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Title Autogenous Connective Tissue Grafts Yield Superior Keratinized Tissue Width and/or Thickness Outcomes Compared to Acellular Dermal Matrix Allografts
Clinical Question For a periodontally healthy patient with thin and narrow gingiva (thin phenotype), do acellular dermal matrix allografts result in greater keratinized tissue width and/or thickness as compared to autogenous connective tissue grafts?
Clinical Bottom Line Autogenous soft tissue graft (CTG/FGG) proved to be superior in widths of keratinized tissue, gingival thickness and less shrinkage after healing than acellular dermal matrix allografts (ADM). However, esthetic perception was superior for ADM.
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) 32392401Barootchi/2020105 RCTs/4,238 treated sitesMeta-Analysis
Key resultsIn root coverage procedures soft tissue autografts yield superior widths of: --keratinized tissue: “CTG(1.09 mm (95% CI [0.78 to 1.38], P < 0.001)), and ADM (0.47 mm (95% CI [0.05 to 0.89], P = 0.02))” --gingival thickness: “CTG (0.66 mm (95% CI [0.51 to 0.81], P < 0.001)), and ADM (0.48 mm (95% CI [0.31 to 0.65], P < 0.001))” For non-root coverage procedures soft tissue autografts yield superior widths of keratinized tissue: “FGG (4.72 mm (95% CI [4.24 to 5.21], P < 0.001)), and ADM (2.54 mm (95% CI [1.67 to 3.41], P = 0.007))”
#2) 31300879Cevallos/202012 patients with need for soft tissue graft on mandibular premolarsRandomized Controlled Trial
Key resultsAfter a 15-year longitudinal split mouth study, approximately “42% of the ADM group remained with nearly 1 mm of KTW and 100% of the FGG group presented KTW superior to 3 mm. In addition, the ADM group presented Tissue thickness (TT) between 0.85 and 1.47 mm and FGG between 1.7 and 3.43 mm.” The FGG group presented creeping attachment whereas the ADM group displayed more gingival recession and tissue contraction. ADM yielded superior professional esthetic scores assessed by VAS: “ADM group (9.25) and FGG group (8.17).”
Evidence Search (("acellular dermis"[MeSH Terms] OR ("acellular"[All Fields] AND "dermis"[All Fields]) OR "acellular dermis"[All Fields] OR ("acellular"[All Fields] AND "dermal"[All Fields] AND "matrix"[All Fields]) OR "acellular dermal matrix"[All Fields]) AND ("gingiva"[MeSH Terms] OR "gingiva"[All Fields] OR "gingivae"[All Fields])) AND ((y_5[Filter]) AND (meta-analysis[Filter]))
Comments on
The Evidence
Validity: The systematic review and meta-analysis yielded 105 eligible RCTs for review, of which 95 pertained to root coverage and 10 to non-root coverage procedures. The results were all similarly conclusive. Cevallos's 15-year longitudinal, split mouth controlled trial used an adequate randomized design and frequent follow-up data collection. Patients were treated by the same experienced operator. Clinical parameters were taken by a calibrated examiner (intraclass correlation coefficient = 0.98) prior to the procedure as a comparison following the surgery and examiners were blinded. However, the study had a relatively small sample size. Risk of bias: Of the 105 studies included in the meta-analysis, 86 showed low to moderate risk, and only 19 showed high risk due to lack of blinded examiners. The large number of included RCTs and overall low risk of bias adds weight to the results of this meta-analysis. Perspective: Future advancements in allograft materials will add to the knowledge base and decision-making on material selection (autografts vs. allografts) for treating patients with a lack of keratinized tissue.
Applicability All patients in need of keratinized tissue or root coverage procedures. The traditional and superior method to gain keratinized tissue is through autogenous soft tissue graft (CTG/FGG). However, CTG/FGG require a donor site, which may lead to morbidity and patient discomfort at the site. Acellular Dermal Matrix allografts provide an adequate alternative to autogenous soft tissue grafts, especially in patients with a high esthetic demand.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords acellular dermal matrix gingiva
ID# 3473
Date of submission: 12/02/2021spacer
E-mail Scotts6@uthscsa.edu
Author Se’quon M. H. Scott D.D.S., M.H.S.
Co-author(s) Ashley I. Shields, DMD
Co-author(s) e-mail shieldsa1@livemail.uthscsa.edu
Faculty mentor/Co-author Brian Mealey, DDS, MS
Faculty mentor/Co-author e-mail mealey@uthscsa.edu
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