Moses Ofer, Artzi Zvi, Sculean Anton, Tal Haim, Kozlovsky Avital, Romanos Georgios E, Nemcovsky Carlos E
Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
J Periodontol. 2006 Feb;77(2):195-202. doi: 10.1902/jop.2006.050008.
Treatment alternatives to cover exposed root surfaces include free grafts, pedicle flaps, and barrier membranes. This 24-month follow-up study clinically evaluated the long-term effect of a coronally advanced flap procedure with the additional use of enamel matrix derivative (EMD) to treat gingival recession versus the subpedicle connective tissue graft (CTG) procedure.
Miller Class I or II buccal recession-type defects in the anterior teeth or premolars in 65 patients (28 in EMD and 37 in CTG groups) were treated in several centers. At baseline and 12 and 24 months post-treatment, vertical recession defect (VRD), height of keratinized tissue (HKT), and probing depth (PD) were recorded, and the percentage of root coverage (PRC) of the original defect was calculated. Student t test, analysis of variance, and analysis of covariance were used for statistical analyses.
At 12- and 24-month evaluations, PRC was 73.2% (SD=15.58%) and 76.9% (SD=16.77%) in the EMD group and 86.8% (SD=12.48%) and 84.3% (SD=13.32%) in the CTG group, respectively (P<0.001). Differences between groups were statistically significant (P=0.002). Baseline HKT was 1.07 mm (SD=0.66 mm) in the EMD group and 1.65 mm (SD=0.92 mm) in the CTG group. At 12 and 24 months, values were 1.75 mm (SD=0.59 mm) and 2.25 mm (SD=0.52 mm) in the EMD group and 4.24 mm (SD=0.89 mm) and 4.05 mm (SD=0.94 mm) in the CTG group, respectively. Differences in HKT were statistically significant within (EMD: P<0.001; CTG: P=0.017) and between (P<0.001) groups.
Both treatments proved clinically successful. CTG treatment showed a higher percentage of root coverage and HKT increase. EMD is a valuable, long-term effective treatment alternative to achieve root coverage together with an increase in HKT.
用于覆盖暴露牙根面的治疗方法包括游离移植、带蒂瓣和屏障膜。这项为期24个月的随访研究从临床角度评估了冠向推进瓣手术联合使用釉基质衍生物（EMD）治疗牙龈退缩与蒂下结缔组织移植（CTG）手术的长期效果。
65例患者（EMD组28例，CTG组37例）前牙或前磨牙的米勒I类或II类颊侧退缩型缺损在多个中心接受治疗。在基线以及治疗后12个月和24个月时，记录垂直退缩缺损（VRD）、角化组织高度（HKT）和探诊深度（PD），并计算原始缺损的牙根覆盖百分比（PRC）。采用学生t检验、方差分析和协方差分析进行统计学分析。
在12个月和24个月的评估中，EMD组的PRC分别为73.2%（标准差=15.58%）和76.9%（标准差=16.77%），CTG组分别为86.8%（标准差=12.48%）和84.3%（标准差=13.32%）（P<0.001）。组间差异具有统计学意义（P=0.002）。EMD组基线HKT为1.07 mm（标准差=0.66 mm），CTG组为1.65 mm（标准差=0.92 mm）。在12个月和24个月时，EMD组的值分别为1.75 mm（标准差=0.59 mm）和2.25 mm（标准差=0.52 mm），CTG组分别为4.24 mm（标准差=0.89 mm）和4.05 mm（标准差=0.94 mm）。HKT在组内（EMD：P<0.001；CTG：P=0.017）和组间（P<0.001）的差异均具有统计学意义。
两种治疗方法在临床上均被证明是成功的。CTG治疗显示出更高的牙根覆盖百分比和HKT增加。EMD是一种有价值的长期有效治疗方法，可实现牙根覆盖并增加HKT。
