Nemcovsky Carlos E, Artzi Zvi, Tal Haim, Kozlovsky Avital, Moses Ofer
Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
J Periodontol. 2004 Apr;75(4):600-7. doi: 10.1902/jop.2004.75.4.600.
Free grafts, pedicle flaps, and barrier membranes have been used to cover exposed root surfaces. The aim of the present study was to evaluate the clinical efficacy of a coronally advanced flap procedure with the additional use of enamel matrix protein derivative (EMD) to treat gingival recession and to compare it to the subpedicle connective tissue graft procedure (CTG).
The study was conducted in six different periodontal clinics. Miller Class I or II buccal recession type defects in the anterior or premolar teeth were treated in 70 consecutive patients, 30 with EMD and 40 with CTG. At baseline and 6 and 12 months post-surgical treatment, vertical recession defect, defined as the distance from cemento-enamel junction to gingival margin; width of keratinized tissue; and probing depth were recorded and the percentage of coverage of the original defect was calculated. Statistical analyses consisted of t-test, analysis of variance, and analysis of covariance.
At 6 months, percent of root coverage was 77.4% +/- 11.92% in EMD and 84.1% +/- 11.97% in CTG (statistically significant at P = 0.024). At 12 months, percent of root coverage in EMD was 71.7% +/- 16.14% and 87.0% +/- 12.22% in CTG; again, differences between groups were statistically significant (P < 0.001). Differences between the 6- and 12-month vertical recession defect and percent of root coverage recordings within each group were also statistically significant.
The connective tissue graft procedure was superior to the coronally positioned flap with the addition of enamel matrix proteins derivative in percentage of coverage and increase in width of keratinized tissue. The EMD procedure is a predictable treatment for root coverage that is relatively easy to perform and presents low patient morbidity, and is appropriate especially where a substantial increase in the width of keratinized tissue is not of prime importance.
游离移植片、带蒂皮瓣和屏障膜已被用于覆盖暴露的牙根表面。本研究的目的是评估冠向推进瓣术联合使用釉基质蛋白衍生物(EMD)治疗牙龈退缩的临床疗效,并将其与蒂下结缔组织移植术(CTG)进行比较。
该研究在六个不同的牙周诊所进行。连续70例患者的前牙或前磨牙存在米勒I类或II类颊侧退缩型缺损,其中30例采用EMD治疗,40例采用CTG治疗。在基线以及手术治疗后6个月和12个月时,记录垂直退缩缺损(定义为从牙骨质-釉质界到牙龈边缘的距离)、角化组织宽度和探诊深度,并计算原始缺损的覆盖百分比。统计分析包括t检验、方差分析和协方差分析。
6个月时,EMD组的牙根覆盖百分比为77.4%±11.92%,CTG组为84.1%±11.97%(P = 0.024,具有统计学意义)。12个月时,EMD组的牙根覆盖百分比为71.7%±16.14%,CTG组为87.0%±12.22%;两组之间的差异同样具有统计学意义(P < 0.001)。每组内6个月和12个月时垂直退缩缺损及牙根覆盖百分比记录之间的差异也具有统计学意义。
在覆盖百分比和角化组织宽度增加方面,结缔组织移植术优于冠向定位瓣联合釉基质蛋白衍生物。EMD手术是一种可预测的牙根覆盖治疗方法,相对容易实施,患者发病率低,尤其适用于角化组织宽度没有显著增加的情况。