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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 Barootchi
  • Lorenzo Tavelli
  • Andrea Ravidà
  • Chin-Wei Wang
  • Hom-Lay Wang
Review
  • 135 Downloads

Abstract

Objectives

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).

Results

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.

Conclusions

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.

Keywords

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

Notes

Funding

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)

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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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