Coronally Advanced flap with Emdogain Vs. Subpedicle Connective Tissue graft

Objectives: The aim of this study was to evaluate the long term efficacy of a coronally advanced flap procedure with the additional use of enamel matrix proteins derivative (EMD) to treat gingival recession while comparing it to the subpedicle connective tissue graft procedure (CTG). Methods: The study was conducted in six different periodontal clinics. Miller Class I or II buccal recession type defects in the anterior or premolar teeth were treated in 70 consecutive patients, 30 with EMD and 40 with CTG. At baseline and 6, 12 and 24 months post-surgical treatment, vertical recession defect, as distance from cemento-enamel junction to gingival margin, width of keratinized tissue, and probing depth were recorded and the percentage of coverage of the original defect was calculated. Statistical analysis consisted of t-test, analysis of variance and analysis of covariance Results: At 6 months, percent of–root coverage was 77.4 ± 11.92% in EMD and 84.1 ± 11.97% in CTG (statistically significant at P = 0.024). At 12 months, percent of root coverage in EMD was 71.7 ± 16.14% and 87.0 ± 12.22% in CTG; again, differences between groups were statistically significant (P <0.001). 63 of the initial 70 patients (28 in EMD and 35 in CTG were available for the 24-months follow-up. At 24 months, percent of–root coverage was 78.5 ± 13.70% in EMD and 86.8 ± 10.56% in CTG (P = 0.034). Differences between the 6-,12- and 24- month vertical recession defect and percent of root coverage within groups were statistically significant. Conclusions: At 24 months the CTG procedure was slightly superior to the EMD in percentage of root coverage. Larger width of keratinized tissue was achieved in CTG. The EMD procedure is a predictable treatment for root coverage, is relatively easy to perform and presents low patient morbidity.