Clinical Oral Investigations

, Volume 23, Issue 2, pp 539–550 | Cite as

Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial

  • Daniel Romeu Benchimol de Resende
  • Sebastião Luiz Aguiar Greghi
  • Aline Franco Siqueira
  • César Augusto Magalhães Benfatti
  • Carla Andreotti Damante
  • Mariana Schutzer Ragghianti ZangrandoEmail author
Original Article



This split-mouth controlled randomized clinical trial evaluated clinical and histological results of acellular dermal matrix allograft (ADM) compared to autogenous free gingival graft (FGG) for keratinized tissue augmentation.

Material and methods

Twenty-five patients with the absence or deficiency of keratinized tissue (50 sites) were treated with FGG (control group) and ADM (test group). Clinical parameters included keratinized tissue width (KTW) (primary outcome), soft tissue thickness (TT), recession depth (RD), probing depth (PD), and clinical attachment level (CAL). Esthetic perception was evaluated by patients and by a calibrated periodontist using visual analog scale (VAS). Histological analysis included biopsies of five different patients from both test and control sites for each evaluation period (n = 25). The analysis included percentage of connective tissue components, epithelial luminal to basal surface ratio, tissue maturation, and presence of elastic fibers. Data were evaluated by ANOVA complemented by Tukey’s tests (p < 0.05).


After 6 months, PD and CAL demonstrated no differences between groups. ADM presented higher RD compared to FGG in all periods. Mean tissue shrinkage for control and test groups was 12.41 versus 55.7%. TT was inferior for ADM group compared to FGG. Esthetics perception by professional evaluation showed superior results for ADM. Histomorphometric analysis demonstrated higher percentage of cellularity, blood vessels, and epithelial luminal to basal surface ratio for FGG group. ADM group presented higher percentage of collagen fibers and inflammatory infiltrate.


Both treatments resulted in improvement of clinical parameters, except for RD. ADM group presented more tissue shrinkage and delayed healing, confirmed histologically, but superior professional esthetic perception.

Clinical relevance

This study added important clinical and histological data to contribute in the decision-making process between indication of FGG or ADM.


Gingival recession Mucogingival surgery Grafts Acellular dermal Gingiva 



This study was supported by a grant (#99/09834-2) from FAPESP (São Paulo Research Foundation).

The work was supported by the Department of Prosthodontics and Periodontics of Bauru School of Dentistry- University of São Paulo, Brazil.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

784_2018_2470_MOESM1_ESM.pdf (3.1 mb)
ESM 1 (PDF 3167 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Daniel Romeu Benchimol de Resende
    • 1
  • Sebastião Luiz Aguiar Greghi
    • 2
  • Aline Franco Siqueira
    • 1
  • César Augusto Magalhães Benfatti
    • 3
  • Carla Andreotti Damante
    • 2
  • Mariana Schutzer Ragghianti Zangrando
    • 2
    Email author
  1. 1.BauruBrazil
  2. 2.Department of Prosthodontics and Periodontics, Bauru School of DentistryUniversity of Sao PauloBauruBrazil
  3. 3.Department of DentistryFederal University of Santa Catarina, UFSCFlorianópolisBrazil

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