12 September 2022

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Treatment of gingival recessions through collagen membranes in comparison with autologous grafts

Lara Figini

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Subepithelial Connective Tissue Graft (CTG) combined with Coronally Repositioned Flap (CAF) is considered the "gold standard" periodontal treatment for gingival recessions. In research various alternatives, and easier to use than autologous grafts, have been proposed, including the positioning of completely resorbable, porous membranes, with collagen matrix of porcine origin and spongy consistency (stable collagen in volume of VCMX matrix). Collagen is extracted from certified veterinary pigs and purified to avoid antigenic reactions. Due to their wettability, suturability and biological properties, these membrane types can integrate well with the surrounding soft tissue.

Materials and methods
In a clinical study, published on Journal of Periodontology, March 2022, the authors conducted a randomized, controlled, double-blind comparison between periodontal treatment of gingival recessions using a stable collagen matrix (VCMX) and periodontal treatment with use of CTG autogenous subepithelial connective tissue graft at four clinical investigation sites. The study included patients with single, contralateral, RT1 recessions within a matched pair of defects and treated:

- In Group 1 or test group with a stable collagen matrix VCMX combined with a CAF coronally repositioned periodontal flap (test) and

- In Group 2 or control group with CTG subepithelial connective tissue graft combined with a CAF coronally repositioned periodontal flap.

The primary efficacy endpoint was established to be the 6-month root coverage rate. Secondary efficacy endpoints included clinical measures such as soft tissue volume, attachment level, and keratinized tissue thickness. Patient-reported data on discomfort, cosmetic outcome, and overall satisfaction were also included. Data was collected for 1 year.

Results
Thirty patients were included in the study and all patients were available for follow-up. The mean percentage of root coverage for the CTG + CAF control group was found to be 90.5% ± 14.87% versus 70.7% ± 28.26% for the experimental group treated with VCMX + CAF. Both therapies produced significant increases in soft tissue volume (control of 84.8 ± 47.43 mm3 versus test 48.90 ± 35.58 mm3, P = 0.0006). In the experimental group, patients reported less postoperative pain and this type of treatment found the greatest satisfaction and preference of patients. All other endpoint measures were not significantly different between the two groups.

Conclusions
From the data of this study, which must be confirmed in other similar studies, it can be concluded that root coverage performed with placement of a VCMX collagen matrix combined with the CAF coronal reposition flap offers inferior clinical results compared to the treatment of gingival recessions performed by CTG autologous epithelial tissue graft combined with the CAF coronal repositioned flap but produces less morbidity and is more responsive to patients.

Clinical implications
The root coverage technique using a VCMX collagen membrane and coronal repositioning flap offers inferior clinical results compared to the autologous graft technique with coronal flap, but in some cases it can be considered as a valid alternative to the latter. It is therefore of the utmost importance to make a careful case / patient selection for the choice of periodontal surgical technique to be undertaken to obtain positive results at a distance.

For additional information: Efficacy of a harvest graft substitute for recession coverage and soft tissue volume augmentation: A randomized controlled trial