Allogenic Acellular Dermal Matrix and Xenogeneic Dermal Matrix as Connective Tissue Graft Substitutes for Long-Term Stability Gingival Recession Therapy: A Systematic Review and Meta-Analysis

Abstract

Connective tissue graft (CTG) serves as a gold standard for gingival recession therapy. Yet the availability of CTG is limited, and it increases patient morbidity. Allogenic acellular dermal matrix (AADM) and xenogeneic dermal matrix (XDM) have been proven to be effective substitutes of CTG although the long-term stability is unclear. The aim of this study was to analyze the long-term stability outcome of gingival recession therapy using AADM and XDM compared to CTG. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted independently from several online databases (PubMed, Scopus, and Embase). Five of 233 publications were included for final qualitative analysis and meta-analysis focusing on the mean difference of clinical parameters such as recession depth (RD), recession width (RW), probing depth (PD), clinical attachment loss (CAL), tissue thickness (TT), keratinized tissue width (KTW), and mean root coverage (MRC). Meta-analyses of RD, RW, CAL, TT, KTW, and MRC display an overall mean of 0.2 mm (95% confidence interval [CI]: –0.45 to –0.05), 0.29 mm (95% CI: –0.65 to 0.08), 0.2 mm (95% CI: –0.69 to 0.29), 0.25 mm (95% CI: –0.53 to 0.03), 0.26 mm (95% CI: –0.5 to 0.02), and 9.19% (95% CI: –13.95 to –4.43]), respectively, favoring the CTG. PD was the only parameter that favored the AADM or XDM with an overall mean of 0.03 mm (95% CI: –0.05 to 0.11). In all, if the long-term stability is the goal, the CTG is considered superior for gingival recession therapy. However, if it is contraindicated, the AADM and XDM might be considered as alternatives.

Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review

“…In Figure 1 , some included articles have been cited more than once since they deal with different treatments considered in the present review [ 4 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…Xenogeneic acellular dermal matrix (XDM) 2.1. Soft tissue augmentation procedures around teeth A recent systematic review aimed to compare long-term (≥1 year) root coverage outcomes between allogeneic and xenogeneic dermal matrices and the established gold standard, CTG [17] (Table 3). Despite a limited number of qualifying studies over the past decade (2014 to March 2023), only five findings meeting the inclusion criteria-with four specifically comparing XDM to CTG [26,[37][38][39][40]-were primarily reported at a 12-month follow-up, except for Gurlek et al [39], which extended to 18 months.…”

Simultaneous Implant and Guided Bone Regeneration Using Bovine-Derived Xenograft and Acellular Dermal Matrix in Aesthetic Zone

“…Acellular Dermal Matrix serves as a valuable resource for augmenting soft tissue thickness [ 31 ]. In addition to its availability in substantial quantities, ADM proves advantageous for cases necessitating a multitude of grafts to address wide defects, eliminating the need for donor site surgery as required for procedures like connective tissue grafts (CTG) [ 53 , 54 ].…”

“…Subsequently, the ADM was meticulously positioned to secure the bone graft in place, and the matrix was fixated using resorbable sutures (Luxcryl PDO, Lux Sutures, Luxembourg) ( Figure 2 E). The incorporation of ADM in this augmentation aimed to augment soft tissue thickness while acting as a barrier to impede soft tissue migration towards the bone graft [ 23 , 31 ]. Suturing was meticulously performed using non-resorbable 5-0 nylon (Luxamid, Lux Sutures, Luxembourg) employing a vertical internal mattress suture technique, combined with continuous locking sutures and simple interrupted sutures ( Figure 2 F) [ 24 ].…”