The histological and thickness changes of attached gingiva following grafting with different soft tissue substitutes in the labial region of the cuspids in Beagles

doi:10.12307/2024.222

Abstract

Abstract: BACKGROUND: Subepithelial connective tissue grafts are generally considered as the gold standard for soft tissue augmentation. However, it needs a second surgical site, which will prolong the surgical time and increase patients’ pain.
OBJECTIVE: To compare the histological and thickness changes of attached gingiva following grafting with different soft tissue substitutes in the labial region of the cuspids.
METHODS: In three Beagle dogs, attached gingival augmentation was performed with double-layer allogeneic acellular dermal matrix membrane (AADM), bovine-derived acellular dermal matrices (BADM) combined with concentrated growth factor membrane or BADM combined with collagen sponge. Thickness of attached gingiva was measured before augmentation, and 1, 2, 3, and 4 months after augmentation. Histological analyses were performed after 4 months.
RESULTS AND CONCLUSION: The mean values of attached gingival thickness and attached gingival thickness augmentation were higher in the double-layer AADM group than in the other two groups (all P < 0.05) from the 1st to 4th month after surgery. At 1 month after surgery, the attached gingival thickness of the three groups increased significantly and then decreased. At 3 months after surgery, the BADM combined with collagen sponge group and the BADM combined with concentrated growth factor membrane group showed no significant difference in the attached gingival thickness of the graft area compared with that before surgery (P > 0.05). At 4 months after surgery, the mean value of attached gingival thickness in the double-layer AADM group was still significantly increased compared with that before surgery (P < 0.05). The value of attached gingival thickness was highest in the double-layer AADM group, followed by the BADM combined with collagen sponge group, and the lowest in the BADM combined with concentrated growth factor membrane group at 1-4 months after surgery. Histological analyses revealed that AADM was well integrated with the host gingival tissue, and new fibrous connective tissue and fibroblasts grew into the AADM. But the grafts in the other two groups were absorbed and the augmentation area was remodeled into a structure consistent with the surrounding host tissue. To conclude, AADM is superior to BADM combined with concentrated growth factor and BADM combined with collagen sponge with regard to gingival augmentation.

Key words: acellular dermal matrix, concentrated growth factor, collagen sponge, gingival augmentation

CLC Number:

Zhang Hongxia, Li Xingchao, Gao Xixin, Zhang Xiao, Mei Shuang, Ma Hanxi, Zhang Tian. The histological and thickness changes of attached gingiva following grafting with different soft tissue substitutes in the labial region of the cuspids in Beagles[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(11): 1660-1665.

