Treatment of human mucogingival defects utilizing a bioabsorbable membrane with and without a demineralized freeze-dried bone allograft

Background: The use of guided tissue regeneration (GTR) has become an effective procedure for the treatment of gingival recession. No reports exist on the use of a bioabsorbable membrane in combination with a demineralized freeze-dried bone allograft (DFDBA) for the treatment of these defects. Methods: Fourteen (14) patients with 17 recession defects were included in this clinical study. Each patient had at least 1 tooth with 3 mm or greater marginal tissue recession on the facial surface as measured from the cemento-enamel junction (CEJ). Each patient was treated by GTR using a bioabsorbable membrane. When the first patient presented for inclusion in the study, a coin was flipped to determine if the tooth being treated would be a test tooth (DFDBA) or a control tooth (no DFDBA). Each subsequent patient was alternated between test and control. Immediately prior to the surgical procedure, measurements were made which included recession depth, recession width at the widest point, probing depth, amount of keratinized tissue, and marginal tissue thickness. Local anesthesia was administered, and a measurement from the CEJ to the bone crest was made by sounding through the attachment. Results: The mean initial recession for all defects was 3.35 mm (SD +/- 0.49) and at 6 months postsurgery, mean recession was 0.47 mm (SD +/- 0.62). This correlated to 86% root coverage for both treatments. For all defects treated, there was a statistically significant increase in keratinized tissue (mean 0.88 mm) and tissue thickness (mean 0.47 mm) and a significant decrease in probing bone level (mean 0.76 mm). No statistically significant differences were observed between groups for any parameter. Conclusions: Although only 14 subjects with 17 defects were included in this study, the results suggest that the treatment of human gingival recession with a bioabsorbable membrane with or without the use of DFDBA results in significant root coverage, and slight, but significant improvements in keratinized tissue, tissue thickness, and bone level. The greatest limitation of the study was its lack of statistical power. Twenty-two (22) subjects would have been required for the results of the study to show equivalence between groups.