Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial

Abstract

Objectives To investigate effects of root conditioning with 24% ethylenediaminetetraacetic acid (EDTA) on the 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG). Materials and methods Twenty patients with 142 GR were treated (72 test sites: SCTG + EDTA and 70 control sites: SCTG). Average and complete root coverage (ARC, CRC), gain in keratinized tissue width (KTW), gain in gingival thickness (GT), root esthetic coverage score (RES), and patient-reported outcome measures (PROMs) were evaluated at 12 months post-operatively. Results Differences between pre- and post-operative values were statistically significant only within but not between treatment modalities. At 12 months, ARC was 86.0% for SCTG + EDTA-treated and 84.6 for SCTG-treated defects (p = 0.6636). CRC was observed in 90.2% (tests) and 91.4% (controls) of all cases (p = 0.9903). Professional assessment of esthetic outcomes using RES showed highly positive results reaching the value of 8.9 in case of test sites and 8.7 for control sites (p = 0.3358). Severity of pain and swelling did not differ between sites, regardless of whether EDTA was used. Conclusions Test and control sites presented similarly positive outcomes related to root coverage, periodontal and esthetic parameters, and patient satisfaction and self-reported morbidity with no statistical differences between them 12 months after surgery. No significant differences in evaluated variables were observed between sites treated with and without 24% EDTA. Clinical relevance Considering the limitations of the present study, the use of 24% EDTA for root conditioning did not improve 12-month outcomes after treatment of multiple RT1 and RT2 gingival recessions with MCAT and SCTG. Trial registration ClinicalTrials.gov identifier: NCT03354104

Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis

“…However, EMD accelerates soft tissue wound healing and maturation, which could contribute to decreased scar tissue formation and improvements in soft tissue texture, marginal tissue contour, MGJ alignment and gingival color [ 38 ]. We previously described similar soft tissue response to root surface modification with either EDTA or EDTA + EMD [ 12 , 22 ], but no other researchers provided results that could be directly compared with ours. However, Aydinyurt et al [ 39 ] assessed the impact of EMD application on esthetic outcomes of CAF + SCTG in treatment of Miller class I and II gingival recessions of contralateral maxillary canines.…”

“…Having said that, it should be understood that blood contamination of the root surfaces might easily occur when MCAT is carried out, which may alter the effectiveness of EDTA root conditioning and the ability of EMD to precipitate and diminish its effectiveness [ 29 ]. By the same token, very recent studies reveal that adjunct application of EDTA alone might provide benefits in terms of GR reduction, and CAL gain when performing root coverage treatment with CAF + SCTG [ 11 ], but not in case of MCAT + SCTG [ 12 ].…”

“…In contrast, agents with a low pH, such as citric acid (pH = 1), can dissolve the collagen fibrous surface, leading to the formation of a granular dentin surface, which might have a deleterious effect on future attachment [ 10 ]. However, there is currently no consensus in the relevant academic literature whether root surface biomodification with EDTA improves clinical outcomes of soft tissue root coverage [ 11 , 12 , 13 ]. Enamel matrix derivative (EMD), on the other hand, accelerates migration, attachment, proliferation and differentiation of endothelial cells, periodontal ligament cells, cementoblasts and osteoblasts [ 14 ].…”

Bone Remodeling during Orthodontic Movement of Lower Incisors—Narrative Review

“…In terms of soft tissue augmentation, the application of subepithelial connective tissue graft is regarded as the gold standard. Attempts have been made to search for alternative materials, such as collagen porcine dermal matrix [ 45 ], 24% EDTA (Ethylenediaminetetraacetic acid) and enamel matrix derivatives [ 46 , 47 ] and concentrated growth factors [ 48 ].…”

Chart selection appropriate for articles in the field of medicine, dentistry and health sciences

“…40 A flowchart (figure 14) is a graphical representation of identification, election and inclusion of articles in a systematic review, 41 a mandatory step according to PRISMA guideline. 42 Although not mandatory, flowcharts are highly recommended to be used in CONSORT (randomized clinical trials) 43 and STROBE (cohort studies) 44 statements.…”