All ETDs from UAB

Advisory Committee Chair

Nico Geurs

Advisory Committee Members

Maria Geisinger

Amjad Javed

Feroz Rahemtulla

Michael Reddy

Philip Vassilopoulos

Document Type

Thesis

Date of Award

2012

Degree Name by School

Master of Dentistry (MDent) School of Dentistry

Abstract

Acellular dermal matrix allograft (ADMA) has emerged as a reliable substitute for autogenous soft tissue grafts in the treatment of gingival recessions and lack of keratinized gingiva (KG). ADMA has been hypothesized to create a zone of "immobile tissue" extending apical to the mucogingival junction (MGJ). This project aims to investigate the presence of this zone associated with the use of a coronally advanced flap in combination with either AlloDerm® (ADMA A) or Puros Dermis® (ADMA B) for root coverage procedures. Twenty patients, each presenting with one Miller Class I or II recession defect, were randomized to receive either ADMA A or B. Further randomization was done in the ADMA B group regarding the orientation of the basement membrane (BM) of the graft, "toward" or "away from" the root surface. Clinical assessments of plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), recession depth (RD) and width (RW), width of keratinized gingiva (KG), gingival thickness (GT1 and GT2), width of immobile tissue (IT), wound healing index (WHI) and patient discomfort level were evaluated between baseline and 12 months postoperatively. Twelve months postoperatively, PI, GI, PD, CAL, KG, WHI and Patient discomfort level were comparable between groups. The amount of root coverage averaged 63% in the ADMA A group and 81% in the ADMA B group. The zone of IT extended apical to MGJ by a mean of 1.88 mm in the ADMA A group and 2.69 mm in the ADMA B group. No statistically significant differences were noted between the groups. A 1-mm longer ADMA B resulted in 0.5-mm increase of IT. GT1 was only increased in the ADMA A group by a mean of 0.92 mm. The placement of BM "away from" rather than "toward" the defect resulted in a 1-mm gain in IT and 0.59-mm loss of GT1 in the ADMA B group. In conclusion, this study demonstrated that the use of either type of ADMA resulted in predictable root coverage and zone of immobile tissue extending apical to MGJ. Hence, minimal or no KG at baseline should not preclude the use of ADMA.

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