Split-mouth evaluation of connective tissue graft with or without enamel matrix derivative for the treatment of isolated gingival recession defects in dogs

  • Y. ShirakataEmail author
  • T. Nakamura
  • Y. Shinohara
  • K. Nakamura-Hasegawa
  • C. Hashiguchi
  • N. Takeuchi
  • T. Imafuji
  • A. Sculean
  • K. Noguchi
Original Article



The potential additive effect of an enamel matrix derivative (EMD) to a subepithelial connective tissue graft (CTG) for recession coverage is still controversially discussed. Therefore, the aim of this study was to histologically evaluate the healing of gingival recessions treated with coronally advanced flap (CAF) and CTG with or without EMD in dogs.

Materials and methods

Gingival recession defects (5 mm wide and 7 mm deep) were surgically created on the labial side of bilateral maxillary canines in 7 dogs. After 8 weeks of plaque accumulation and subsequent 2 weeks of chemical plaque control, the 14 chronic defects were randomized to receive either CAF with CTG (CAF/CTG) or CAF with CTG and EMD (CAF/CTG/EMD). The animals were sacrificed 10 weeks after reconstructive surgery for histologic evaluation.


Treatment with CAF/CTG/EMD demonstrated statistically significantly better results in terms of probing pocket depth reduction (P < 0.05) and clinical attachment level gain (P < 0.001). The length of the epithelium was statistically significantly shorter in the CAF/CTG/EMD group than in the CAF/CTG group (1.00 ± 0.75 mm vs. 2.38 ± 1.48 mm, respectively, P < 0.01). Cementum formation was statistically significantly greater in the CAF/CTG/EMD group than following treatment with the CAF/CTG group (3.20 ± 0.89 mm vs. 1.88 ± 1.58 mm, respectively, P < 0.01). The CAF/CTG/EMD group showed statistically significantly greater complete periodontal regeneration (i.e., new cementum, new periodontal ligament, and new bone) than treatment with CAF/CTG (0.54 ± 0.73 mm vs. 0.07 ± 0.27 mm, respectively, P < 0.05).


Within their limits, the present findings indicate that the additional use of EMD in conjunction with CAF + CTG favors periodontal regeneration in gingival recession defects.

Clinical relevance

The present findings support the use of EMD combined with CTG and CAF for promoting periodontal regeneration in isolated gingival recession defects.


Coronally advanced flap Subepithelial connective tissue graft Enamel matrix derivative Gingival recession Histological investigation Animal study 



This study was partly supported by Grants-in-Aid for Scientific Research (C) (No.16K11652) and (B) (No. 15H05036) and a Grant-in-Aid for Young Scientists (B) (No. 15K20484) from the Japan Society for the Promotion of Science.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed, and all procedures performed in studies involving animals were in accordance with the ethical standards of the ethical committee of the Animal Research Center of Kagoshima University, Japan (Approval No. D16023).

Informed consent

For this type of study, formal consent was not required.


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Copyright information

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

Authors and Affiliations

  • Y. Shirakata
    • 1
    Email author
  • T. Nakamura
    • 1
  • Y. Shinohara
    • 1
  • K. Nakamura-Hasegawa
    • 1
  • C. Hashiguchi
    • 1
  • N. Takeuchi
    • 1
  • T. Imafuji
    • 1
  • A. Sculean
    • 2
  • K. Noguchi
    • 1
  1. 1.Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
  2. 2.Department of Periodontology, School of Dental MedicineUniversity of BernBernSwitzerland

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