Amniotic Allograft with Coronally Advanced Flap for Treatment of Gingival Recession: A Randomized, Controlled Clinical Trial
Amniotic allograft for gingival recession
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Abstract
Objectives: Amniotic membrane (AM) is an allograft obtained from humans that contains a variety of growth factors, and has outstanding healing qualities. This study aimed to assess the efficacy of amniotic allograft with coronally advanced flap (CAF) for root coverage.
Materials and Methods: This randomized controlled clinical trial comprised 24 individuals with Miller's Class I and II root resorption defects. Each patient received treatment using the CAF approach, with the test group receiving a combined therapy using an AM. Measurements were made at baseline and 6 months after surgery for gingival biotype (GB), dentin hypersensitivity (DH), recession depth (RD), recession width (RW), gingival recession total surface area (GRTSA), keratinized tissue width (KTW) and probing depth (PD).
Results: There was a statistically significant reduction in RD (from 2.83 mm to 0.92 mm), a significant increase in KTW (from 3.17 mm to 4.25 mm), improvement in GB, and a reduction in DH in the test group compared to the control group (P<0.05).
Conclusion: Miller’s Class I and II root recession defects can be effectively treated with a CAF. Application of AM under the CAF improved root coverage and GB, and further increased the KTW after 6 months, compared to CAF alone.
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10. Lafzi A, MostofiR, Farahani Z, Shoja M, Tubbs R, Golgasht St, et al. Amniotic membrane: A potential candidate for periodontal guided tissue regeneration. Med. Hypotheses 2007;69(2):454-73.
11. Hao Y, Hui-Kang D, Hwang DG, Kim W, Zhang F. Identification of Anti-angiogenic and Antiinflammatory Proteins in Human Amniotic Membrane. Cornea 2000 May;19(3):348-52.
12. Loe H, Silness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 1963 Jan;21(6):533-51.
13. Lekovic V, Camargo PM, Weinlaender M, Vasilic N, Kenney EB. Comparison of platelet-rich plasma, bovine porous bone mineral, and guided tissue regeneration versus platelet-rich plasma and bovine porous bone mineral in the treatment of intrabony defects: A reentry study. J Periodontol 2002 Feb;73(2):198-205.
14. Bernimoulin JP, Lüscher B, Mühlemann HR. Coronally repositioned flap. Clinical evaluation after one year. J Clin Periodontol 1975 Feb;2(1):1-13.
15. Lee E, Meraw S. Comparative histologic analysis of coronally advanced flap with or without collagen membrane for root coverage. J Periodontol 2002 July;73(7):779-88.
16. Ghahroudi AA, Khorsand A, Rokn AR, Sabounchi SS, Shayesteh YS, Soolari A. Comparison of amnion allograft with connective tissue graft for root coverage procedures: a double-blind, randomized, controlled clinical trial. J Int Acad Periodontol. 2013 Oct;15(4):101-12.
17. Agarwal SK, Jhingran R, Bains VK, Srivastava R, Madan R, Rizvi I. Patient-centered evaluation of microsurgical management of gingival recession using coronally advanced flap with platelet-rich fibrin or amnion membrane: A comparative analysis. Eur J Dent 2016 Jan-Mar; 10(1):121-33.
18. Jain A, Jaiswal GR, Kumathalli K, Kumar R, Singh A, Sarwan A. Comparative Evaluation of Platelet Rich Fibrin and Dehydrated Amniotic Membrane for the Treatment of Gingival Recession-A Clinical Study. J Clin Diagn Res. 2017 Aug;11(8): ZC24-8.
19. Sharma A, Yadav K. Amniotic membrane -A Novel material for the root coverage: A case series. J Indian Soc Periodontol 2015 Jul-Aug;19(4):444-8.
20. Ainamo A, Bergenholtz A, Hugoson A, Ainamo J. Location of the mucogingival junction 18 years after apically repositioned flap surgery. J Clin Periodontol 1992 Jan;19(1):49-52.
