Clinical Oral Investigations

, Volume 22, Issue 8, pp 2727–2741 | Cite as

Effect of EDTA root conditioning on the outcome of coronally advanced flap with connective tissue graft: a systematic review and meta-analysis

  • Shayan BarootchiEmail author
  • Lorenzo Tavelli
  • Andrea Ravidà
  • Chin-Wei Wang
  • Hom-Lay Wang



CAF in combination with a connective tissue graft (CTG) is considered the technique of choice for treating gingival recessions (GRs). Among the many recognized factors that can affect the outcomes, the use of chemical agents has been proposed. The effect of EDTA, as a commonly used agent, remains controversial. Therefore, the aim of this review was to assess the efficacy of EDTA root conditioning when combined to CAF + CTG.

Material and methods

A literature search was conducted to identify randomized clinical trials (RCTs) that performed CAF + CTG with and without EDTA for root coverage procedures. The following outcomes were assessed: recession reduction (Rec Red), complete root coverage (CRC), keratinized tissue gain (KT gain), clinical attachment level changes (CAL gain), and changes in pocket depth (PD changes).


Fourteen RCTs (575 GRs) were included and analyzed. Six articles were included in the EDTA group, with 8 in the non-EDTA group. Meta-analyses revealed statistically significant differences for the outcomes of Rec Red (3.68 mm versus 3.07 mm), CAL gain (4.15 mm versus 3.07 mm), and PD changes (− 0.44 mm versus 0.27 mm) in favor of the EDTA group, while outcomes of CRC (odds ratio of 1.15) and KT gain (1.98 mm versus 1.62 mm) were not significantly different.


Limited evidence is available when evaluating the effectiveness of EDTA root conditioning with CAF + CTG. However, the adjunct application of EDTA with CAF + CTG appears to be beneficial.

Clinical relevance

The adjunct application of EDTA may provide benefits when performing root coverage procedure via CAF + CTG.


Gingival recession Root coverage Subepithelial connective tissue graft Mucogingival surgery Ethylenediaminetetraacetic acid (EDTA) Meta-analysis 



This paper was partially supported by the University of Michigan Periodontal Graduate Student Research Fund.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

784_2018_2635_MOESM1_ESM.docx (15 kb)
Data S1 Characteristics and references of the excluded articles. (DOCX 14 kb)
784_2018_2635_MOESM2_ESM.docx (17 kb)
Data S2 Bias risk assessment for the included RCTs using The Cochrane Risk of Bias Tool for Randomized Controlled Trials (DOCX 16 kb)
784_2018_2635_Fig5_ESM.png (1.2 mb)
Data S3

Meta-analysis and comparisons of baseline characteristics and WMV for the EDTA and non-EDTA groups for Initial Recession and KT height. A) Initial recession of EDTA studies, B) Initial recession of non-EDTA studies, C) Comparison of both groups for Initial recession, D) KT height of EDTA studies at baseline, E) KT height of non-EDTA studies at baseline, F) comparison of baseline KT height for both groups. (PNG 1195 kb)

784_2018_2635_MOESM3_ESM.tif (2.3 mb)
High resolution image (TIF 2398 kb)
784_2018_2635_Fig6_ESM.png (1 mb)
Data S4

Meta-analysis and comparisons of baseline characteristics and WMV for the EDTA and non-EDTA groups for CAL and PD. A) Initial CAL for EDTA studies, B) Initial CAL for non-EDTA studies, C) Comparison of Initial CAL in both groups, D) Initial PD for EDTA studies, E) Initial PD for non-EDTA studies, F) Comparison of initial PD for both groups (PNG 1037 kb)

784_2018_2635_MOESM4_ESM.tif (2.2 mb)
High resolution image (TIF 2245 kb)
784_2018_2635_Fig7_ESM.png (740 kb)
Data S5

Funnel plots assessing potential publication bias among the selected trials for the evaluated outcomes of: Rec Red in A) EDTA studies, and B) non-EDTA studies; CRC of C) EDTA studies, and D) non-EDTA studies; KT gain of E) EDTA studies, and F) non-EDTA studies; CAL gain of G) EDTA studies, and H) non-EDTA studies; PD reduction of I) EDTA studies, and J) non-EDTA studies. (PNG 739 kb)

784_2018_2635_MOESM5_ESM.tif (5.8 mb)
High resolution image (TIF 5958 kb)


