ABSTRACT
Background: Nonsurgical periodontal therapy results in the formation of a smear layer which inhibits tissue regeneration. Root biomodification (RB) using various agents has been tried for the enhancement of new attachment formation. However, no substantial therapeutic advantages of currently available root conditioning agents have been reported emphasizing the need for additional biologically acceptable agents. Glycolic acid (GA) due to its antimicrobial nature and ability of initiation and proliferation of fibroblasts may potentially modify root surface enabling regeneration. Materials and Methods: Eighty specimens from 40 single-rooted teeth were treated with 17% ethylenediaminetetraacetic acid (EDTA) and 5% GA and scanning electron microscopy analysis was done. The micrographs were examined for the evaluation of smear layer removal, total number of dentinal tubules, total number of patent dentinal tubules, mean diameter and surface area of dentinal tubules, and dentin erosion. Statistical analysis was done using unpaired t-test for intergroup comparison. Results: The efficacy of smear layer removal (P = 0.01) and dentin erosion (P = 0.042) was significantly better in the GA group. Both the groups showed no difference in dentinal tubule-related parameters. Conclusion: GA showed improved RB with greater smear layer removal and lesser dentin erosion, indicating its use as a potent alternative to the conventional EDTA root conditioning.
ABSTRACT
OBJECTIVES: Root coverage (RC) is an integral part in management of gingival recessions. Unlike isolated recessions, treating multiple recessions is the most challenging scenario especially in smokers who have reported reduced RC in terms of quantity and stability. Modified coronally advanced tunnel (MCAT) technique due to its improved vascularity along with use of porcine-derived collagen matrix (PDCM) (Mucograft™) with its bilayered dense collagen matrix may be a predictable alternative to conventional gold standard subepithelial connective tissue graft (SCTG). The purpose of this study was to compare the results of RC achieved using PDCM and SCTG with the MCAT approach in the treatment of multiple gingival recessions in smokers. METHODOLOGY: This is a prospective randomized controlled clinical study registered under clinical trial registry (CTRI no. CTRI/2020/03/024238) including 28 patients with 64 recession defects. Smokers (≥ 10 cigarettes/day for ≥ 5 years) fulfilling the inclusion criteria were randomized into the SCTG and PDCM groups which were treated with SCTG using MCAT and PDCM using MCAT technique, respectively. Recession depth (RD), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized gingiva (TKG), and %RC were assessed at baseline, 3, and 6 months. Complete RC (CRC) at 3 and 6 months, RC aesthetic scores (RCES) at 6 months. RESULTS: Both groups showed significant improvement in all clinical parameters. Intergroup comparison of root coverage parameters in smokers showed better performance of the PDCM group in terms of RD, %RC, TKG, WKT, CRC (45.06%), and RCES (p < 0.001) compared to the SCTG group. Time taken for surgical procedure and visual analog pain scores were significantly lesser in the PDCM group. CONCLUSION: PDCM showed good predictable results in terms of all RC parameters compared to SCTG and thus may be used as a predictable alternative to SCTG for RC in smokers. CLINICAL SIGNIFICANCE: PDCM can be used as a potential alternative to gold standard subepithelial connective tissue graft in smokers with better patient compliance.
