Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue: comparison of clinical parameters at 10 years.

BACKGROUND The effective treatment of gingival recession (GR) defects is crucial for predictable outcomes. The most common treatment is the subepithelial connective tissue graft (CTG), but good outcomes have also been obtained using enamel matrix derivative (EMD). A split-mouth, randomized controlled trial was previously performed during a 12-month period to evaluate primary and secondary outcomes in Miller Class I and II GR defects treated with CTG or EMD, both in combination with coronally advanced flap (CAF). The purpose of the current study is to examine the major qualitative and quantitative parameters of this study after a 10-year follow-up. METHODS Nine of 17 original patients were available for follow-up evaluation 10 years after the original surgery. The parameters measured were: (1) GR depth; (2) probing depth (PD); (3) clinical attachment level; (4) width of keratinized tissue (wKT); (5) percentage of root coverage; (6) root dentin hypersensitivity; (7) color, texture, and contour of treatment sites; and (8) patient satisfaction at 10 years. Results at 1 and 10 years of these nine patients (nine test and nine control teeth) were compared to original baseline values. In addition, results within treatment groups between 1 and 10 years and between treatment groups (i.e., EMD versus CTG) at the same time points were examined. RESULTS At 10 years, all quantitative parameters except PD for both treatment protocols showed statistically significant improvements from baseline values, including wKT in the EMD group, which at 1 year was not significantly improved compared with baseline wKT. In addition, at 10 years, there were no statistically significant differences between EMD + CAF and CTG + CAF for any measured parameter. The only statistically significant finding in this study was the difference in wKT found at 1 year (EMD, 3.00 mm; CTG, 3.89 mm; P = 0.031). Qualitative parameters at 10 years demonstrated similar stability. The only major qualitative difference was the marginal tissue contour, which was similar to adjacent tissues at EMD-treated sites but greater than adjacent tissues at all CTG sites except one. Esthetically, both EMD- and CTG-mediated treatments were similar at 10 years. However, given the choice, six of nine patients would choose EMD over CTG treatment to avoid a secondary harvesting procedure. CONCLUSIONS This paper highlights the importance of long-term data as it relates to procedural effectiveness in selecting optimally effective protocols to treat gingival recession. Based on the results of this 10-year follow-up investigation, treatment with either EMD + CAF or CTG + CAF for Miller Class I and II GR defects appears stable, clinically effective, and similar to each other on all measured parameters.