Advertisement

Free gingival graft and acellular dermal matrix for gingival augmentation: a 15-year clinical study

  • Cecilia Amparo Reyes CevallosEmail author
  • Daniel Romeu Benchimol de Resende
  • Carla Andreotti Damante
  • Adriana Campos Passanezi Sant’Ana
  • Maria Lúcia Rubo de Rezende
  • Sebastião Luiz Aguiar Greghi
  • Mariana Schutzer Ragghianti Zangrando
Original Article

Abstract

Objectives

This study evaluated clinical outcomes of acellular dermal matrix (ADM) allograft compared with autogenous free gingival graft (FGG) for gingival augmentation after 15 years.

Material and methods

Twenty-two patients were originally included and evaluated by de Resende et al. (Clin Oral Investig 23:539–550, 2019), and 12 accepted to participate in this longitudinal evaluation. Clinical parameters evaluated were recession depth (RD), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and soft tissue thickness (TT). In addition, esthetic perception was evaluated by patients and by a calibrated periodontist. Data were evaluated by ANOVA complemented by Tukey tests (p < 0.05).

Results

After 15 years, both treatments provided a significant increase in KTW and TT but with superior results for the FGG group (p < 0.05). No differences were observed between groups for PD and CAL. In the ADM group, RD significantly increased in long term, as well as the rate of tissue contraction. The percentage of shrinkage for the ADM group was 59.6%. Conversely, the FGG group presented a creeping attachment of 17.6% and RD significantly decreased in long term. The ADM group presented superior results considering professional esthetic perception.

Conclusions

Both treatments longitudinally promoted significant gain of keratinized tissue width and thickness with superior outcomes for the FGG group. The ADM group demonstrated more tissue contraction and gingival recession whereas the FGG group presented creeping attachment. Professional esthetic perception was superior for the ADM group.

Clinical relevance

This study added important clinical data with long-term evaluation of ADM compared with FGG.

Keywords

Mucogingival surgery Grafts Acellular dermal Gingiva Postoperative period 

Notes

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Brasil (CAPES)-Finance code 001. Part of this study was supported by a grant (no. 99/09834-2) from FAPESP (São Paulo Research Foundation). The work was financially 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.

