Comparative study of two root coverage procedures: A 24-month follow-up multicenter study

Background: Treatment alternatives to cover exposed root surfaces include free grafts, pedicle flaps, and barrier membranes. This 24-month follow-up study clinically evaluated the long-term effect of a coronally advanced flap procedure with the additional use of enamel matrix derivative (EMD) to treat gingival recession versus the subpedicle connective tissue graft (CTG) procedure. Methods: Miller Class I or II buccal recession-type defects in the anterior teeth or premolars in 65 patients (28 in EMD and 37 in CTG groups) were treated in several centers. At baseline and 12 and 24 months post-treatment, vertical recession defect (VRD), height of keratinized tissue (HKT), and probing depth (PD) were recorded, and the percentage of root coverage (PRC) of the original defect was calculated. Student t test, analysis of variance, and analysis of covariance were used for statistical analyses. Results: At 12- and 24-month evaluations, PRC was 73.2% (SD = 15.58%) and 76.9% (SD = 16.77%) in the EMD group and 86.8% (SD = 12.48%) and 84.3% (SD = 13.32%) in the CTG group, respectively (P < 0.001). Differences between groups were statistically significant (P = 0.002). Baseline HKT was 1.07 mm (SD = 0.66 mm) in the EMD group and 1.65 mm (SD = 0.92 mm) in the CTG group. At 12 and 24 months, values were 1.75 mm (SD = 0.59 mm) and 2.25 mm (SD = 0.52 mm) in the EMD group and 4.24 mm (SD = 0.89 mm) and 4.05 mm (SD = 0.94 mm) in the CTG group, respectively. Differences in HKT were statistically significant within (EMD: P < 0.001; CTG: P = 0.017) and between (P < 0.001) groups. Conclusions: Both treatments proved clinically successful. CTG treatment showed a higher percentage of root coverage and HKT increase. EMD is a valuable, long-term effective treatment alternative to achieve root coverage together with an increase in HKT.