J Periodontal Implant Sci.  2016 Feb;46(1):22-34. 10.5051/jpis.2016.46.1.22.

Root coverage using a coronally advanced flap with or without acellular dermal matrix: a meta-analysis

• Guan W
• Liao H
• Guo L
• Wang C
• Cao Z

• KMID: 2391727
• DOI: http://doi.org/10.5051/jpis.2016.46.1.22

Abstract

PURPOSE
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.
METHODS
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).
RESULTS
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.
CONCLUSIONS
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.

Keyword

Acellular Dermis; Gingival recession; Meta-analysis

MeSH Terms

Acellular Dermis*
Allografts
Connective Tissue
Gingival Recession
Transplants

Figure

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  Figure 1 Flowchart of the literature search.

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  Figure 2 Forest plots for (A) the reduction in recession, (B) the reduction in probing depth, (C) the gain in clinical attachment level, and (D) the gain in keratinized tissue. CAF, coronally advanced flap; ADM, acellular dermal matrix; CTG, connective tissue grafting.

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  Figure 3 Funnel plot for recession changes. CAF, coronally advanced flap; ADM, acellular dermal matrix; CTG, connective tissue grafting; SE, standard error; MD: mean difference.

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  Figure 4 Egger funnel plot for recession change.

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  Figure 5 Sensitivity analysis for (A) recession reduction comparing CAF with ADM and CAF with CTG, (B) recession reduction comparing CAF with ADM and CAF alone, and (C) KT gain comparing CAF with ADM and CAF with CTG. CAF, coronally advanced flap; ADM, acellular dermal matrix; CTG, connective tissue grafting; KT, keratinized tissue.

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