ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Use of Either Emdogain or Subepithelial Connective Tissue Graft Shows Greatest Clinical Results When Combined with Coronally Positioned Flaps
Clinical Question In a patient with isolated gingival recession, does the use of a coronally positioned flap have a better success rate with Emdogain or a traditional connective tissue graft?
Clinical Bottom Line Both enamel matrix derivative (EMD) and subepithelial connective tissue graft in conjunction with coronally positioned flaps showed similar increase in keratinized tissue width.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 14514224McGuire/200320 patients with incisor or premolar facial recession (4mm)Randomized Controlled Trial
Key resultsBoth the EMD and subepithelial connective tissue graft showed significant increase in the amount of keratinized tissue. A gain of 4.5mm (range 4 to 8mm) of tissue covering the previously exposed root surfaces was completed in both groups. A success rate of 100% root coverage was found 89.5% and 79% of the time for the coronally advanced flap with EMD and subepithelial CT graft respectively.
#2) 18724847Cairo/2008530 patients from 25 RCTsSystematic review of randomized trials
Key resultsThe addition of connective tissue graft or enamel matrix derivative enhanced the clinical outcomes of coronally advanced flap in terms of complete root coverage but barrier membranes did not.
#3) 25039691Cheng/2015321 Adult Patients from 13 RCTSMeta-Analysis
Key resultsCoronally advanced flaps (CAF) in addition to connective tissue grafts improved keratinized tissue width (KTF) far more than CAF alone. CAF and enamel matrix derivative (EMD) also gained more KTF than CAF alone. EMD reduced probing depths but no significant differences were found. Overall, CTG increased KTW more the EMD, but EMD appeared helpful for would healing.
Evidence Search (coronally[All Fields] AND advanced[All Fields] AND ("surgical flaps"[MeSH Terms] OR ("surgical"[All Fields] AND "flaps"[All Fields]) AND ("connective tissue"[MeSH Terms] OR ("connective"[All Fields] AND "tissue"[All Fields]) OR "connective tissue"[All Fields]) AND “graft"[All Fields])) AND (Randomized Controlled Trial[ptyp] OR Meta-Analysis[ptyp])
Comments on
The Evidence
McGuire’s RCT showed moderate bias due to patient reporting discomfort in which no standard can be made based of patients varying pain threshhold's. Cairo’s systematic review evaluated 530 patients from 25 RCTs however; few evaluated clinical outcomes at 1-year follow up. Not all studies were also measured with 100% completion. Cheng’s performed a meta-analysis of RCTs, which compared multiple options for gingival recession. All selected RCTs had strict criteria to be met.
Applicability These articles all correlate to patients who exhibit gingival recession of Millers Class I or II. All patients had no other restorations on dentition in question and were in good overall health.
Specialty/Discipline (Periodontics)
Keywords Gingival Recession, Dental Enamel proteins/therapeutic use
ID# 2982
Date of submission: 02/09/2016spacer
E-mail gutierrezmn@livemail.uthscsa.edu
Author Michelle N. Gutierrez
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Shannon Roberts, DDS
Faculty mentor/Co-author e-mail dobelbower@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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