21. Kothiwale SV, Anuroopa P, Gajiwala AL. A clinical and radiological evaluation of DFDBA with amniotic membrane versus bovine derived xenograft with amniotic membrane in human periodontal grade II furcation defects. Cell tissue bank 2009 Nov;10(4):317-26.
22. Gurinsky B. A novel dehydrated amnion allograft for use in the treatment of gingival recession: An observational case series. J Implant Adv Clin Dent. 2009 Mar;1(1):65-73.
23. Huang LH, Neiva RE, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 2005 Oct;76(10):1729-34.
24. Shetty SS, Chatterjee A, Bose S. Bilateral multiple recession coverage with platelet-rich fibrin in comparison with amniotic membrane. J Indian Soc Periodontol 2014 Jan;18(1):102-6.
25. Pundir AJ, Agrawal V, Pundir S, Diwan V, Bodhi S. Comparative evaluation of the efficacy of human chorion and amnion with coronally advanced flap for recession coverage: A case series. Clin Adv Periodontics 2016 Aug;6(3):118-26.
26. Mormann W, Ciancio SG. Blood supply of human gingiva following periodontal surgery. A fluorescein angiographic study. J Periodontol 1977 Nov;48(11):681-92.
27. Shimmura S, Shimazaki J, Ohashi Y, Tsubota K. Antiinflammatory effects of amniotic membrane transplantation in ocular surface disorders. Cornea. 2001 May;20(4):408-13.
28. Burkhardt R, Lang NP. Coverage of localized gingival recessions: comparison of micro- and macrosurgical techniques. J Clin Periodontol 2005 Mar;32(3):287-93.
2. Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 2014 Apr;41(Suppl.15):S44-62.
3. Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA. Can subepithelial connective tissue graft be considered the gold standard procedure in the treatment of Miller class I and II recessions-type defects? J Dent 2008 Sep; 36(9):659-71.
4. Cohen E. Atlas of cosmetic and Reconstructive surgery. 3rd. edition
5. Gurinsky B. A novel dehydrated amnion allograft for use in the treatment of gingival recession: An observational case series. J Implant Adv Clin Dent. 2009 Mar;1(1):65-73.
6. Jones CJ, Jauniaux E. Ultrastructure of the materno-embryonic interface in the first trimester of pregnancy. Micron. 1995 Jan 1;26(2):145-73.
7. Adams EA, Choi HM, Cheung CY, Brace RA. Comparison of amniotic and intramembranous unidirectional permeabilities in late gestation sheep. Am J Obstet Gynecol 2005 Jul;193(1):247-55.
8. Masato K, Yasushi S, Ryuji M, Masahiko U. Immunogenicity of human amniotic membrane in experimental xenotransplantation. Invest Ophthalmol Vis Sci. 2001 Jun;42(7):1539-46.
9. Mahgoub MA, Ammar A, Fayez M, Edris A, Hazem A, Akl M, et al. Neovascularization of the amniotic membrane as a biological immune barrier. Transplant Proc 2004 May;36(4):1194-8.
10. Lafzi A, MostofiR, Farahani Z, Shoja M, Tubbs R, Golgasht St, et al. Amniotic membrane: A potential candidate for periodontal guided tissue regeneration. Med. Hypotheses 2007;69(2):454-73.
11. Hao Y, Hui-Kang D, Hwang DG, Kim W, Zhang F. Identification of Anti-angiogenic and Antiinflammatory Proteins in Human Amniotic Membrane. Cornea 2000 May;19(3):348-52.
12. Loe H, Silness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 1963 Jan;21(6):533-51.
13. Lekovic V, Camargo PM, Weinlaender M, Vasilic N, Kenney EB. Comparison of platelet-rich plasma, bovine porous bone mineral, and guided tissue regeneration versus platelet-rich plasma and bovine porous bone mineral in the treatment of intrabony defects: A reentry study. J Periodontol 2002 Feb;73(2):198-205.
