Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis
Objective This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth. Methods Five data...
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| Veröffentlicht in: | Clinical oral investigations 2021-04, Vol.25 (4), p.1613-1626 |
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| creator | Meza Mauricio, Jonathan Furquim, Camila Pinheiro Bustillos-Torrez, Willy Soto-Peñaloza, David Peñarrocha-Oltra, David Retamal-Valdes, Belen Faveri, Marcelo |
| description | Objective
This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth.
Methods
Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of
p
value.
Results
From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (
p
≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (
p
≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW.
Conclusion
The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12 months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use.
Clinical relevance
To know if EMD could improve the results for root coverage. |
| doi_str_mv | 10.1007/s00784-021-03782-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2479749209</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2501660788</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-6fce60efcb8e430c51d014ff3602dec07b9dbca749191e053d739848b36705d03</originalsourceid><addsrcrecordid>eNp9UU1v1DAQjRCIlsIf4IAsceFi8EdiJydUlQIrFXGBc-TYk8VV4iwe77b73_hxne4WkDhw8Yxm3nsznldVL6V4K4Ww75CetuZCSS60bRVXj6pTWWvDtbXy8SFX3HStPKmeIV4LIWtj9dPqROva1kbp0-rXhwWQQXIzTGx2JcdbFiDHnStxB8xtNlP0lC-JbfKyi4FqIcT7gpuYn2Ki9sQGSDDGgiwmVn4AKxlcmSEVtowkexunyeU9-0IRMtEcIlsxlwJbrdg6pjUNnFgGD4gk_Z6dM9xjAdooeqrvItwc4DMUxx3N3mPE59WT0U0ILx7iWfX94-W3i8_86uun1cX5FffaNoWb0YMRMPqhhVoL38hAlxhHbYQK4IUdujB4Z-tOdhJEo4PVXVu3gzZWNEHos-rNUZdO8HMLWPo5ogf6U4Jli72qbUdsJTqCvv4Her1sM-1LqEZIY8iyllDqiPJ5Qcww9pscZ7pQL0V_721_9LYnb_uDt70i0qsH6e0wQ_hD-W0mAfQRgNRKa8h_Z_9H9g4dabK6</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2501660788</pqid></control><display><type>article</type><title>Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Meza Mauricio, Jonathan ; Furquim, Camila Pinheiro ; Bustillos-Torrez, Willy ; Soto-Peñaloza, David ; Peñarrocha-Oltra, David ; Retamal-Valdes, Belen ; Faveri, Marcelo</creator><creatorcontrib>Meza Mauricio, Jonathan ; Furquim, Camila Pinheiro ; Bustillos-Torrez, Willy ; Soto-Peñaloza, David ; Peñarrocha-Oltra, David ; Retamal-Valdes, Belen ; Faveri, Marcelo</creatorcontrib><description>Objective
This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth.
Methods
Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of
p
value.
Results
From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (
p
≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (
p
≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW.
Conclusion
The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12 months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use.
Clinical relevance
To know if EMD could improve the results for root coverage.</description><identifier>ISSN: 1432-6981</identifier><identifier>EISSN: 1436-3771</identifier><identifier>DOI: 10.1007/s00784-021-03782-2</identifier><identifier>PMID: 33474623</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Bayes Theorem ; Bayesian analysis ; Clinical trials ; Connective Tissue ; Connective tissues ; Dental enamel ; Dental Enamel Proteins ; Dentistry ; Enamel ; Gingiva ; Gingival Recession - surgery ; Gingivoplasty ; Humans ; Maxilla ; Medicine ; Meta-analysis ; Review ; Statistical analysis ; Tooth Root ; Treatment Outcome</subject><ispartof>Clinical oral investigations, 2021-04, Vol.25 (4), p.1613-1626</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature 2021</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-6fce60efcb8e430c51d014ff3602dec07b9dbca749191e053d739848b36705d03</citedby><cites>FETCH-LOGICAL-c375t-6fce60efcb8e430c51d014ff3602dec07b9dbca749191e053d739848b36705d03</cites><orcidid>0000-0002-4878-9835</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00784-021-03782-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00784-021-03782-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33474623$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meza Mauricio, Jonathan</creatorcontrib><creatorcontrib>Furquim, Camila Pinheiro</creatorcontrib><creatorcontrib>Bustillos-Torrez, Willy</creatorcontrib><creatorcontrib>Soto-Peñaloza, David</creatorcontrib><creatorcontrib>Peñarrocha-Oltra, David</creatorcontrib><creatorcontrib>Retamal-Valdes, Belen</creatorcontrib><creatorcontrib>Faveri, Marcelo</creatorcontrib><title>Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis</title><title>Clinical oral investigations</title><addtitle>Clin Oral Invest</addtitle><addtitle>Clin Oral Investig</addtitle><description>Objective
This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth.
Methods
Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of
p
value.
Results
From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (
p
≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (
p
≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW.
Conclusion
The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12 months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use.