  1. 1.
    Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 41(Suppl 15):S44–S62. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Graziani F, Gennai S, Roldan S, Discepoli N, Buti J, Madianos P, Herrera D (2014) Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. J Clin Periodontol 41(Suppl 15):S63–S76. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 35:136–162. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Tonetti MS, Jepsen S, Working Group 2 of the European Workshop on P (2014) Clinical efficacy of periodontal plastic surgery procedures: consensus report of Group 2 of the 10th European Workshop on Periodontology. J Clin Periodontol 41(Suppl 15):S36–S43. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Cincinelli S, Pini-Prato G (2012) Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial. J Clin Periodontol 39:760–768. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Saletta D, Pini Prato G, Pagliaro U, Baldi C, Mauri M, Nieri M (2001) Coronally advanced flap procedure: is the interdental papilla a prognostic factor for root coverage? J Periodontol 72:760–766. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Huang LH, Neiva RE, Wang HL (2005) Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 76:1729–1734. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ozcelik O, Seydaoglu G, Haytac MC (2015) Prediction of root coverage for single recessions in anterior teeth: a 6-month study. J Clin Periodontol 42:860–867. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Zucchelli G, Mele M, Checchi L (2006) The papilla amplification flap for the treatment of a localized periodontal defect associated with a palatal groove. J Periodontol 77:1788–1796. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Mazzocco F, Comuzzi L, Stefani R, Milan Y, Favero G, Stellini E (2011) Coronally advanced flap combined with a subepithelial connective tissue graft using full- or partial-thickness flap reflection. J Periodontol 82:1524–1529. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Skurska A, Dolinska E, Sulewska M, Milewski R, Pietruski J, Sobaniec S, Pietruska M (2015) The assessment of the influence of vertical incisions on the aesthetic outcome of the Miller class I and II recession treatment: a split-mouth study. J Clin Periodontol 42:756–763. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zucchelli G, Stefanini M, Ganz S, Mazzotti C, Mounssif I, Marzadori M (2016) Coronally advanced flap with different designs in the treatment of gingival recession: a comparative controlled randomized clinical trial. Int J Periodontics Restorative Dent 36:319–327. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    de Sanctis M, Clementini M (2014) Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 41(Suppl 15):S108–S122. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Pini-Prato G, Baldi C, Pagliaro U, Nieri M, Saletta D, Rotundo R, Cortellini P (1999) Coronally advanced flap procedure for root coverage. Treatment of root surface: root planning versus polishing. J Periodontol 70:1064–1076. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Zucchelli G, Mounssif I, Stefanini M, Mele M, Montebugnoli L, Sforza NM (2009) Hand and ultrasonic instrumentation in combination with root-coverage surgery: a comparative controlled randomized clinical trial. J Periodontol 80:577–585. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Oles RD, Ibbott CG, Laverty WH (1988) Effect of root curettage and sodium hypochlorite treatment on pedicle flap coverage of localized recession. J Can Dent Assoc 54:515–517PubMedPubMedCentralGoogle Scholar
  17. 17.
    Selvig KA, Ririe CM, Nilveus R, Egelberg J (1981) Fine structure of new connective tissue attachment following acid treatment of experimental furcation pockets in dogs. J Periodontal Res 16:123–129CrossRefGoogle Scholar
  18. 18.
    Polson AM, Proye MP (1982) Effect of root surface alterations on periodontal healing. II. Citric acid treatment of the denuded root. J Clin Periodontol 9:441–454CrossRefGoogle Scholar
  19. 19.
    Register AA, Burdick FA (1975) Accelerated reattachment with cementogenesis to dentin, demineralized in situ. I. Optimum range. J Periodontol 46:646–655. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Polson AM, Proye MP (1983) Fibrin linkage: a precursor for new attachment. J Periodontol 54:141–147. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Stabholz A, Kettering J, Aprecio R, Zimmerman G, Baker PJ, Wikesjo UM (1993) Antimicrobial properties of human dentin impregnated with tetracycline HCl or chlorhexidine. An in vitro study. J Clin Periodontol 20:557–562CrossRefGoogle Scholar
  22. 22.
    Caffesse RG, Kerry GJ, Chaves ES, McLean TN, Morrison EC, Lopatin DE, Caffesse ER, Stults DL (1988) Clinical evaluation of the use of citric acid and autologous fibronectin in periodontal surgery. J Periodontol 59:565–569. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Blomlof J, Lindskog S (1995a) Periodontal tissue-vitality after different etching modalities. J Clin Periodontol 22:464–468CrossRefGoogle Scholar