14. Bernimoulin JP, Lüscher B, Mühlemann HR. Coronally repositioned flap. Clinical evaluation after one year. J Clin Periodontol 1975 Feb;2(1):1-13.
15. Lee E, Meraw S. Comparative histologic analysis of coronally advanced flap with or without collagen membrane for root coverage. J Periodontol 2002 July;73(7):779-88.
16. Ghahroudi AA, Khorsand A, Rokn AR, Sabounchi SS, Shayesteh YS, Soolari A. Comparison of amnion allograft with connective tissue graft for root coverage procedures: a double-blind, randomized, controlled clinical trial. J Int Acad Periodontol. 2013 Oct;15(4):101-12.
17. Agarwal SK, Jhingran R, Bains VK, Srivastava R, Madan R, Rizvi I. Patient-centered evaluation of microsurgical management of gingival recession using coronally advanced flap with platelet-rich fibrin or amnion membrane: A comparative analysis. Eur J Dent 2016 Jan-Mar; 10(1):121-33.
18. Jain A, Jaiswal GR, Kumathalli K, Kumar R, Singh A, Sarwan A. Comparative Evaluation of Platelet Rich Fibrin and Dehydrated Amniotic Membrane for the Treatment of Gingival Recession-A Clinical Study. J Clin Diagn Res. 2017 Aug;11(8): ZC24-8.
19. Sharma A, Yadav K. Amniotic membrane -A Novel material for the root coverage: A case series. J Indian Soc Periodontol 2015 Jul-Aug;19(4):444-8.
20. Ainamo A, Bergenholtz A, Hugoson A, Ainamo J. Location of the mucogingival junction 18 years after apically repositioned flap surgery. J Clin Periodontol 1992 Jan;19(1):49-52.
21. Kothiwale SV, Anuroopa P, Gajiwala AL. A clinical and radiological evaluation of DFDBA with amniotic membrane versus bovine derived xenograft with amniotic membrane in human periodontal grade II furcation defects. Cell tissue bank 2009 Nov;10(4):317-26.
22. Gurinsky B. A novel dehydrated amnion allograft for use in the treatment of gingival recession: An observational case series. J Implant Adv Clin Dent. 2009 Mar;1(1):65-73.
23. Huang LH, Neiva RE, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 2005 Oct;76(10):1729-34.
24. Shetty SS, Chatterjee A, Bose S. Bilateral multiple recession coverage with platelet-rich fibrin in comparison with amniotic membrane. J Indian Soc Periodontol 2014 Jan;18(1):102-6.
25. Pundir AJ, Agrawal V, Pundir S, Diwan V, Bodhi S. Comparative evaluation of the efficacy of human chorion and amnion with coronally advanced flap for recession coverage: A case series. Clin Adv Periodontics 2016 Aug;6(3):118-26.
26. Mormann W, Ciancio SG. Blood supply of human gingiva following periodontal surgery. A fluorescein angiographic study. J Periodontol 1977 Nov;48(11):681-92.
27. Shimmura S, Shimazaki J, Ohashi Y, Tsubota K. Antiinflammatory effects of amniotic membrane transplantation in ocular surface disorders. Cornea. 2001 May;20(4):408-13.
28. Burkhardt R, Lang NP. Coverage of localized gingival recessions: comparison of micro- and macrosurgical techniques. J Clin Periodontol 2005 Mar;32(3):287-93.
| Issue | Vol 22 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v22i7.17840 | |
| Keywords | ||
| Amnion Surgical Flaps Gingival Recession Tooth Root Surgery | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Kalyani Kondepudi L, Koneru S, Dwarakanath C. Amniotic Allograft with Coronally Advanced Flap for Treatment of Gingival Recession: A Randomized, Controlled Clinical Trial. Front Dent. 2025;22.
