Comparison Between Porcine Acellular Dermal Matrix (Mucoderm®) Versus Connective Tissue Graft in the Treatment of Multiple Adjacent Gingival Recessions Associated With Non-carious Cervical Lesion Partially Restored.
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- Percentage of defect coverage
研究概览
简要总结
The aim of the present study is to compare two different multidisciplinary protocols using two types of grafts, porcine acellular dermal matrix (Mucoderm®) versus connective tissue graft, both associated with modified coronally advanced flap, in the treatment of multiple adjacent gingival recessions associated with non-carious cervical lesion partially (NCCL) restored by composite resin.
详细描述
This is a prospective, parallel and controlled clinical trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. The population that will be evaluated in this is study will be enrolled at São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos.
Forty patients with multiple adjacent gingival recessions associated with non-carious cervical lesion will be enrolled and randomly allocated to one of the following groups:
- Test group (n=20): partial restoration of cervical lesion and modified coronally advanced flap for root coverage associated with porcine acellular dermal matrix (MCAF+PR+XMD)
- Control group (n=20): partial restoration of cervical lesion and modified coronally advanced flap associated with connective tissue graft (MCAF+PR+CTG).
The restorative treatment of non-carious cervical lesion will be performed one week prior the surgical procedures and will be conducted as follows. After local anesthesia, rubber dam isolation will be placed, and a coronal bevel will be performed at the incisal margin of the NCCL to reduce the step of lesions and to allow a correct and harmonious emergence profile of the restoration. Afterward, acid etching with 37% phosphoric acid will be performed and washed for 30 seconds with water-air-jet. The lesion will be dried with sterile cotton pellets to prevent dehydration, and the adhesive will be applied according to the manufacturer's instructions (Single Bond Universal, 3M ESPE). The adhesive will be light cured for 20 seconds, and the restoration will be made with resin composite (Filtek Z350 XT, 3M ESPE). The apical margin of the restoration will be determined to be 1 mm apical to the estimated position of the cementoenamel junction(CEJ) in order to rebuild only the anatomical part of the crown destroyed by the NCCL and 1 mm of the root surface, once the apical portion of the root surface will be covered by gingival tissue after periodontal surgery. After rubber dam removal, the restoration will be finished with ultrafine-grained burs, and 48 hours after the restoration procedure, polishing will be completed with diamond paste and felt discs.
All surgeries will be performed by the same expert periodontist (MPS). The surgical procedure for root coverage will be carried out according to Zucchelli's technique (Zucchelli et al., 2000). In brief description, following local anesthesia, oblique submarginal incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects, will be carried out keeping a blade 15c (Swann-Morton® - Sheffield, England) mounted on No. 3 scalpel handle parallel to the long axis of the teeth to dissect in a split-thickness manner the surgical papilla. Each surgical papilla will be dislocated with respect to the anatomic papilla by the oblique submarginal interdental incisions. The envelope flap will be raised with a split-full-split thickness in the coronal-apical direction: gingival tissue apical to the root exposures will be raised in a full-thickness manner to provide that portion of the flap critical for root coverage with more thickness and the most apical portion of the flap will be elevated in a split-thickness manner to facilitate the coronal displacement of the flap. The portion of the root exposure with loss of clinical attachment will be instrumented with the use of curets. The remaining tissue of the anatomic interdental papilla will be de-epithelialized to create connective tissue beds to which the surgical papilla will be sutured through sling sutures to coronally cover 2 mm above the CEJ after the placement of the grafts. For the test group (MCAF+PR+XMD), a porcine acellular dermal matrix (Mucoderm®, Botiss, Berlin, Germany) will be trimmed with a scalpel in appropriate shape and size to cover the root surfaces and underlying bone. Lastly, for the control group (MCAF + PR + CTG), a connective tissue graft will be harvested from the palate according to Bruno's technique (Bruno JF, 1994).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •patients presenting three or more Miller class I or II multiple adjacent gingival recessions (recession depth ≥ 2,5 mm) in incisors, canines or premolars associated with non-carious cervical lesion;
- •teeth included in the study should present pulp vitality;
- •patients presenting no signs of active periodontal disease and full-mouth plaque and bleeding score ≤ 20%;
- •patients older than 18 years old;
- •probing depth ˂ 3 mm in the included teeth;
- •patients who agreed to participate and signed an informed consent form.
排除标准
- •patients with systemic problems (cardiovascular, blood dyscrasias, immunodeficiency, and diabetes, among others) that will contraindicate the surgical procedure
- •patients taking medications known to interfere with the wound healing process or that contraindicate the surgical procedure
- •smokers or pregnant women
- •patients who underwent periodontal surgery in the area of interest;
研究组 & 干预措施
MCAF+PR+CTG
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive the connective tissue graft harvested from the palate on the recessed area before the sutures.Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: MCAF (Procedure)
MCAF+PR+CTG
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive the connective tissue graft harvested from the palate on the recessed area before the sutures.Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: PR (Procedure)
MCAF+PR+CTG
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive the connective tissue graft harvested from the palate on the recessed area before the sutures.Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: CTG (Procedure)
MCAF+PR+CTG
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive the connective tissue graft harvested from the palate on the recessed area before the sutures.Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: Sodium dipyrone (Drug)
MCAF+PR+CTG
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive the connective tissue graft harvested from the palate on the recessed area before the sutures.Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: chlorhexidine rinse (Drug)
MCAF+PR+XMD(Mucoderm®)
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive a porcine acellular dermal matrix on the recessed area before the sutures. Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: MCAF (Procedure)
MCAF+PR+XMD(Mucoderm®)
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive a porcine acellular dermal matrix on the recessed area before the sutures. Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: PR (Procedure)
MCAF+PR+XMD(Mucoderm®)
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive a porcine acellular dermal matrix on the recessed area before the sutures. Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: XMD(Mucoderm®) (Procedure)
MCAF+PR+XMD(Mucoderm®)
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive a porcine acellular dermal matrix on the recessed area before the sutures. Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: Sodium dipyrone (Drug)
MCAF+PR+XMD(Mucoderm®)
The partial restoration of the NCCL will be performed prior the surgeries and will be carried out with composite resin.The surgical procedure for root coverage will be carried out by means modified coronally advanced flap and will be performed by starting with oblique incisions in the interdental areas, which continued with the intrasulcular incision at the recession defects.Each surgical papilla will be dissected in a split-thickness and the envelope flap will be raised with a split-full-split thickness in the coronal-apical direction. Additionally, this group will receive a porcine acellular dermal matrix on the recessed area before the sutures. Then, the flap will be coronally positioned and sutured to completely cover the graft.
干预措施: chlorhexidine rinse (Drug)
结局指标
主要结局
Percentage of defect coverage
时间窗: 6 months
Percentage mean (%) of root surface covered by the surgical treatment, measured through a periodontal probe.
次要结局
- Modified root coverage esthetic score(6 months)
- Patient-centred esthetic evaluation(6 months)
- Dentine hypersensitivity(6 months)
- Patient recovery(14 days)
研究者
Mauro Pedrine Santamaria
Associate professor
Universidade Estadual Paulista Júlio de Mesquita Filho