  24. 24.
    Blomlof J, Lindskog S (1995b) Root surface texture and early cell and tissue colonization after different etching modalities. Eur J Oral Sci 103:17–24CrossRefGoogle Scholar
  25. 25.
    Blomlof J, Jansson L, Blomlof L, Lindskog S (1996a) Root surface etching at neutral pH promotes periodontal healing. J Clin Periodontol 23:50–55CrossRefGoogle Scholar
  26. 26.
    Blomlof L, Jonsson B, Blomlof J, Lindskog S (2000a) A clinical study of root surface conditioning with an EDTA gel. II. Surgical periodontal treatment. Int J Periodontics Restorative Dent 20:566–573PubMedPubMedCentralGoogle Scholar
  27. 27.
    Kassab MM, Cohen RE, Andreana S, Dentino AR (2006) The effect of EDTA in attachment gain and root coverage. Compend Contin Educ Dent 27:353–360 quiz 361PubMedPubMedCentralGoogle Scholar
  28. 28.
    Bittencourt S, Ribeiro Edel P, Sallum EA, Sallum AW, Nociti FH Jr, Casati MZ (2007) Root surface biomodification with EDTA for the treatment of gingival recession with a semilunar coronally repositioned flap. J Periodontol 78:1695–1701. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Mariotti A (2003) Efficacy of chemical root surface modifiers in the treatment of periodontal disease. A systematic review. Ann Periodontol 8:205–226. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Karam PS, Sant'Ana AC, de Rezende ML, Greghi SL, Damante CA, Zangrando MS (2016) Root surface modifiers and subepithelial connective tissue graft for treatment of gingival recessions: a systematic review. J Periodontal Res 51:175–185. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Oliveira GH, Muncinelli EA (2012) Efficacy of root surface biomodification in root coverage: a systematic review. J Can Dent Assoc 78:c122PubMedPubMedCentralGoogle Scholar
  32. 32.
    Liu X, Mao M, Ma T (2016) The effect of EDTA root conditioning on periodontal surgery outcome: a meta-analysis. Quintessence Int 47:833–841. CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Mayfield L, Soderholm G, Norderyd O, Attstrom R (1998) Root conditioning using EDTA gel as an adjunct to surgical therapy for the treatment of intraosseous periodontal defects. J Clin Periodontol 25:707–714CrossRefGoogle Scholar
  34. 34.
    Blomlof L, Bergman E, Forsgardh A, Foss L, Larsson A, Sjoberg B, Uhlander L, Jonsson B, Blomlof J, Lindskog S (2000b) A clinical study of root surface conditioning with an EDTA gel. I. Nonsurgical periodontal treatment. Int J Periodontics Restorative Dent 20:560–565PubMedPubMedCentralGoogle Scholar
  35. 35.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Miller PD Jr (1985) A classification of marginal tissue recession. Int J Periodontics Restorative Dent 5:8–13PubMedPubMedCentralGoogle Scholar
  37. 37.
    Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U (2011) The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 38:661–666. CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Roccuzzo M, Bunino M, Needleman I, Sanz M (2002) Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 29(Suppl 3):178–194 discussion 195-6CrossRefGoogle Scholar
  39. 39.
    Oates TW, Robinson M, Gunsolley JC (2003) Surgical therapies for the treatment of gingival recession. A systematic review. Ann Periodontol 8:303–320. CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Pagliaro U, Nieri M, Franceschi D, Clauser C, Pini-Prato G (2003) Evidence-based mucogingival therapy. Part 1: a critical review of the literature on root coverage procedures. J Periodontol 74:709–740. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini-Prato G (2003) Evidence-based mucogingival therapy. Part 2: ordinary and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the outcome variable. J Periodontol 74:741–756. CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Al-Hamdan K, Eber R, Sarment D, Kowalski C, Wang HL (2003) Guided tissue regeneration-based root coverage: meta-analysis. J Periodontol 74:1520–1533. CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Gapski R, Parks CA, Wang HL (2005) Acellular dermal matrix for mucogingival surgery: a meta-analysis. J Periodontol 76:1814–1822. CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Hwang D, Wang HL (2006) Flap thickness as a predictor of root coverage: a systematic review. J Periodontol 77:1625–1634. CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Cheng YF, Chen JW, Lin SJ, Lu HK (2007) Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage? A systemic review. J Periodontal Res 42:474–485. CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA (2008) Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller class I and II recession-type defects? J Dent 36:659–671. CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Chambrone LA, Chambrone L (2009) Treatment of Miller class I and II localized recession defects using laterally positioned flaps: a 24-month study. Am J Dent 22:339–344PubMedPubMedCentralGoogle Scholar
