Mauro Pedrine Santamaria, Manuela Maria Viana Miguel, Amanda Rossato, Ana Carolina Ferreira Bonafé, Isabel Vasconcellos de Souza, Thiago Marchi Martins, Marcelo Pereira Nunes, Ingrid Fernandes Mathias‐Santamaria
{"title":"体积稳定的胶原基质治疗与非龋牙性宫颈病变相关的牙龈萎缩:随机临床试验","authors":"Mauro Pedrine Santamaria, Manuela Maria Viana Miguel, Amanda Rossato, Ana Carolina Ferreira Bonafé, Isabel Vasconcellos de Souza, Thiago Marchi Martins, Marcelo Pereira Nunes, Ingrid Fernandes Mathias‐Santamaria","doi":"10.1002/jper.11386","DOIUrl":null,"url":null,"abstract":"BackgroundCollagen matrices (CMs) have been used for the treatment of gingival recession defects. A new volume‐stable collagen matrix (VCMX) was developed focused on enhancing tissue thickness due to a cross‐linked collagen structure. Thus, the present randomized clinical trial aims to evaluate clinical and patient‐centered parameters in the treatment of gingival recession (GR) RT1 associated with non‐carious cervical lesions (NCCL) B+ partially restored using coronally advanced flap (CAF) alone or CAF and VCMX.MethodsForty patients diagnosed with GR RT1 plus NCCL B+ were treated with partial restorations (composite apical margin 1 mm beyond the estimated level cement–enamel junction), followed by CAF alone or with VCMX. Clinical, patient‐related outcomes and esthetic measurements were assessed after 6 months. The recession reduction (RecRed) was the primary outcome.ResultsCAF and CAF+VCMX provided significant RecRed (1.87 vs. 1.78 mm; <jats:italic>p</jats:italic> = 0.76) and combined defect coverage (%CDC: 50.95 vs. 48.64%, <jats:italic>p</jats:italic> = 0.60) after 6 months. No difference was observed regarding the estimated root coverage (73.54 vs. 69.65%, <jats:italic>p</jats:italic> = 0.75). Greater gingival thickness (GT) gain was observed with VCMX (0.43 vs. 0.15 mm, <jats:italic>p</jats:italic> = 0.003). Both treatments decreased dentin hypersensitivity, achieved aesthetic satisfaction, and provided similar patient comfort. Keratinized tissue width is an important predictor for root coverage success while VCMX depends on it for greater RecRed (β = 1.775; <jats:italic>p</jats:italic> = 0.004). Combined defect (CD) height and depth can have both positive and negative impacts on coverage parameters.ConclusionsBoth therapies provided significant CD coverage and RecRed, with no superiority of CAF+VCMX over CAF. However, VCMX led to a higher GT gain after 6 months (NCT05916716; IRB:46852621.0.0000.0077).Plain Language SummaryCombined defects (CDs), where gingival recession (GR) is associated with non‐carious cervical lesions (NCCL), represent a clinical condition that clinicians frequently encounter. The lack of treatment worsens dentin hypersensitivity (DH) and esthetic perceptions. Some CDs require a surgical‐restorative protocol. To date, partial restorative fillings combined with a coronally advanced flap (CAF), and connective tissue graft (CTG) surgical technique is considered the most predictable approach; however, the use of CTG has some drawbacks, including the risk of bleeding and patient discomfort. The use of collagen matrices (CMs) as an alternative to CTG has been assessed in the literature. This study aimed to evaluate a cross‐linked collagen matrix (VCMX) in the treatment of GR/RT1 associated with NCCL/B+ partially restored. Despite similar recession reduction and combined defect coverage of up to 6 months, the VCMX promoted a greater increase in gingival thickness (GT) (0.43 mm). This is a crucial parameter for maintaining long‐term clinical outcomes. Patient comfort and reduced analgesic intake in both groups display the clinical benefit against autogenous grafts. However, achieving satisfactory outcomes with VCMX requires adequate soft tissue features before surgery, such as a larger keratinized tissue width. While both treatments performed similarly, the higher GT gain was observed with VCMX.