-Dias, S. B., Jardini, M., & Tatakis, D. N. (2017). Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. Journal of clinical periodontology, 44(5), 540–547. https://doi.org/10.1111/jcpe.12714
Sanz, M., Lorenzo, R., Aranda, J. J., Martin, C., & Orsini, M. (2009). Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. Journal of clinical periodontology, 36(10), 868–876. https://doi.org/10.1111/j.1600-051X.2009.01460.x
Slade G. D. (1997). Derivation and validation of a short-form oral health impact profile. Community dentistry and oral epidemiology, 25(4), 284–290. https://doi.org/10.1111/j.1600-0528.1997.tb00941.x
Stefanini, M., Jepsen, K., de Sanctis, M., Baldini, N., Greven, B., Heinz, B., Wennström, J., Cassel, B., Vignoletti, F., Sanz, M., Jepsen, S., & Zucchelli, G. (2016). Patient-reported outcomes and aesthetic evaluation of root coverage procedures: a 12-month follow-up of a randomized controlled clinical trial. Journal of clinical periodontology, 43(12), 1132–1141. https://doi.org/10.1111/jcpe.12626
Tonetti, M. S., Cortellini, P., Pellegrini, G., Nieri, M., Bonaccini, D., Allegri, M., Bouchard, P., Cairo, F., Conforti, G., Fourmousis, I., Graziani, F., Guerrero, A., Halben, J., Malet, J., Rasperini, G., Topoll, H., Wachtel, H., Wallkamm, B., Zabalegui, I., & Zuhr, O. (2018). Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. Journal of clinical periodontology, 45(1), 78–88. https://doi.org/10.1111/jcpe.12834
Zucchelli, G., & De Sanctis, M. (2000). Treatment of multiple recession-type defects in patients with esthetic demands. Journal of periodontology, 71(9), 1506–1514. https://doi.org/10.1902/jop.2000.71.9.1506
Zuhr, O., Bäumer, D., & Hürzeler, M. (2014). The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. Journal of clinical periodontology, 41 Suppl 15, S123–S142. https://doi.org/10.1111/jcpe.12185
Wennström J. L. (1996). Mucogingival therapy. Annals of periodontology, 1(1), 671–701. https://doi.org/10.1902/annals.19220.127.116.111
How to Cite
Copyright (c) 2021 Raphaella Coelho Michel; Rafael Ferreira; Erika Beatriz Spada de Carvalho; Talyta Sasaki Jurkevicz ; Carla Andreotti Damante ; Adriana Campos Passanezi Sant’Ana ; Mariana Schutzer Ragghianti Zangrando
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.