  48. 48.
    Chambrone L, Sukekava F, Araujo MG, Pustiglioni FE, Chambrone LA and Lima LA (2009) Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev CD007161. doi:
  49. 49.
    Chambrone L, Pannuti CM, Tu YK, Chambrone LA (2012) Evidence-based periodontal plastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage. J Periodontol 83:477–490. CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Buti J, Baccini M, Nieri M, La Marca M, Pini-Prato GP (2013) Bayesian network meta-analysis of root coverage procedures: ranking efficacy and identification of best treatment. J Clin Periodontol 40:372–386. CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Cheng GL, Fu E, Tu YK, Shen EC, Chiu HC, Huang RY, Yuh DY, Chiang CY (2015) Root coverage by coronally advanced flap with connective tissue graft and/or enamel matrix derivative: a meta-analysis. J Periodontal Res 50:220–230. CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Chambrone L, Tatakis DN (2015) Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 86:S8–S51. CrossRefGoogle Scholar
  53. 53.
    Atieh MA, Alsabeeha N, Tawse-Smith A, Payne AG (2016) Xenogeneic collagen matrix for periodontal plastic surgery procedures: a systematic review and meta-analysis. J Periodontal Res 51:438–452. CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Cairo F, Pagliaro U, Buti J, Baccini M, Graziani F, Tonelli P, Pagavino G, Tonetti MS (2016) Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta-analysis. J Clin Periodontol 43:965–975. CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Zucchelli G, De Sanctis M (2000) Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol 71:1506–1514. CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    de Sanctis M, Zucchelli G (2007) Coronally advanced flap: a modified surgical approach for isolated recession-type defects: three-year results. J Clin Periodontol 34:262–268. CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    McGuire MK, Nunn M (2003) Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: comparison of clinical parameters. J Periodontol 74:1110–1125. CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    McGuire MK, Scheyer ET (2010) Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. J Periodontol 81:1108–1117. CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Zucchelli G, Marzadori M, Mounssif I, Mazzotti C, Stefanini M (2014a) Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors. A controlled randomized clinical trial. J Clin Periodontol 41:806–813. CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Zucchelli G, Mounssif I, Mazzotti C, Montebugnoli L, Sangiorgi M, Mele M, Stefanini M (2014b) Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. J Clin Periodontol 41:708–716. CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L (2014c) Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: a comparative short- and long-term controlled randomized clinical trial. J Clin Periodontol 41:396–403. CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Azaripour A, Kissinger M, Farina VS, Van Noorden CJ, Gerhold-Ay A, Willershausen B, Cortellini P (2016) Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial. J Clin Periodontol 43:1142–1150. CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Kuis D, Sciran I, Lajnert V, Snjaric D, Prpic J, Pezelj-Ribaric S, Bosnjak A (2013) Coronally advanced flap alone or with connective tissue graft in the treatment of single gingival recession defects: a long-term randomized clinical trial. J Periodontol 84:1576–1585. CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Roman A, Soanca A, Kasaj A, Stratul SI (2013) Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of Miller class I and II gingival recessions: a controlled randomized clinical trial. J Periodontal Res 48:563–572. CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Zucchelli G, Amore C, Sforza NM, Montebugnoli L, De Sanctis M (2003) Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study. J Clin Periodontol 30:862–870CrossRefGoogle Scholar
  67. 67.
    Zucchelli G, Marzadori M, Mele M, Stefanini M, Montebugnoli L (2012) Root coverage in molar teeth: a comparative controlled randomized clinical trial. J Clin Periodontol 39:1082–1088. CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M (2010) Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 37:728–738. CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Gobbato L, Nart J, Bressan E, Mazzocco F, Paniz G, Lops D (2016) Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial. Clin Oral Investig 20:2191–2202. CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Nemcovsky CE, Artzi Z, Tal H, Kozlovsky A, Moses O (2004) A multicenter comparative study of two root coverage procedures: coronally advanced flap with addition of enamel matrix proteins and subpedicle connective tissue graft. J Periodontol 75:600–607. CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Rasperini G, Roccuzzo M, Francetti L, Acunzo R, Consonni D, Silvestri M (2011) Subepithelial connective tissue graft for treatment of gingival recessions with and without enamel matrix derivative: a multicenter, randomized controlled clinical trial. Int J Periodontics Restorative Dent 31:133–139PubMedPubMedCentralGoogle Scholar
