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      The effect of enamel matrix derivatives on root coverage: a 12-month follow-up of a randomized clinical trial

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          Abstract

          Abstract Subepithelial connective tissue grafts (SCTGs) with a coronally advanced flap (CAF) are accepted as the gold standard for covering denuded root surfaces. In recent years, enamel matrix derivatives (EMDs) have been used for their regenerative potential in periodontics. The aim of this split-mouth and randomized controlled study was to assess the clinical and aesthetical impacts of EMD application in combination with SCTG+CAF in patients with Miller’s Class I and II gingival recessions in contralateral canines of the maxilla. Participants who underwent SCTG+CAF+EMD application were identified as the test group (n = 19) and those who underwent SCTG+CAF as control group (n = 19). The outcome parameters were recession depth/width, root coverage percentage, and root coverage aesthetic score (RES). RES was evaluated by two calibrated blind periodontists one year after the treatment. Statistically significant root coverage percentage was observed at one year post-treatment for both groups (p < 0.05). However, significant differences between the groups were not observed in terms of total RES and complete root coverage rate (p > 0.05). The test group had significantly better results than the control according to the soft tissue texture and mucogingival junction alignment results (p < 0.05). These results indicate that EMDs contribute to the healing of soft tissue without scarring. As a result of better wound healing, the EMD-added group exhibited better results in terms of the harmony of the mucogingival junction between adjacent teeth. This paper is the first split-mouth study in which SCTG+CAF and SCTG+CAF+EMD were compared using RES in bilateral canines.

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          The etiology and prevalence of gingival recession.

          Gingival recession in its localized or generalized form is an undesirable condition resulting in root exposure. The result often is not esthetic and may lead to sensitivity and root caries. Exposed root surfaces also are prone to abrasion. The purpose of this article is to describe the prevalence, etiology and factors associated with gingival recession. The authors reviewed cross-sectional epidemiologic studies of gingival recession and found that they correlated the prevalence of recession to trauma, sex, malpositioned teeth, inflammation and tobacco consumption. The recent surveys they reviewed revealed that 88 percent of people 65 years of age and older and 50 percent of people 18 to 64 years of age have one or more sites with recession. The presence and extent of gingival recession also increased with age. More than 50 percent of the population has one or more sites with gingival recession of 1 mm or more. The prevalence of gingival recession was found in patients with both good and poor oral hygiene. It has been proposed that recession is multifactorial, with one type being associated with anatomical factors and another type with physiological or pathological factors. Recession has been found more frequently on buccal surfaces than on other aspects of the teeth. Dentists should be knowledgeable about the etiology, prevalence and associating factors of gingival recession, as well as treatment options, so that appropriate treatment modalities can be offered to patients. Treatments for gingival recession include gingival grafting, guided tissue regeneration and orthodontic therapy. Such treatments typically result in esthetic improvement, elimination of sensitivity and a decreased risk of developing root caries.
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            The design and analysis of split-mouth studies: what statisticians and clinicians should know.

            The split-mouth design is a popular design in oral health research. In the most common split-mouth study, each of two treatments are randomly assigned to either the right or left halves of the dentition. The attractiveness of the design is that it removes a lot of inter-individual variability from the estimates of the treatment effect. However, already about 20 years ago the pitfalls of the design have been reported in the oral health literature. Yet, many clinicians are not aware of the potential problems with the split-mouth design. Further, it is our experience that most statisticians are not even aware of the existence of this design. Since most of the critical remarks appeared in the oral health literature, we argue that it is necessary to introduce the split-mouth design to a statistical audience, so that both clinicians and statisticians clearly understand the advantages, limitations, statistical considerations, and implications of its use in clinical trials and advise them on its use in practice. Copyright (c) 2009 John Wiley & Sons, Ltd.
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              Treatment of gingival recession with coronally advanced flap procedures: a systematic review.

              The treatment of buccal gingival recessions is a common requirement due to aesthetic concern or root sensitivity. The aim of this manuscript was to systematically review the literature on coronally advanced flap (CAF) alone or in combination with tissue grafts, barrier membranes (BM), enamel matrix derivative (EMD) or other material for treating gingival recession. Randomized clinical trials on treatment of Miller Class I and II gingival recessions with at least 6 months of follow-up were identified. Data sources included electronic databases and hand-searched journals. The primary outcome variable was complete root coverage (CRC). The secondary outcome variables were recession reduction, clinical attachment gain, keratinized tissue gain, aesthetic satisfaction, root sensitivity, post-operative patient pain and complications. A total of 794 Miller Class I and II gingival recessions in 530 patients from 25 RCTs were evaluated in this systematic review. CAF was associated with mean recession reduction and CRC. The addition of connective tissue graft (CTG) or EMD enhanced the clinical outcomes of CAF in terms of CRC, while BM did not. The results with respect to the adjunctive use of acellular dermal matrix were controversial. CTG or EMD in conjunction with CAF enhances the probability of obtaining CRC in Miller Class I and II single gingival recessions.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                bor
                Brazilian Oral Research
                Braz. oral res.
                Sociedade Brasileira de Pesquisa Odontológica - SBPqO (São Paulo, SP, Brazil )
                1806-8324
                1807-3107
                February 2019
                : 33
                : 0
                : e006
                Affiliations
                [1] Van orgnameYüzüncü Yıl Üniversitesi orgdiv1Faculty of Dentistry orgdiv2Department of Periodontology Turkey
                [3] Izmir orgnameIzmir Katip Celebi University orgdiv1Faculty of Dentistry orgdiv2Department of Periodontology Turkey
                [2] Edirne orgnameTrakya University orgdiv1Faculty of Dentistry orgdiv2Department of Periodontology Turkey
                Article
                S1806-83242019000100203
                10.1590/1807-3107bor-2019.vol33.0006
                ac423ab6-4d32-4ea3-b873-0fd3ffb21295

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 29 March 2018
                : 06 December 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 0
                Product

                SciELO Brazil

                Categories
                Original Research

                Gingival Recession,Autrografts,Periodontics
                Gingival Recession, Autrografts, Periodontics

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