Wei P C, Laurell L, Geivelis M, Lingen M W, Maddalozzo D
Department of Periodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
J Periodontol. 2000 Aug;71(8):1297-305. doi: 10.1902/jop.2000.71.8.1297.
Freeze-dried acellular dermal matrix (ADM) allograft, originally used for full-thickness burn wounds, was recently introduced as an alternative to the autogenous free gingival graft (FGG) in achieving increased attached keratinized tissue. The aim of part 1 of this study was to investigate the clinical efficacy of the ADM allograft for this particular purpose.
Twelve patients, 7 males and 5 females, with attached gingiva < or =1 mm on the facial aspect of mandibular anterior teeth demonstrating a tendency of progressive marginal tissue recession, were randomly assigned to either test or control treatment. Six patients received ADM graft (test) and 6 patients received an autogenous FGG harvested from the hard palate (control). Clinical variables including plaque index (PI), gingival index (GI), probing depth (PD), attached tissue width (AT), and gingival recession (GR) were recorded immediately before surgery and at the 6-month postoperative visit. Patients were seen at 2, 4, 6, 8, and 12 weeks to monitor wound healing and oral hygiene performance (PI and GI). Graft width was also measured, in corono-apical direction, on individually involved teeth during the surgery.
When values between baseline and 6 months were compared in both groups, there was no statistically significant difference in changes of PI, GI, PD, and GR (P>0.05) with the exception of PD in the FGG group (1.01 +/- 0.03 versus 1.27 +/- 0.20 mm, P= 0.042). There was a statistically significant (P <0.05) increase in AT in both groups. Although the ADM group received wider grafts than the FGG group (8.81 +/- 0.46 versus 6.70 +/- 0.89 mm), the AT gain was significantly smaller (2.59 +/- 0.92 versus 5.57 +/- 0.44 mm) and the graft shrinkage significantly greater (71 +/- 10% versus 16 +/- 12%) in the ADM group than in the FGG group (P<0.01).
The results of this study suggest that in procedures aiming at increasing the width of attached gingiva: 1) the ADM allograft was less effective and less predictable than the autogenous FGG in terms of increasing attached keratinized tissue due to considerable shrinkage and inconsistent quality of the attached tissue gained and 2) the esthetic results using the ADM allograft might be better than those using the autogenous FGG.
冻干脱细胞真皮基质（ADM）同种异体移植物最初用于全层烧伤创面，最近被引入作为自体游离龈瓣移植（FGG）的替代方法，以增加附着角化组织。本研究第一部分的目的是调查ADM同种异体移植物用于这一特定目的的临床疗效。
12例患者，男性7例，女性5例，下颌前牙唇面附着龈≤1mm，表现为边缘组织渐进性退缩倾向，被随机分配到试验组或对照组。6例患者接受ADM移植（试验组），6例患者接受从硬腭获取的自体FGG移植（对照组）。在手术前及术后6个月复诊时记录临床变量，包括菌斑指数（PI）、牙龈指数（GI）、探诊深度（PD）、附着组织宽度（AT）和牙龈退缩（GR）。在术后2、4、6、8和12周对患者进行检查，以监测伤口愈合和口腔卫生状况（PI和GI）。手术过程中还在个别受累牙齿上沿冠根方向测量移植宽度。
两组在基线和6个月时的值进行比较，除FGG组的PD外，PI、GI、PD和GR的变化无统计学显著差异（P>0.05）（1.01±0.03对1.27±0.20mm，P=0.042）。两组的AT均有统计学显著增加（P<0.05）。尽管ADM组接受的移植片比FGG组宽（8.81±0.46对6.70±0.89mm），但ADM组的AT增加明显较小（2.59±0.92对5.57±0.44mm），移植片收缩明显更大（71±10%对16±12%），与FGG组相比差异有统计学意义（P<0.01）。
本研究结果表明，在旨在增加附着龈宽度的手术中：1）由于获得的附着组织收缩明显且质量不一致，ADM同种异体移植物在增加附着角化组织方面比自体FGG效果更差且可预测性更低；2）使用ADM同种异体移植物的美学效果可能优于使用自体FGG。
