Guan Wei, Liao Haiqing, Guo Li, Wang Changning, Cao Zhengguo
Department of Periodontology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST KLOS) & Key Laboratory for Oral Biomedical Engineering of Ministry of Education (KLOBME), School & Hospital of Stomatology, Wuhan University, Wuhan, China .
J Periodontal Implant Sci. 2016 Feb;46(1):22-34. doi: 10.5051/jpis.2016.46.1.22. Epub 2016 Feb 15.
Gingival recession is a major esthetic concern and may lead to root sensitivity during periodontal treatment. Coronally advanced flaps (CAFs) with and without acellular dermal matrix (ADM) are widely used in root coverage procedures. The aim of this study was to analyze the efficacy of CAF in combination with ADM in the treatment of gingival recession.
PubMed, The Cochrane Library, and Embase were used to identify relevant articles. The articles were screened, data were extracted, and the quality of the studies was assessed by three reviewers with expertise in clinical practice, trials, statistics, and biomedical editing. The clinical endpoints of interest included changes in recession, probing depth (PD), clinical attachment level (CAL), and keratinized tissue (KT).
Ten randomized controlled trials were identified, including six studies that compared CAFs with ADM and CAFs using connective tissue grafting (CTG) and four studies that compared CAFs with or without ADM. No statistically significant differences were found between the use of ADM and CTG, whereas statistically significant differences were found between groups in which ADM and CAF were combined and groups that underwent CAF alone with regard to recession coverage, CAL, and KT. The combination of CAF with an ADM allograft achieved more favorable recession coverage and recovery of CAL and KT than CAF alone.
The results from the ADM and CTG groups suggest that both procedures may be equally effective in clinical practice. Given the limitations of this study, further investigation is needed to clarify the effectiveness of ADM and CAF in clinical practice.
牙龈退缩是一个主要的美学问题，在牙周治疗期间可能导致牙根敏感。带或不带脱细胞真皮基质（ADM）的冠向推进瓣（CAF）广泛用于牙根覆盖手术。本研究的目的是分析CAF联合ADM治疗牙龈退缩的疗效。
使用PubMed、Cochrane图书馆和Embase检索相关文章。由三位在临床实践、试验、统计学和生物医学编辑方面具有专业知识的评审员对文章进行筛选、提取数据并评估研究质量。感兴趣的临床终点包括退缩、探诊深度（PD）、临床附着水平（CAL）和角化组织（KT）的变化。
共纳入10项随机对照试验，其中6项研究比较了CAF联合ADM与使用结缔组织移植（CTG）的CAF，4项研究比较了使用或未使用ADM的CAF。ADM与CTG的使用之间未发现统计学上的显著差异，而在退缩覆盖、CAL和KT方面，ADM与CAF联合组与单纯CAF组之间存在统计学上的显著差异。CAF与ADM同种异体移植物联合使用比单纯CAF在退缩覆盖、CAL和KT的恢复方面更有利。
ADM组和CTG组的结果表明，这两种手术在临床实践中可能同样有效。鉴于本研究的局限性，需要进一步研究以阐明ADM和CAF在临床实践中的有效性。
