McGuire Michael K, Janakievski Jim, Scheyer E Todd, Velásquez Diego, Gunsolley John C, Heard Rick H, Morelli Thiago
The McGuire Institute (iMc - practice-based clinical research network); Private practice, Houston, TX.
iMc; Private practice, Tacoma, WA; Department of Periodontics, School of Dentistry, University of Washington, Seattle, WA.
J Periodontol. 2022 Mar;93(3):333-342. doi: 10.1002/JPER.21-0131. Epub 2021 Aug 16.
The autogenous connective tissue graft (CTG) with coronally advanced flap (CTG+CAF) is the "gold standard" for recession defect coverage; however, researchers continue to pursue lower morbidity, more convenient and unlimited supply harvest graft substitutes, including those that could provide soft tissue volume augmentation.
A randomized, controlled, double-masked comparison of a volume-stable collagen matrix (VCMX) versus CTG was conducted at four clinical investigation sites. Single, contralateral, within patient matched-pair, RT1 recession defects were treated with VCMX+CAF (test) and CTG+CAF (control). The primary efficacy end point was percent root coverage at 6 months. Secondary efficacy end points included clinical measures such as soft tissue volume, attachment level, and keratinized tissue width. Patient-reported outcomes included measures such as discomfort, esthetics, and overall satisfaction; 6-month end point results were followed for 1 year.
Thirty patients received control and test therapies, and all patients were available for follow-up measures. Average percent root coverage for CTG+CAF was 90.5% ± 14.87% versus 70.7% ± 28.26% for VCMX+CAF, P <0.0001. Both therapies produced significant soft tissue volume increases (84.8 ± 47.43 mm control versus 48.90 ± 35.58 mm test, P = 0.0006). The test, harvest graft substitute produced less postoperative pain and was preferred by patients at the 6-month end point. All other end point measures were not significantly different.
VCMX+CAF root coverage was inferior to CTG+CAF but produced less morbidity and was preferred by patients. Case/patient selection and surgical technique appear key to achieving successful results with the harvest graft alternative.
带冠向推进瓣的自体结缔组织移植（CTG+CAF）是覆盖退缩性缺损的“金标准”；然而，研究人员仍在寻求发病率更低、更便捷且供应不受限的移植替代物，包括那些能够增加软组织体积的替代物。
在四个临床研究地点对体积稳定的胶原基质（VCMX）与CTG进行了随机、对照、双盲比较。对单颗、双侧、患者体内配对的RT1退缩性缺损采用VCMX+CAF（试验组）和CTG+CAF（对照组）进行治疗。主要疗效终点是6个月时的牙根覆盖百分比。次要疗效终点包括软组织体积、附着水平和角化组织宽度等临床指标。患者报告的结果包括不适、美观和总体满意度等指标；对6个月终点结果进行了1年的随访。
30例患者接受了对照和试验治疗，所有患者均可供进行随访测量。CTG+CAF的平均牙根覆盖百分比为90.5%±14.87%，而VCMX+CAF为70.7%±28.26%，P<0.0001。两种治疗方法均使软组织体积显著增加（对照组为84.8±47.43mm，试验组为48.90±35.58mm，P=0.0006）。试验组的移植替代物术后疼痛较轻，在6个月终点时更受患者青睐。所有其他终点指标无显著差异。
VCMX+CAF的牙根覆盖效果不如CTG+CAF，但发病率较低，更受患者青睐。病例/患者选择和手术技术似乎是使用移植替代物取得成功结果的关键。