  72. 72.
    Cortellini P, Pini Prato G (2012) Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience. Periodontol 2000(59):158–184. CrossRefGoogle Scholar
  73. 73.
    Guiha R, el Khodeiry S, Mota L, Caffesse R (2001) Histological evaluation of healing and revascularization of the subepithelial connective tissue graft. J Periodontol 72:470–478. CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Blomlof J, Blomlof L, Lindskog S (1997) Effect of different concentrations of EDTA on smear removal and collagen exposure in periodontitis-affected root surfaces. J Clin Periodontol 24:534–537CrossRefGoogle Scholar
  75. 75.
    Blomlof JP, Blomlof LB, Lindskog SF (1996b) Smear removal and collagen exposure after non-surgical root planing followed by etching with an EDTA gel preparation. J Periodontol 67:841–845. CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Ruggeri A Jr, Prati C, Mazzoni A, Nucci C, Di Lenarda R, Mazzotti G, Breschi L (2007) Effects of citric acid and EDTA conditioning on exposed root dentin: an immunohistochemical analysis of collagen and proteoglycans. Arch Oral Biol 52:1–8. CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Lowenberg B, Thibault J, Lawrence C, Sodek J (1986) The influence of chemically-induced modifications of root surfaces on cell migration, attachment, and orientation. J Dent Res 65:1010–1015. CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Babay N (2001a) The effect of EDTA on the attachment and growth of cultured human gingival fibroblasts in periodontitis-affected root surface. J Contemp Dent Pract 2:13–23PubMedPubMedCentralGoogle Scholar
  79. 79.
    Babay N (2001b) Attachment of human gingival fibroblasts to periodontally involved root surface following scaling and/or etching procedures: a scanning electron microscopy study. Braz Dent J 12:17–21PubMedPubMedCentralGoogle Scholar
  80. 80.
    Kasaj A, Klein MO, Dupont J, Willershausen B, Krahn U, Gotz H, Zeiler J, Brullmann D, Duschner H (2013) Early root surface colonization by human periodontal ligament fibroblasts following treatment with different biomaterials. Acta Odontol Scand 71:1579–1587. CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Gamal AY, Abdel-Ghaffar KA, Zouair MG, Salama MH, Destawy MTE (2018) Dimensional evaluation of blood clot gap distances within the intrabony defects following grafting and EDTA root surface treatment—experimental study in dogs. J Periodontol 89:691–698. CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Wikesjo UM, Claffey N, Egelberg J (1991) Periodontal repair in dogs. Effect of heparin treatment of the root surface. J Clin Periodontol 18:60–64CrossRefGoogle Scholar
  83. 83.
    Wikesjo UM, Nilveus R (1990) Periodontal repair in dogs: effect of wound stabilization on healing. J Periodontol 61:719–724. CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Agudio G, Nieri M, Rotundo R, Franceschi D, Cortellini P, Pini Prato GP (2009) Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study. J Periodontol 80:1399–1405. CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P (2010) Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol 37:644–650. CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Zuhr O, Baumer D, Hurzeler M (2014) The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 41(Suppl 15):S123–S142. CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Zucchelli G, Mounssif I (2015) Periodontal plastic surgery. Periodontol 2000(68):333–368. CrossRefGoogle Scholar
  88. 88.
    Rebele SF, Zuhr O, Schneider D, Jung RE, Hurzeler MB (2014) Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II. Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol 41:593–603. CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Agudio G, Chambrone L, Pini Prato G (2017) Biologic remodeling of periodontal dimensions of areas treated with gingival augmentation procedure: a 25-year follow-up observation. J Periodontol 88:634–642. CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Matter J (1980) Creeping attachment of free gingival grafts. A five-year follow-up study. J Periodontol 51:681–685. CrossRefPubMedPubMedCentralGoogle Scholar
  91. 91.
    Harris RJ (1997) Creeping attachment associated with the connective tissue with partial-thickness double pedicle graft. J Periodontol 68:890–899. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Periodontics & Oral Medicine, School of DentistryUniversity of MichiganAnn ArborUSA

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