Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
J Periodontol. 2020 Nov;91(11):1386-1399. doi: 10.1002/JPER.19-0715. Epub 2020 Jun 12.
The periodontal phenotype consists of the bone morphotype, the keratinized tissue (KT), and gingival thickness (GT). The latter two components, overlying the bone, constitute the gingival phenotype. Several techniques have been proposed for enhancing or augmenting KT or GT. However, how phenotype modification therapy (PMT) affects periodontal health and whether the obtained outcomes are maintained over time have not been elucidated. The aim of the present review was to summarize the available evidence in regard to the utilized approaches for gingival PMT and assess their comparative efficacy in augmenting KT, GT and in improving periodontal health using autogenous, allogenic, and xenogeneic grafting approaches.
A detailed systematic search was performed to identify eligible randomized clinical trials (RCTs) reporting on the changes in GT and KT (primary outcomes). The selected articles were segregated into the type of approach based on having performed a root coverage, or non-root coverage procedure. A network meta-analysis (NMA) was conducted for each approach to assess and compare the outcomes among different treatment arms for the primary outcomes.
A total of 105 eligible RCTs were included. 95 pertaining to root coverage (3,539 treated gingival recessions [GRs]), and 10 for non-root coverage procedures (699 total treated sites). The analysis on root coverage procedures showed that all investigated techniques (the acellular dermal matrix [ADM], collagen matrix [CM], connective tissue graft [CTG]) are able to significantly increase the GT, compared with treatment with flap alone. However, KT was only significantly increased with the use of CTG or ADM. Early post-treatment GT was found to inversely predict future GR. For non-root coverage procedures, only the changes in KT could be analyzed; all investigated treatment groups (ADM, CM, free gingival graft [FGG], living cellular construct [LCC], in combination with an apically positioned flap [APF]), resulted in significantly more KT than treatment with APF alone. Additionally, the augmented GT was shown to be sustained, and KT displayed an incremental increase over time.
Within its limitations, it was observed that any graft material was able to significantly enhance GT, while KT in root coverage procedures was significantly enhanced with CTG and ADM, and in non-root coverage procedures, with ADM, CM, FGG, and LCC compared with APF alone. The autogenous soft tissue graft (CTG/FGG) proved to be superior in all comparisons for both outcomes of GT and KT.
牙周表型由骨形态、角化组织（KT）和牙龈厚度（GT）组成。后两者覆盖在骨头上，构成了牙龈表型。已经提出了几种增强或增加 KT 或 GT 的技术。然而，表型修饰疗法（PMT）如何影响牙周健康，以及获得的结果是否能随着时间的推移而保持，这些都尚未阐明。本综述的目的是总结关于牙龈 PMT 所使用方法的现有证据，并评估使用自体、同种异体和异种移植物进行牙龈 PMT 的相对疗效，以增加 KT、GT 并改善牙周健康。
详细的系统检索以确定报告 GT 和 KT 变化的（主要结果）的合格随机临床试验（RCT）。将所选文章根据是否进行根覆盖或非根覆盖程序进行分组。对每种方法进行网络荟萃分析（NMA），以评估和比较不同治疗臂的主要结果。
共纳入 105 项合格 RCT。95 项涉及根覆盖（3539 个治疗性牙龈退缩[GR]），10 项涉及非根覆盖程序（699 个总治疗部位）。根覆盖程序的分析表明，所有研究的技术（脱细胞真皮基质[ADM]、胶原基质[CM]、结缔组织移植物[CTG]）都能显著增加 GT，与单独使用瓣相比。然而，只有使用 CTG 或 ADM 才能显著增加 KT。治疗后早期的 GT 被发现与未来的 GR 呈反比。对于非根覆盖程序，只能分析 KT 的变化；所有研究的治疗组（ADM、CM、游离牙龈移植[FGG]、活细胞构建体[LCC]，结合根尖定位瓣[APF]）都比单独使用 APF 显著增加 KT。此外，增加的 GT 被证明是可持续的，并且 KT 随着时间的推移呈递增趋势。
在其局限性内，观察到任何移植物材料都能显著增加 GT，而在根覆盖程序中，CTG 和 ADM 显著增加 KT，在非根覆盖程序中，与单独使用 APF 相比，ADM、CM、FGG 和 LCC 都显著增加 KT。自体软组织移植物（CTG/FGG）在 GT 和 KT 的所有比较中都被证明是优越的。
