Department of Periodontology, University of Bern, 3010 Bern, Switzerland.
J Clin Periodontol. 2013 Jul;40(7):713-20. doi: 10.1111/jcpe.12112. Epub 2013 Apr 30.
A newly developed collagen matrix (CM) of porcine origin has been shown to represent a potential alternative to palatal connective tissue grafts (CTG) for the treatment of single Miller Class I and II gingival recessions when used in conjunction with a coronally advanced flap (CAF). However, at present it remains unknown to what extent CM may represent a valuable alternative to CTG in the treatment of Miller Class I and II multiple adjacent gingival recessions (MAGR). The aim of this study was to compare the clinical outcomes following treatment of Miller Class I and II MAGR using the modified coronally advanced tunnel technique (MCAT) in conjunction with either CM or CTG.
Twenty-two patients with a total of 156 Miller Class I and II gingival recessions were included in this study. Recessions were randomly treated according to a split-mouth design by means of MCAT + CM (test) or MCAT + CTG (control). The following measurements were recorded at baseline (i.e. prior to surgery) and at 12 months: Gingival Recession Depth (GRD), Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Keratinized Tissue Width (KTW), Gingival Recession Width (GRW) and Gingival Thickness (GT). GT was measured 3-mm apical to the gingival margin. Patient acceptance was recorded using a Visual Analogue Scale (VAS). The primary outcome variable was Complete Root Coverage (CRC), secondary outcomes were Mean Root Coverage (MRC), change in KTW, GT, patient acceptance and duration of surgery.
Healing was uneventful in both groups. No adverse reactions at any of the sites were observed. At 12 months, both treatments resulted in statistically significant improvements of CRC, MRC, KTW and GT compared with baseline (p < 0.05). CRC was found at 42% of test sites and at 85% of control sites respectively (p < 0.05). MRC measured 71 ± 21% mm at test sites versus 90 ± 18% mm at control sites (p < 0.05). Mean KTW measured 2.4 ± 0.7 mm at test sites versus 2.7 ± 0.8 mm at control sites (p > 0.05). At test sites, GT values changed from 0.8 ± 0.2 to 1.0 ± 0.3 mm, and at control sites from 0.8 ± 0.3 to 1.3 ± 0.4 mm (p < 0.05). Duration of surgery and patient morbidity was statistically significantly lower in the test compared with the control group respectively (p < 0.05).
The present findings indicate that the use of CM may represent an alternative to CTG by reducing surgical time and patient morbidity, but yielded lower CRC than CTG in the treatment of Miller Class I and II MAGR when used in conjunction with MCAT.
一种新开发的源自猪的胶原基质（CM）已被证明在与冠向推进瓣（CAF）联合使用时，可作为治疗单 Miller Ⅰ类和Ⅱ类牙龈退缩的腭结缔组织移植物（CTG）的潜在替代物。然而，目前尚不清楚 CM 在治疗 Miller Ⅰ类和Ⅱ类多个相邻牙龈退缩（MAGR）方面相对于 CTG 有多大的价值。本研究旨在比较使用改良的冠向推进隧道技术（MCAT）联合 CM 或 CTG 治疗 Miller Ⅰ类和Ⅱ类 MAGR 的临床效果。
本研究纳入了 22 名共 156 个 Miller Ⅰ类和Ⅱ类牙龈退缩的患者。采用随机分组、双侧对照的方法，根据改良的冠向推进隧道技术（MCAT）联合 CM（试验组）或 CTG（对照组）治疗。分别在基线（即手术前）和 12 个月时记录以下测量值：牙龈退缩深度（GRD）、探诊牙周袋深度（PD）、临床附着水平（CAL）、角化组织宽度（KTW）、牙龈退缩宽度（GRW）和牙龈厚度（GT）。GT 是在牙龈边缘上方 3mm 处测量的。采用视觉模拟评分（VAS）记录患者的接受程度。主要结局变量是完全根覆盖（CRC），次要结局变量是平均根覆盖（MRC）、KTW、GT、患者接受程度和手术时间的变化。
两组的愈合均顺利，没有观察到任何部位的不良反应。12 个月时，两种治疗方法均使 CRC、MRC、KTW 和 GT 与基线相比均有统计学意义的改善（p<0.05）。试验组的 CRC 发生率为 42%，对照组为 85%（p<0.05）。试验组的 MRC 为 71±21%mm，对照组为 90±18%mm（p<0.05）。试验组的平均 KTW 为 2.4±0.7mm，对照组为 2.7±0.8mm（p>0.05）。试验组 GT 值从 0.8±0.2mm 变为 1.0±0.3mm，对照组从 0.8±0.3mm 变为 1.3±0.4mm（p<0.05）。试验组的手术时间和患者发病率明显低于对照组（p<0.05）。
本研究结果表明，CM 的使用可能通过减少手术时间和患者发病率，为 CTG 提供替代方案，但在与 MCAT 联合使用治疗 Miller Ⅰ类和Ⅱ类 MAGR 时，其 CRC 低于 CTG。