References

  1. 1.
    Wei P, Laurell L, Geivelis M, Lingen MW, Maddalozzo D (2000) Acellular dermal matrix allografts to achieve increased attached gingiva. Part 1. A clinical study. J Periodontol 71:1297–1305CrossRefGoogle Scholar
  2. 2.
    Nevins M, Nevins ML, Kim SW, Schupbach P, Kim DM (2011) The use of mucograft collagen matrix to augment the zone of keratinized tissue around teeth: a pilot study. Int J Periodontics Restorative Dent 31:367–373Google Scholar
  3. 3.
    Agarwal C, Tarun Kumar AB, Mehta DS (2015) Comparative evaluation of free gingival graft and AlloDerm(®) in enhancing the width of attached gingival: a clinical study. Contemp Clin Dent 6:483–488CrossRefGoogle Scholar
  4. 4.
    Kuru B, Yildirim S (2013) Treatment of localized gingival recessions using gingival unit grafts: a randomized controlled clinical trial. J Periodontol 84(Suppl.1):S41–S50CrossRefGoogle Scholar
  5. 5.
    Feitosa DS, Santamaria MP, Sallum EA, Nociti Junior FH, Casati MZ, Toledo S (2008) Indicações atuais dos enxertos gengivais libres. RGO 56(Suppl. 2):S1–S6Google Scholar
  6. 6.
    Björn H (1963) Free transplantation of gingiva propria. Odont Revy 14:323Google Scholar
  7. 7.
    Shah R, Thomas R, Mehta DS (2015) Recent modifications of free gingival graft: a case series. Contemp Clin Dent 6(Suppl.3):S425–S427CrossRefGoogle Scholar
  8. 8.
    Zuhr O, Bäumer D, Hürzeler 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–S142CrossRefGoogle Scholar
  9. 9.
    Kassab M, Badawi H, Dentino A (2010) Treatment of gingival recession. Dent Clin N Am 54(Suppl.1):S129–S140CrossRefGoogle Scholar
  10. 10.
    Callan DP, Silverstein LH (1998) Use of acellular dermal matrix for increasing keratinized tissue around teeth and implants. Pract Periodont Aesthet Dent 10:731–734Google Scholar
  11. 11.
    Hashemi H, Parhiz A, Ghafari S (2012) Vestibuloplasty: allograft versus mucosal graft. Int J Oral Maxillofac Surg 41:527–530CrossRefGoogle Scholar
  12. 12.
    de Resende DRB, Greghi SLA, Siqueira AF, Benfatti CAM, Damante CA, Ragghianti Zangrando MS (2019) Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial. Clin Oral Investig 23(Suppl.2):S539–S550CrossRefGoogle Scholar
  13. 13.
    Harris RJ (2001) Clinical evaluation of 3 techniques to augment keratinized tissue without root coverage. J Periodontol 72:932–938CrossRefGoogle Scholar
  14. 14.
    De Resende DRB (2004) Avaliação comparativa clínica e histológica de enxertos gengivais livres autógenos e de matriz dérmica acelular alógena na criação e manutenção de uma faixa de mucosa ceratinizada em humanos. Teses Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru (SP)Google Scholar
  15. 15.
    Löe H, Silness J (1963) Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 21:533–551CrossRefGoogle Scholar
  16. 16.
    Silness J, Löe H (1964) Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135CrossRefGoogle Scholar
  17. 17.
    Agudio G, Chambrone L, Pini Prato G (2017) Biologic remodeling of periodontal dimensions of areas treated with gingival augmentation procedure (GAP). A 25-year follow-up observation. J Periodontol 88:634–642CrossRefGoogle Scholar
  18. 18.
    Agudio G, Cortellini P, Buti J, Pini Prato G (2016) Periodontal conditions of sites treated with gingival augmentation surgery compared with untreated contralateral homologous sites: an 18-to 35-year long-term study. J Periodontol 87:1371–1378CrossRefGoogle Scholar
  19. 19.
    Gapski R, Parks CA, Wang H (2005) Acellular dermal matrix for mucogingival surgery: a meta-analysis. J Periodontol 76:1814–1822CrossRefGoogle Scholar
  20. 20.
    Dragan IF, Hotlzman LP, Karimbux NY, Morin RA, Bassir SH (2017) Clinical outcomes of comparing soft tissue alternatives to free gingival graft: a systematic review and meta-analysis. J Evidence Dent Pract 17(Suppl.4):S370–S380CrossRefGoogle Scholar
  21. 21.
    Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L et al (2010) Patient morbidity and root coverage outcome after subepithelial connective tissue and deepithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 37(Suppl.8):S728–SS38Google Scholar
  22. 22.
    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(Suppl.11):S1082–S1088CrossRefGoogle Scholar
  23. 23.
    Zucchelli G, Mounssif I, Mazzotti C, Montebugnoli L, Sangiorgi M, Mele M et al (2014) Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. J Clin Periodontol 41(Suppl.7):S708–S716CrossRefGoogle Scholar
  24. 24.
    Frost NA, Mealey BL, Jones AA, Huynh-Ba G (2010) Periodontal biotype: gingival thickness as it relates to probe visibility and buccal plate thickness. J Periodontol 86(Suppl.10):S1141–S1149Google Scholar
  25. 25.
    Egreja AM, Kahn S, Barceleiro M, Bittencourt S (2012) Relationship between the width of the zone of keratinized tissue and thickness of gingival tissue in the anterior maxilla. Int J Periodontics Restorative Dent 32(Suppl.5):573–579Google Scholar
  26. 26.
    Manjunath RGS, Rana A, Sarkar A (2015) Gingival biotype assessment in a healthy periodontium: transgingival probing method. J Clin Diagn Res 9(Suppl.5):S66–S69Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Cecilia Amparo Reyes Cevallos
    • 1
    Email author
  • Daniel Romeu Benchimol de Resende
    • 2
  • Carla Andreotti Damante
    • 1
  • Adriana Campos Passanezi Sant’Ana
    • 1
  • Maria Lúcia Rubo de Rezende
    • 1
  • Sebastião Luiz Aguiar Greghi
    • 1
  • Mariana Schutzer Ragghianti Zangrando
    • 1
  1. 1.Department of Prosthodontics and Periodontics, Bauru School of DentistryUniversity of Sao PauloBauruBrazil
  2. 2.BauruBrazil

Personalised recommendations