Gingival Recession Treatment with the Use of Xenogeneic Matrix: Optimization of Patient-Centered Outcomes by the Digital Soft Tissue Design
Keywords:
Gingival Recession, Patient Outcome Assessment, HeterograftsAbstract
Objective: To evaluate the impact of the originally-developed approach aimed at pre-treatment graphical modelling of soft-tissue changes (digital soft tissue design) for the optimization of patient-centered outcomes after Class I and Class II single gingival recessions treatment with the use of a xenogeneic dermal matrix. Material and Methods: Patients enrolled in the study group received single gingival recession treatment via CAF+XDM method supported by pre-treatment graphical modelling of potential soft-tissue changes (digital soft tissue design), while patients enrolled in the control group received single gingival recession treatment via CAF+CTG method with no pre-treatment graphical modeling of gingival level changes. Patient-centered outcomes were measured by visual analogue scale, OHIP-14, and Mahajan’s scales. Results: Realization of pre-treatment graphical modelling of soft-tissue changes supported the achievement of better patient-centered outcomes, such as root coverage (p<0.05), surgical phase (p<0.05), post-surgical phase (p<0.05), cost-effectiveness (p<0.05) and diagnostics and patient-orientation (p<0.05) based on patient's personal perception grades. Conclusion: Patient-centered results were found to be more successful within the group using the xenogeneic type of graft accompanied with the implementation of pre-treatment graphical modeling of soft tissue changes, which helped to balance patients’ pre-operative expectations and post-operative satisfaction with the received results, reduce post-operative morbidity and improve oral health-related quality of life.
References
Joda T, Bornstein MM, Jung RE, Ferrari M, Waltimo T, Zitzmann NU. Recent trends and future direction of dental research in the digital era. Int J Environ Res Public Health 2020; 17(6):1987. https://doi.org/10.3390/ijerph17061987
Belibasakis GN, Bostanci N, Marsh PD, Zaura E. Applications of the oral microbiome in personalized dentistry. Arch Oral Biol 2019; 104:7-12. https://doi.org/10.1016/j.archoralbio.2019.05.023
Jingarwar MM, Bajwa NK, Pathak A. Minimal intervention dentistry–a new frontier in clinical dentistry. J Clin Diagn Res 2014; 8(7):ZE04-ZE08. https://doi.org/10.7860/JCDR/2014/9128.4583
Radaic A, Kapila YL. The oralome and its dysbiosis: New insights into oral microbiome-host interactions. Comput Struct Biotechnol J 2021; 19:1335-60. https://doi.org/10.1016/j.csbj.2021.02.010
Perazzo MF, Serra-Negra JM, Firmino RT, Pordeus IA, Martins-Júnior PA, Paiva SM. Patient-centered assessments: how can they be used in dental clinical trials?. Braz Oral Res 2020; 34Suppl 2:e075. https://doi.org/10.1590/1807-3107bor-2020.vol34.0075
Calciolari E, Donos N. The use of omics profiling to improve outcomes of bone regeneration and osseointegration. How far are we from personalized medicine in dentistry?. J Proteomics 2018; 188:85-96. https://doi.org/10.1016/j.jprot.2018.01.017
Refai AK, Cochran DL. Harnessing Omics Sciences and Biotechnologies in Understanding Osseointegration--Personalized Dental Implant Therapy. Int J Oral Maxillof Implants 2020; 35(3):e27-e39. https://doi.org/10.11607/jomi.7272
Misch CM. Personalised medicine: Applications for dental implant therapy. Int J Oral Implantol 2021; 14(2):119-20.