Clinical relevance
To know if EMD could improve the results for root coverage.</description><subject>Bayes Theorem</subject><subject>Bayesian analysis</subject><subject>Clinical trials</subject><subject>Connective Tissue</subject><subject>Connective tissues</subject><subject>Dental enamel</subject><subject>Dental Enamel Proteins</subject><subject>Dentistry</subject><subject>Enamel</subject><subject>Gingiva</subject><subject>Gingival Recession - surgery</subject><subject>Gingivoplasty</subject><subject>Humans</subject><subject>Maxilla</subject><subject>Medicine</subject><subject>Meta-analysis</subject><subject>Review</subject><subject>Statistical analysis</subject><subject>Tooth Root</subject><subject>Treatment Outcome</subject><issn>1432-6981</issn><issn>1436-3771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9UU1v1DAQjRCIlsIf4IAsceFi8EdiJydUlQIrFXGBc-TYk8VV4iwe77b73_hxne4WkDhw8Yxm3nsznldVL6V4K4Ww75CetuZCSS60bRVXj6pTWWvDtbXy8SFX3HStPKmeIV4LIWtj9dPqROva1kbp0-rXhwWQQXIzTGx2JcdbFiDHnStxB8xtNlP0lC-JbfKyi4FqIcT7gpuYn2Ki9sQGSDDGgiwmVn4AKxlcmSEVtowkexunyeU9-0IRMtEcIlsxlwJbrdg6pjUNnFgGD4gk_Z6dM9xjAdooeqrvItwc4DMUxx3N3mPE59WT0U0ILx7iWfX94-W3i8_86uun1cX5FffaNoWb0YMRMPqhhVoL38hAlxhHbYQK4IUdujB4Z-tOdhJEo4PVXVu3gzZWNEHos-rNUZdO8HMLWPo5ogf6U4Jli72qbUdsJTqCvv4Her1sM-1LqEZIY8iyllDqiPJ5Qcww9pscZ7pQL0V_721_9LYnb_uDt70i0qsH6e0wQ_hD-W0mAfQRgNRKa8h_Z_9H9g4dabK6</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Meza Mauricio, Jonathan</creator><creator>Furquim, Camila Pinheiro</creator><creator>Bustillos-Torrez, Willy</creator><creator>Soto-Peñaloza, David</creator><creator>Peñarrocha-Oltra, David</creator><creator>Retamal-Valdes, Belen</creator><creator>Faveri, Marcelo</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4878-9835</orcidid></search><sort><creationdate>20210401</creationdate><title>Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis</title><author>Meza Mauricio, Jonathan ; Furquim, Camila Pinheiro ; Bustillos-Torrez, Willy ; Soto-Peñaloza, David ; Peñarrocha-Oltra, David ; Retamal-Valdes, Belen ; Faveri, Marcelo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-6fce60efcb8e430c51d014ff3602dec07b9dbca749191e053d739848b36705d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Bayes Theorem</topic><topic>Bayesian analysis</topic><topic>Clinical trials</topic><topic>Connective Tissue</topic><topic>Connective tissues</topic><topic>Dental enamel</topic><topic>Dental Enamel Proteins</topic><topic>Dentistry</topic><topic>Enamel</topic><topic>Gingiva</topic><topic>Gingival Recession - surgery</topic><topic>Gingivoplasty</topic><topic>Humans</topic><topic>Maxilla</topic><topic>Medicine</topic><topic>Meta-analysis</topic><topic>Review</topic><topic>Statistical analysis</topic><topic>Tooth Root</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meza Mauricio, Jonathan</creatorcontrib><creatorcontrib>Furquim, Camila Pinheiro</creatorcontrib><creatorcontrib>Bustillos-Torrez, Willy</creatorcontrib><creatorcontrib>Soto-Peñaloza, David</creatorcontrib><creatorcontrib>Peñarrocha-Oltra, David</creatorcontrib><creatorcontrib>Retamal-Valdes, Belen</creatorcontrib><creatorcontrib>Faveri, Marcelo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical oral investigations</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meza Mauricio, Jonathan</au><au>Furquim, Camila Pinheiro</au><au>Bustillos-Torrez, Willy</au><au>Soto-Peñaloza, David</au><au>Peñarrocha-Oltra, David</au><au>Retamal-Valdes, Belen</au><au>Faveri, Marcelo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis</atitle><jtitle>Clinical oral investigations</jtitle><stitle>Clin Oral Invest</stitle><addtitle>Clin Oral Investig</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>25</volume><issue>4</issue><spage>1613</spage><epage>1626</epage><pages>1613-1626</pages><issn>1432-6981</issn><eissn>1436-3771</eissn><abstract>Objective
This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth.
Methods
Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of
p
value.
Results
From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (
p
≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (
p
≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW.
Conclusion
The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12 months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use.
Clinical relevance
To know if EMD could improve the results for root coverage.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33474623</pmid><doi>10.1007/s00784-021-03782-2</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-4878-9835</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Clinical oral investigations, 2021-04, Vol.25 (4), p.1613-1626 |
| issn | 1432-6981 1436-3771 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Bayes Theorem Bayesian analysis Clinical trials Connective Tissue Connective tissues Dental enamel Dental Enamel Proteins Dentistry Enamel Gingiva Gingival Recession - surgery Gingivoplasty Humans Maxilla Medicine Meta-analysis Review Statistical analysis Tooth Root Treatment Outcome |
| title | Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis |
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