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"49 1","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Volume‐stable collagen matrix to treat gingival recession associated with non‐carious cervical lesions: Randomized clinical trial\",\"authors\":\"Mauro Pedrine Santamaria, Manuela Maria Viana Miguel, Amanda Rossato, Ana Carolina Ferreira Bonafé, Isabel Vasconcellos de Souza, Thiago Marchi Martins, Marcelo Pereira Nunes, Ingrid Fernandes Mathias‐Santamaria\",\"doi\":\"10.1002/jper.11386\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BackgroundCollagen matrices (CMs) have been used for the treatment of gingival recession defects. A new volume‐stable collagen matrix (VCMX) was developed focused on enhancing tissue thickness due to a cross‐linked collagen structure. Thus, the present randomized clinical trial aims to evaluate clinical and patient‐centered parameters in the treatment of gingival recession (GR) RT1 associated with non‐carious cervical lesions (NCCL) B+ partially restored using coronally advanced flap (CAF) alone or CAF and VCMX.MethodsForty patients diagnosed with GR RT1 plus NCCL B+ were treated with partial restorations (composite apical margin 1 mm beyond the estimated level cement–enamel junction), followed by CAF alone or with VCMX. Clinical, patient‐related outcomes and esthetic measurements were assessed after 6 months. The recession reduction (RecRed) was the primary outcome.ResultsCAF and CAF+VCMX provided significant RecRed (1.87 vs. 1.78 mm; <jats:italic>p</jats:italic> = 0.76) and combined defect coverage (%CDC: 50.95 vs. 48.64%, <jats:italic>p</jats:italic> = 0.60) after 6 months. No difference was observed regarding the estimated root coverage (73.54 vs. 69.65%, <jats:italic>p</jats:italic> = 0.75). Greater gingival thickness (GT) gain was observed with VCMX (0.43 vs. 0.15 mm, <jats:italic>p</jats:italic> = 0.003). Both treatments decreased dentin hypersensitivity, achieved aesthetic satisfaction, and provided similar patient comfort. Keratinized tissue width is an important predictor for root coverage success while VCMX depends on it for greater RecRed (β = 1.775; <jats:italic>p</jats:italic> = 0.004). Combined defect (CD) height and depth can have both positive and negative impacts on coverage parameters.ConclusionsBoth therapies provided significant CD coverage and RecRed, with no superiority of CAF+VCMX over CAF. However, VCMX led to a higher GT gain after 6 months (NCT05916716; IRB:46852621.0.0000.0077).Plain Language SummaryCombined defects (CDs), where gingival recession (GR) is associated with non‐carious cervical lesions (NCCL), represent a clinical condition that clinicians frequently encounter. The lack of treatment worsens dentin hypersensitivity (DH) and esthetic perceptions. Some CDs require a surgical‐restorative protocol. To date, partial restorative fillings combined with a coronally advanced flap (CAF), and connective tissue graft (CTG) surgical technique is considered the most predictable approach; however, the use of CTG has some drawbacks, including the risk of bleeding and patient discomfort. The use of collagen matrices (CMs) as an alternative to CTG has been assessed in the literature. This study aimed to evaluate a cross‐linked collagen matrix (VCMX) in the treatment of GR/RT1 associated with NCCL/B+ partially restored. Despite similar recession reduction and combined defect coverage of up to 6 months, the VCMX promoted a greater increase in gingival thickness (GT) (0.43 mm). This is a crucial parameter for maintaining long‐term clinical outcomes. Patient comfort and reduced analgesic intake in both groups display the clinical benefit against autogenous grafts. However, achieving satisfactory outcomes with VCMX requires adequate soft tissue features before surgery, such as a larger keratinized tissue width. While both treatments performed similarly, the higher GT gain was observed with VCMX.\",\"PeriodicalId\":16716,\"journal\":{\"name\":\"Journal of periodontology\",\"volume\":\"49 1\",\"pages\":\"\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-08-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of periodontology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/jper.11386\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of periodontology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jper.11386","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景胶原基质(CMs)已被应用于牙龈退缩缺损的治疗。一种新的体积稳定的胶原基质(VCMX)被开发出来,主要是由于交联的胶原结构而增强组织厚度。因此,本随机临床试验旨在评估使用冠状进展皮瓣(CAF)单独或CAF和VCMX治疗龈退缩(GR) RT1相关的非龋齿宫颈病变(NCCL) B+部分修复的临床和患者中心参数。方法40例诊断为GR RT1 + NCCL B+的患者采用部分修复(复合根尖缘比骨水泥-牙釉质接点估计水平高出1mm),然后单独CAF或VCMX治疗。