Yu N, Nguyen T, Cho YD, Kavanagh NM, Ghassib I, Giannobile WV. Personalized scaffolding technologies for alveolar bone regenerative medicine. Orthod Craniofac Res 2019; 22 Suppl 1(Suppl 1):69-75. https://doi.org/10.1111/ocr.12275
Barazanchi A, Li KC, Al‐Amleh B, Lyons K, Waddell JN. Additive technology: update on current materials and applications in dentistry. J Prosthodont 2017; 26(2):156-63. https://doi.org/10.1111/jopr.12510
de Carvalho Formiga M, Nagasawa MA, Moraschini V, Ata-Ali J, Sculean A, Shibli JA. Clinical efficacy of xenogeneic and allogeneic 3D matrix in the management of gingival recession: a systematic review and meta-analysis. Clin Oral investig 2020; 24(7):2229-45. https://doi.org/10.1007/s00784-020-03370-w
Amine K, El Amrani Y, Chemlali S, Kissa J. Alternatives to connective tissue graft in the treatment of localized gingival recessions: A systematic review. J Stomatol Oral Maxillofac Surg 2018; 119(1):25-32. https://doi.org/10.1016/j.jormas.2017.09.005
Santamaria MP, Mathias-Santamaria IF, Ferraz LF, Casarin RC, Romito GA, Sallum EA, Pini-Prato GP, Casati MZ. Rethinking the decision-making process to treat gingival recession associated with non-carious cervical lesions. Brazi Oral Res 2021; 35(Supp 2):e096. https://doi.org/10.1590/1807-3107bor-2021.vol35.0096
Chambrone L, Boltelho J, Machado V, Mascarenhas P, Mendes JJ, Avila‐Ortiz G. Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta‐analysis. J Periodontol 2022. https://doi.org/10.1002/JPER.22-0167
Huang JP, Liu JM, Wu YM, Chen LL, Ding PH. Efficacy of xenogeneic collagen matrix in the treatment of gingival recessions: A systematic review and meta‐analysis. Oral Dis 2019; 25(4):996-1008. https://doi.org/10.1111/odi.12949
Moraschini V, de Almeida DC, Sartoretto S, Bailly Guimarães H, Chaves Cavalcante I, Diuana Calasans-Maia M. Clinical efficacy of xenogeneic collagen matrix in the treatment of gingival recession: a systematic review and meta-analysis. Acta Odontol Scandi 2019; 77(6):457-67. https://doi.org/10.1080/00016357.2019.1588372
Atieh MA, Alsabeeha N, Tawse‐Smith A, Payne AG. Xenogeneic collagen matrix for periodontal plastic surgery procedures: A systematic review and meta‐analysis. J Periodontal Res 2016; 51(4):438-52. https://doi.org/10.1111/jre.12333
Coachman C, Calamita MA, Sesma N. Dynamic documentation of the smile and the 2D/3D digital smile design process. Int J Periodontics Restorative Dent 2017; 37(2):183-93. https://doi.org/10.11607/prd.2911
Santos FR, Kamarowski SF, Lopez CA, Storrer CL, Neto AT, Deliberador TM. The use of the digital smile design concept as an auxiliary tool in periodontal plastic surgery. Dent Res J (Isfahan) 2017; 14(2):158-161.
Cattoni F, Chirico L, Merlone A, Manacorda M, Vinci R, Gherlone EF. Digital smile designed computer-aided surgery versus traditional workflow in “all on four” rehabilitations: a randomized clinical trial with 4-years follow-up. Int J Environ Res Public Health 2021; 18(7):3449. https://doi.org/10.3390/ijerph18073449
Jafri Z, Ahmad N, Sawai M, Sultan N, Bhardwaj A. Digital Smile Design-An innovative tool in aesthetic dentistry. J Oral Biol Craniofac Res 2020; 10(2):194-8. https://doi.org/10.1016/j.jobcr.2020.04.010
Reeves BC, Gaus W. Guidelines for reporting non-randomised studies. Forsch Komplementarmed Klass Naturheilkd 2004; 11(Suppl. 1):46-52. https://doi.org/10.1159/000080576
Lancaster GA, Thabane L. Guidelines for reporting non-randomised pilot and feasibility studies. Pilot and feasibility studies 2019; 5(1):1-6. https://doi.org/10.1186/s40814-019-0499-1
Zhan Y, Wang M, Cao X, Liu F. Effectiveness of acellular dermal matrix graft with a coronally advanced flap for the treatment of Miller Class I/II single gingival recession with thin gingival phenotype: study protocol for a split-mouth randomised controlled trial. BMJ open 2022; 12(1):e047703. https://doi.org/10.1136/bmjopen-2020-047703
Kumar A, Bains VK, Jhingran R, Srivastava R, Madan R, Rizvi I. Patient-centered microsurgical management of gingival recession using coronally advanced flap with either platelet-rich fibrin or connective tissue graft: A comparative analysis. Contemp Clin Dent 2017; 8(2):293-304. https://doi.org/10.4103/ccd.ccd_70_17
Jepsen K, Jepsen S, Zucchelli G, Stefanini M, De Sanctis M, Baldini N, et al. Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol 2013; 40(1):82-9. https://doi.org/10.1111/jcpe.12019
Closs LQ, Branco P, Rizzatto SD, Raveli DB, Rösing CK. Gingival margin alterations and the pre-orthodontic treatment amount of keratinized gingiva. Braz Oral Res 2007; 21:58-63. https://doi.org/10.1590/s1806-83242007000100010
De Sanctis M, Zucchelli G. Coronally advanced flap: A modified surgical approach for isolated recession‐type defects: Three‐year results. J Clin Periodontol 2007; 34(3):262-8. https://doi.org/10.1111/j.1600-051X.2006.01039.x
Institute of Biomedical Technologies. Dental Membranes. Available from: https://ibt.in.ua/eng/dental.html. [Accessed on July 15, 2022.].
Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Pagavino G, et al. Stability of root coverage outcomes at single maxillary gingival recession with loss of interdental attachment: 3‐year extension results from a randomized, controlled, clinical trial. J Clin Periodontol 2015; 42(6):575-81. https://doi.org/10.1111/jcpe.12412
Cairo F, Rotundo R, Miller Jr PD, Pini Prato GP. Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 2009; 80(4):705-10. https://doi.org/10.1902/jop.2009.080565
Mahajan A, Dixit J, Verma UP. A patient‐centered clinical evaluation of acellular dermal matrix graft in the treatment of gingival recession defects. J Periodontol 2007; 78(12):2348-55. https://doi.org/10.1902/jop.2007.070074
Rocha dos Santos M, Sangiorgio JP, Neves FL, França‐Grohmann IL, Nociti Jr FH, Silverio Ruiz KG, et al. Xenogenous collagen matrix and/or enamel matrix derivative for treatment of localized gingival recessions: a randomized clinical trial. Part II: patient‐reported outcomes. J Periodontol 2017; 88(12):1319-28. https://doi.org/10.1902/jop.2017.170127
Sangiorgio JP, Neves FL, Rocha dos Santos M, França‐Grohmann IL, Casarin RC, Casati MZ, et al. Xenogenous collagen matrix and/or enamel matrix derivative for treatment of localized gingival recessions: a randomized clinical trial. Part I: clinical outcomes. J Periodontol 2017; 88(12):1309-18. https://doi.org/10.1902/jop.2017.170126
Santamaria MP, Rossato A, Miguel MM, Fonseca MB, Bautista CR, de Marco AC, et al. Comparison of two types of xenogeneic matrices to treat single gingival recessions: A randomized clinical trial. J Periodontol 2021; 93(5):709-720. https://doi.org/10.1002/JPER.21-0212
Vincent-Bugnas S, Laurent J, Naman E, Charbit M, Borie G. Treatment of multiple gingival recessions with xenogeneic acellular dermal matrix compared to connective tissue graft: a randomized split-mouth clinical trial. J Periodontal Implant Sci 2021; 51(2):77-87. https://doi.org/10.5051/jpis.2002400120
Mounssif I, Stefanini M, Mazzotti C, Marzadori M, Sangiorgi M, Zucchelli G. Esthetic evaluation and patient‐centered outcomes in root‐coverage procedures. Periodontology 2000 2018; 77(1):19-53. https://doi.org/10.1111/prd.12216
Zangrando MS, Eustachio RR, de Rezende ML, Sant'ana AC, Damante CA, Greghi SL. Clinical and patient‐centered outcomes using two types of subepithelial connective tissue grafts: A split‐mouth randomized clinical trial. J Periodontol 2021; 92(6):814-22. https://doi.org/10.1002/JPER.19-0646
Goyal N, Gupta R, Pandit N, Dahiya P. Analysis of patient acceptance following treatment of Miller's class II gingival recession with acellular dermal matrix and connective tissue graft. Journal of Indian Society of Periodontology 2014; 18(3):352-356. https://doi.org/10.4103/0972-124X.134574
Romanos AH, Abou-Arraj RV, Cruz SE, Majzoub ZA. Clinical and patient-centered outcomes following treatment of multiple gingival recessions using acellular dermal matrix allografts. Int J Periodontics Restorative Dent 2017; 37(6):843-51. https://doi.org/10.11607/prd.3335
Suzuki KT, de Jesus Hernandez Martinez C, Suemi MI, Palioto DB, Messora MR, de Souza SL, et al. Root coverage using coronally advanced flap with porcine-derived acellular dermal matrix or subepithelial connective tissue graft: a randomized controlled clinical trial. Clin Oral Investig 2020; 24(11):4077-87. https://doi.org/10.1007/s00784-020-03280-x
Ferraz LFF, Miguel MMV, Rossato A, Fonseca MB, Mathias-Santamaria IF, Santamaria MP. Effect of xenogeneic dermal matrix associated with coronally advanced flap in the treatment of single gingival recession: a case series. J Int Acad Periodontol 2021; 23(3):259-65.
Pietruska M, Skurska A, Podlewski Ł, Milewski R, Pietruski J. 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. https://doi.org/10.1111/jcpe.13031
Cairo F, Barootchi S, Tavelli L, Barbato L, Wang HL, Rasperini G, et al. Aesthetic‐and patient‐related outcomes following root coverage procedures: a systematic review and network meta‐analysis. J Clin Periodontol 2020; 47(11):1403-15. https://doi.org/10.1111/jcpe.13346
Yılmaz M, Oduncuoğlu BF, Nişancı Yılmaz MN. Evaluation of patients’ perception of gingival recession, its impact on oral health-related quality of life, and acceptance of treatment plan. Acta Odontol Scand 2020; 78(6):454-62. https://doi.org/10.1080/00016357.2020.1758773
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Pesquisa Brasileira em Odontopediatria e Clínica Integrada
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.