McGuire Michael K, Scheyer E Todd
Private practice, Houston, TX.
J Periodontol. 2016 Mar;87(3):221-7. doi: 10.1902/jop.2015.150386. Epub 2015 Oct 15.
Although connective tissue grafts with coronally advanced flaps (CTG + CAF) have been deemed the gold standard for recession defect treatment, to provide adequate recession coverage, the periodontal profession continues to pursue lower-morbidity, patient-preferred substitutes that are more convenient and of unlimited supply.
Using a randomized, controlled, and masked contralateral comparison of matched-pair, within-patient recession defects, collagen matrix (CMX) + CAF therapy was compared with CTG + CAF at 6 months and 5 years. The primary efficacy endpoint was percentage of root coverage (RC). Secondary efficacy parameters included width of keratinized tissue (KTw), probing depth (PD), clinical attachment level (CAL), clinician rating of color and texture compared with surrounding tissues, and patient esthetic satisfaction.
Seventeen patients were available for the 5-year recall. Mean RC between 6 months and 5 years changed from 89.5% to 77.6% for CMX + CAF test sites and 97.5% to 95.5% for CTG + CAF control sites. KTw averaged >3 mm for both test and control sites at 5 years. PD was equivalent at all time points. The 6-month to 5-year changes for RC, KTw, and PD were not significantly different between therapies. CAL change from 6 months to 5 years was greater for CTG + CAF (0.26 mm) than CMX + CAF (-0.21 mm). Tissue color match to surrounding tissues remained similar for both therapies throughout the study. There was a difference in tissue texture at both 6 months and 5 years, with CMX + CAF sites tending to be "equally firm" and CTG + CAF sites "more firm." Patient satisfaction was high, with no statistical difference in satisfaction between therapies at any time point.
When balanced with patient-reported satisfaction, clinical rankings of esthetics, and control and historical RC results reported by other investigators, CMX + CAF appears to present a viable and long-term alternative to traditional CTG + CAF therapy.
尽管带冠向推进瓣的结缔组织移植术（CTG+CAF）被视为治疗牙龈退缩缺损的金标准，但为了提供足够的牙龈退缩覆盖，牙周专业领域仍在寻求发病率更低、患者更青睐的替代方法，这些方法更方便且供应无限制。
采用随机、对照、配对患者内牙龈退缩缺损的对侧掩蔽比较，在6个月和5年时将胶原基质（CMX）+CAF疗法与CTG+CAF进行比较。主要疗效终点是牙根覆盖（RC）百分比。次要疗效参数包括角化组织宽度（KTw）、探诊深度（PD）、临床附着水平（CAL）、与周围组织相比的临床医生对颜色和质地的评分以及患者的美学满意度。
17名患者可供5年随访。CMX+CAF试验部位6个月至5年的平均RC从89.5%变为77.6%，CTG+CAF对照部位从97.5%变为95.5%。5年时，试验部位和对照部位的KTw平均均>3mm。各时间点的PD相当。两种疗法之间，RC、KTw和PD从6个月到5年的变化无显著差异。CTG+CAF从6个月到5年的CAL变化（0.26mm）大于CMX+CAF（-0.21mm）。在整个研究过程中，两种疗法的组织颜色与周围组织的匹配度均保持相似。在6个月和5年时，组织质地存在差异，CMX+CAF部位倾向于“同样坚实”，CTG+CAF部位“更坚实”。患者满意度较高，两种疗法在任何时间点的满意度均无统计学差异。
当与患者报告的满意度、美学临床排名以及其他研究者报告的对照和既往RC结果相平衡时，CMX+CAF似乎是传统CTG+CAF疗法可行的长期替代方法。
