J Korean Assoc Oral Maxillofac Surg.  2021 Dec;47(6):438-444. 10.5125/jkaoms.2021.47.6.438.

A novel amnion-chorion allograft membrane combined with a coronally advanced flap: a minimally invasive surgical therapy to regenerate interdental papillary soft tissue recession – a six-month postoperative image analysis-based clinical trial

• Pitale U
• Pal PC
• Boyapati R
• Bali A
• Varma M
• Khetarpal S

• KMID: 2524703
• DOI: http://doi.org/10.5125/jkaoms.2021.47.6.438

Abstract

Objectives
Loss of the interdental papilla is multi-factorial and creates a multitude of problems. Autogenous connective tissue/biomaterial-based regen-eration has been attempted for decades to reconstitute the black space created due to the loss of papilla. The aim of this present study was to regenerate papillary recession defects using an amnion-chorion membrane (ACM) allograft and to evaluate the clinical outcome up to six months postoperatively.
Materials and Methods
Twenty patients with 25 Nordland and Tarnow’s Class I/II interdental papillary recession defects were treated with ACM and coronal advancement of the gingivo-papillary unit via a semilunar incision on the labial aspect followed by a sulcular incision in the area of interest. A photographic image analysis was carried out using the GNU Image Manipulation software program from the baseline to three and six months postoperatively. The black triangle height (BTH) and the black triangle width (BTW) were calculated using the pixel size and were then converted into millimeters. The mean and standard deviation values were determined at baseline and then again at three and six months postoperatively. The probability values (P<0.05 and P≤0.01) were considered statistically significant and highly significant, respectively. An analysis of variance and post hoc Bonferroni test were carried out to compare the mean values.
Results
Our evaluation of the BTH and BTW showed a statistically and highly significant difference from the baseline until both three and six months postoperatively (P=0.01). A post hoc Bonferroni test disclosed a statistically significant variance from the baseline until three and six months postoperatively (P<0.05) and a non-significant difference from three to six months after the procedure (P≥0.05).
Conclusion
An ACM allograft in conjunction with a coronally advanced flap could be a suitable minimally invasive alternative for papillary regeneration.

Keyword

Guided tissue regeneration; Gingival recession; Amnion; Chorion; Image analysis

Figure

• 

  Fig. 1 A. The gingivo-papillary unit was coronally advanced to create a pouch-like space. B. The measured amnion-chorion membrane allograft was placed into the pouch space. C. Photographs obtained at baseline show a papillary recession between #11-#21. D. The three-month postoperative result showing regeneration of the interdental papilla. E. The six-month evaluation showing persistent results.

• 

  Fig. 2 A. An image analysis of papillary recession between #11-#21 at baseline. B. The image analysis shows an improvement of results after three months. C. The image analysis shows persistent results at six months postoperatively.

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