6个月后评估临床、患者相关结果和美学测量。减少经济衰退(RecRed)是主要结果。结果scaf和CAF+VCMX在6个月后具有显著的RecRed (1.87 vs. 1.78 mm, p = 0.76)和综合缺陷覆盖率(%CDC: 50.95 vs. 48.64%, p = 0.60)。估计的根盖度没有差异(73.54 vs 69.65%, p = 0.75)。VCMX组牙龈厚度(GT)增加较大(0.43 vs. 0.15 mm, p = 0.003)。两种治疗方法都能减少牙本质过敏,达到审美满意,并提供相似的患者舒适度。角化组织宽度是根覆盖成功的重要预测因子,而VCMX依赖于它来获得更大的RecRed (β = 1.775; p = 0.004)。组合缺陷(CD)高度和深度对覆盖参数既有正影响,也有负影响。结论两种治疗方法均具有显著的CD覆盖率和RecRed, CAF+VCMX优于CAF。然而,VCMX在6个月后导致了更高的GT收益(NCT05916716; IRB:46852621.0.0000.0077)。合并缺陷(cd),其中牙龈萎缩(GR)与非龋齿宫颈病变(NCCL)相关,是临床医生经常遇到的临床状况。缺乏治疗恶化了牙本质过敏(DH)和审美知觉。一些cd需要手术修复方案。迄今为止,部分修复性填充物联合冠状进展皮瓣(CAF)和结缔组织移植物(CTG)手术技术被认为是最可预测的方法;然而,使用CTG有一些缺点,包括出血和患者不适的风险。使用胶原基质(CMs)作为CTG的替代品已经在文献中进行了评估。本研究旨在评估交联胶原基质(VCMX)治疗与NCCL/B+部分恢复相关的GR/RT1。尽管有类似的萎缩减少和长达6个月的缺损覆盖,VCMX促进了牙龈厚度(GT)的更大增加(0.43 mm)。这是维持长期临床结果的关键参数。两组患者的舒适度和镇痛剂量的减少显示了抗自体移植物的临床益处。然而,使用VCMX获得满意的结果需要在手术前有足够的软组织特征,例如更大的角化组织宽度。虽然两种治疗的效果相似,但观察到VCMX治疗的GT增益更高。
Volume‐stable collagen matrix to treat gingival recession associated with non‐carious cervical lesions: Randomized clinical trial
BackgroundCollagen matrices (CMs) have been used for the treatment of gingival recession defects. A new volume‐stable collagen matrix (VCMX) was developed focused on enhancing tissue thickness due to a cross‐linked collagen structure. Thus, the present randomized clinical trial aims to evaluate clinical and patient‐centered parameters in the treatment of gingival recession (GR) RT1 associated with non‐carious cervical lesions (NCCL) B+ partially restored using coronally advanced flap (CAF) alone or CAF and VCMX.MethodsForty patients diagnosed with GR RT1 plus NCCL B+ were treated with partial restorations (composite apical margin 1 mm beyond the estimated level cement–enamel junction), followed by CAF alone or with VCMX. Clinical, patient‐related outcomes and esthetic measurements were assessed after 6 months. The recession reduction (RecRed) was the primary outcome.ResultsCAF and CAF+VCMX provided significant RecRed (1.87 vs. 1.78 mm; p = 0.76) and combined defect coverage (%CDC: 50.95 vs. 48.64%, p = 0.60) after 6 months. No difference was observed regarding the estimated root coverage (73.54 vs. 69.65%, p = 0.75). Greater gingival thickness (GT) gain was observed with VCMX (0.43 vs. 0.15 mm, p = 0.003). Both treatments decreased dentin hypersensitivity, achieved aesthetic satisfaction, and provided similar patient comfort. Keratinized tissue width is an important predictor for root coverage success while VCMX depends on it for greater RecRed (β = 1.775; p = 0.004). Combined defect (CD) height and depth can have both positive and negative impacts on coverage parameters.ConclusionsBoth therapies provided significant CD coverage and RecRed, with no superiority of CAF+VCMX over CAF. However, VCMX led to a higher GT gain after 6 months (NCT05916716; IRB:46852621.0.0000.0077).Plain Language SummaryCombined defects (CDs), where gingival recession (GR) is associated with non‐carious cervical lesions (NCCL), represent a clinical condition that clinicians frequently encounter. The lack of treatment worsens dentin hypersensitivity (DH) and esthetic perceptions. Some CDs require a surgical‐restorative protocol. To date, partial restorative fillings combined with a coronally advanced flap (CAF), and connective tissue graft (CTG) surgical technique is considered the most predictable approach; however, the use of CTG has some drawbacks, including the risk of bleeding and patient discomfort. The use of collagen matrices (CMs) as an alternative to CTG has been assessed in the literature. This study aimed to evaluate a cross‐linked collagen matrix (VCMX) in the treatment of GR/RT1 associated with NCCL/B+ partially restored. Despite similar recession reduction and combined defect coverage of up to 6 months, the VCMX promoted a greater increase in gingival thickness (GT) (0.43 mm). This is a crucial parameter for maintaining long‐term clinical outcomes. Patient comfort and reduced analgesic intake in both groups display the clinical benefit against autogenous grafts. However, achieving satisfactory outcomes with VCMX requires adequate soft tissue features before surgery, such as a larger keratinized tissue width. While both treatments performed similarly, the higher GT gain was observed with VCMX.