Aim: To evaluate the efficacy of soft tissue substitutes, namely acellular dermal matrix (ADM), collagen matrix (CM), and titanium-prepared platelet-rich fibrin (T-PRF) in comparison to subepithelial connective tissue graft (SECTG) by tunnel or modified coronally advanced tunnel technique (MCAT) in root coverage.
Materials and methods: A literature search on MEDLINE, PubMed, Cochrane Libraries, Embase and hand-searched journals were covered from January 1999 to August 2020, which investigated the efficacy of soft tissue substitutes in comparison to SECTG by tunnel technique (TUN) or MCAT for root coverage procedures. Only randomized control trials (RCTs) were considered for the comparison.
Results: Seven studies were included for qualitative synthesis. SECTG, ADM and T-PRF were more effective for complete/partial root coverage (CRC) which was considered as the primary outcome according to Miller's classification. SECTG showed better results when secondary outcomes were considered.
Conclusion: The clinical efficacy of SECTG seemed to be higher in tunnel or MCAT for root coverage. Hence, SECTG can be a better option compared to other substitutes.
Clinical significance: Clinicians should be aware that SECTG can be considered as the first choice in root coverage when compared to other soft tissue substitutes. Nevertheless, these substitutes should be considered when there are anatomical variations or in situations where SECTG cannot be opted.
Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique. Int J Periodontics Restorative Dent 1994;14(3):216–227.
Azzi R, Étienne D. Recouvrement radiculaire et reconstruction papillaire par greffon conjonctif enfoui sous un lambeau vestibulaire tunnélisé et tracté coronairement. J Parodontol Implant Orale 1998;17:71–77.
Aroca S, Molnar B, Windisch P, et al. Treatment of multiple adjacent Miller class I and II gingival recessions with a modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. J Clin Periodontol 2013;40(7):713–720. DOI: 10.1111/jcpe.12112
Chambrone L, Chambrone D, Pustiglioni FE, et al. 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 2008;36(9):659–671. DOI: 10.1016/j.jdent.2008.05.007
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6(7):e1000097. DOI: 10.1371/journal.pmed.1000097
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17(1):1–12. DOI: 10.1016/0197-2456(95)00134-4
Higgins JPT, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. DOI: 10.1136/bmj.d5928
Cieślik-Wegemund M, Wierucka-Młynarczyk B, Tanasiewicz M, et al. Tunnel technique with collagen matrix compared with connective tissue graft for treatment of periodontal recession: a randomized clinical trial. J Periodontol 2016;87(12):1436–1443. DOI: 10.1902/jop.2016.150676
Pietruska M, Skurska A, Podlewski L, et al. Clinical evaluation of Miller class I and II recessions treatment with the use of modified coronally advanced tunnel technique with either collagen matrix or subepithelial connective tissue graft: a randomized clinical study. J Clin Periodontol 2019;46(1):86–95. DOI: 10.1111/jcpe.13031
Rakasevic DL, Milinkovic IZ, Jankovic SM, et al. The use of collagen porcine dermal matrix and connective tissue graft with modified coronally advanced tunnel technique in the treatment of multiple adjacent type I gingival recessions: a randomized, controlled clinical trial. J Esthet Restor Dent 2020;32(7):681–690. DOI: 10.1111/jerd.12624
Bednarz W, Zurek J, Gedrange T, et al. A preliminary clinical comparison of the use of fascia lata allograft and autogenous connective tissue graft in multiple gingival recession coverage based on the tunnel technique. Adv Clin Exp Med 2016;25(3):587–598. DOI: 10.17219/acem/44849
Fahmy RA, Taalab MR. Modified tunnel technique for management of gingival recession in esthetic zone using acellular dermal matrix versus connective tissue graft. Future Dent J 2018;2314–7180. DOI: 10.1016/j.fdj.2018.12.001
Uzun BC, Ercan E, Tunal M. Effectiveness and predictability of titanium-prepared platelet-rich fibrin for the management of multiple gingival recessions. Clin Oral Investig 2018;22(3):1345–1354. DOI: 10.1007/s00784-017-2211-2
Ghanaati S, Schlee M, Webber MJ, et al. Evaluation of the tissue reaction to a new bilayered collagen matrix in vivo and its translation to the clinic. Biomed Mater 2011;6(1):015010. DOI: 10.1088/1748-6041/6/1/015010
Nunez J, Caffesse R, Vignoletti F, et al. Clinical and histological evaluation of an acellular dermal matrix allograft in combination with the coronally advanced flap in the treatment of Miller Class I recession defects: an experimental study in the mini-pig. J Clin Periodontol 2009;36(6):523–531. DOI: 10.1111/j.1600-051X.2009.01401.x
Ayub LG, Ramos UD, Reino DM, et al. A randomized comparative clinical study of two surgical procedures to improve root coverage with the acellular dermal matrix graft. J Clin Periodontol 2012;39(9):871–878. DOI: 10.1111/j.1600-051X.2012.01915.x