Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft for the treatment of multiple gingival recessions with thin tissue biotype

The objective of this randomized, parallel and controlled study was to assess the clinical effectiveness of acellular dermal matrix graft (ADM) combination with coronally advanced flap (CAF) on complete defect coverage, esthetics and patient satisfaction compared to CAF alone for the treatment of Miller Class I & II multiple buccal recessions with gingival thickness (GT) < 0.8 mm.A total of 24 patients (12 females and 12 males) with 48 Miller Class I & II multiple recessions ?3 mm were included and divided into test (CAF+ADM) and control (CAF) groups. At baseline and 12 months after the surgery, plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing depth (PD), clinical attachment level (CAL), recession height (RH), keratinized tissue height (KT), gingival thickness (GT), mean and complete defect coverage were evaluated. Patient satisfaction, root coverage esthetic score (RES) and the correlation between GT and defect coverage were also assessed.Baseline RH in CAF+ADM and CAF groups was 3.25 ± 0.34 mm and 3.21 ± 0.26 mm, respectively. Intra-group comparisons revealed statistically significant differences at 12 months compared to baseline data for all parameters (p<0.05). GT increased from 0.75 ± 0.06 mm to 1.41 ± 0.11 mm in test group, and from 0.71 ± 0.08 mm to 0.77 ± 0.09 mm in control group. Mean and complete defect coverage were 94.84% (RH reduction: 3.08 ± 0.51 mm) and 83.33% in test group, 74.99% (RH reduction: 2.37 ± 0.83 mm) and 50.00% in control group, respectively. Inter- group differences were found to be statistically significant for RH reduction, attachment gain, KT and GT increase, mean defect coverage, RES in favor of test group (p<0.05). There was a significant positive correlation between GT and mean defect coverage (r=0.465; p<0.05).Better esthetic results and clinical improvements were achieved with ADM combination. Tissue thickness significantly increased with the use of ADM graft. The thicker (?1.3 mm) the gingival tissue gets with the adjunctive use of ADM, the higher percentage of complete defect coverage is achieved in Miller Class I & II multiple recession defects. ADM can be used as an effective alternative to subepithelial connective tissue graft for the treatment of multiple defects. CAF in association with ADM can be proposed as a valid therapeutic approach for the treatment of multiple gingival recessions with thin tissue biotype.