Figures/Tables 6

References

[1] BASSETTI RG, STÄHLI A, BASSETTI MA, et al. Soft tissue augmentation procedures at second-stage surgery: a systematic review. Clin Oral Investig. 2016;20(7):1369-1387.
[2] ADZHIEVA АB, VORONOV IА, IVANOV SS, et al. Optiminization of regeneration at the stages of soft tissue augmentation using a collagen matrix. Эндодонтия Today. 2021;19(4):317-319.
[3] GIANNOBILE WV, JUNG RE, SCHWARZ F, et al. Evidence‐based knowledge on the aesthetics and maintenance of peri‐implant soft tissues: Osteology Foundation Consensus Report Part 1-Effects of soft tissue augmentation procedures on the maintenance of peri‐implant soft tissue health. Clin Oral Implants Res. 2018;29 Suppl 15:7-10.
[4] LISSEK M, BOEKER M, HAPPE A. How thick is the oral mucosa around implants after augmentation with different materials: A systematic review of the effectiveness of substitute matrices in comparison to connective tissue grafts. Int J Mol Sci. 2020;21(14):5043.
[5] DADLANI S. Porcine Acellular Dermal Matrix: An Alternative to Connective Tissue Graft-A Narrative Review. Int J Dent. 2021;2021:1652032.
[6] TAVELLI L, MCGUIRE MK, ZUCCHELLI G, et al. Extracellular matrix‐based scaffolding technologies for periodontal and peri‐implant soft tissue regeneration. J Periodontol. 2020;91(1):17-25.
[7] Cevallos CAR, de Resende DRB, Damante CA, et al. Free gingival graft and acellular dermal matrix for gingival augmentation: A 15-year clinical study. Clin Oral Investig. 2020;24(3):1197-1203.
[8] SHIRAKATA Y, SCULEAN A, SHINOHARA Y, et al. Healing of localized gingival recessions treated with a coronally advanced flap alone or combined with an enamel matrix derivative and a porcine acellular dermal matrix: A preclinical study. Clin Oral Investig. 2016;20(7):1791-1800.
[9] SCHMITT CM, BRÜCKBAUER P, SCHLEGEL KA, et al. Volumetric soft tissue alterations in the early healing phase after peri‐implant soft tissue contour augmentation with a porcine collagen matrix versus the autologous connective tissue graft: A controlled clinical trial. J Clin Periodontol. 2021;48(1):145-162.
[10] LIU C, SU Y, TAN B, et al. Reconstruction of attached soft tissue around dental implants by acelluar dermal matrix grafts and resin splint. Int J Clin Exp Med. 2014;7(12):4666-4676.
[11] 黄江波. 不同修复材料在即刻种植牙膜引导骨再生治疗中的效果比较[J]. 中国民康医学,2022,34(23):148-150.
[12] 田媛,马秀岚. 异种脱细胞真皮基质修复耳廓前面皮肤缺损[J]. 中国医科大学学报. 2020,49(12):1136-1139.
[13] 胡琼方,胡永琼,梅时友. 异种脱细胞真皮基质,异体脱细胞真皮基质与自体皮瓣修复颌面部软组织缺损疗效对比[J]. 中国美容医学,2020,29(7):61-64.
[14] 陈先锋,陈竹林,刘晶. 异种脱细胞真皮基质在口腔颌面部软组织缺损修复的应用[J]. 生物医学工程与临床,2021,25(1):66-68.
[15] HAN C, CAI Q, LI B, et al. Keratinized mucosa augmentation guided by double xenogeneic collagen matrix membranes around implants in the posterior mandible: A case report. Medicine (Baltimore). 2021;100(3):e23609.
[16] 周炜丹. 探究CGF与PRF在牙周炎患牙位点保存治疗中的效果[J]. 现代口腔医学杂志,2020,34(2):82-85.
[17] LEE H, SHEN E, SHEN J T, et al. Tensile strength, growth factor content and proliferation activities for two platelet concentrates of platelet-rich fibrin and concentrated growth factor. J Dent Sci. 2020;15(2):141-146.
[18] 王亚楠,王佐林. 浓缩生长因子促进牙龈软组织缺损修复的实验研究[J].口腔颌面外科杂志,2018,28(3):121-126.
[19] FANG D, LONG Z, HOU J. Clinical application of concentrated growth factor fibrin combined with bone repair materials in jaw defects. J Oral Maxillofac Surg. 2020;78(6):882-892.
[20] QI L, GE W, CAO N, et al. Effects of autologous concentrated growth factor on gingival thickness in periodontal accelerated osteogenic orthodontics: a 6-month randomized controlled trial. BMC Oral Health. 2021;21(1):1-11.
[21] 岑雯,王轶,黄江琴,等. 胶原蛋白海绵在磨牙区即刻种植创口关闭中的应用[J]. 中国口腔种植学杂志,2018,23(4):176-179.
[22] 李丽曼,赵丽萍,徐涛,等. 罹患重度牙周病变磨牙采取微创拔牙和微翻瓣位点保存术后种植修复效果观察(附1例3年随访报告)[J]. 中国实用口腔科杂志, 2020;13(3):139-145.
[23] 彭锦辉,钱齐荣,刘宁,等. 可即邦胶原蛋白海绵在控制膝关节置换术后出血中的价值[J]. 中国骨与关节杂志,2013,2(3):155-158.
[24] DALMIA P, PARTHASARATHY H, TADEPALLI A, et al. Evaluation of Changes in the Palatal Mucosal Thickness Post-augmentation using a Xenogeneic Collagen Matrix-An Interventional Study. J Clin Diagn Res. 2022;16(3):1-4.
[25] 金鑫,周健. 异种和异体脱细胞真皮基质修复颊部软组织缺损疗效观察[J]. 中国实用口腔科杂志,2013,6(5):282-284.
[26] 曾薇,陈美珍,伍健辉. 脱细胞异体真皮与自体刃厚皮片修复外耳道皮肤缺损的比较[J].中国医药科学,2021,11(14):213-216.
[27] NOVAES JR AB, PALIOTO DB. Experimental and clinical studies on plastic periodontal procedures. Periodontol. Periodontol 2000. 2019;79(1):56-80.
[28] LU W, QI G, DING Z, et al. Clinical efficacy of acellular dermal matrix for plastic periodontal and implant surgery: a systematic review. Int J Oral Maxillofac Surg. 2020;49(8):1057-1066.
[29] PUISYS A, VINDASIUTE E, LINKEVCIENE L, et al. The use of acellular dermal matrix membrane for vertical soft tissue augmentation during submerged implant placement: a case series. Clin Oral Implants Res. 2015;26(4):465-470.
[30] ZANG J, SU L, LUAN Q, et al. Clinical and histological evaluation of the use of acellular dermal matrix (ADM) membrane in peri‐implant vertical soft tissue augmentation: a controlled clinical trial. Clin Oral Implants Res. 2022;33(6):586-597.
[31] AROCA S, MOLNÁR B, WINDISCH P, et al. Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. J Clin Periodontol. 2013;40(7):713-720.
[32] 潘腾飞,陶剑,蒋彩云,等. 两种脱细胞支架原位植入转归动物试验研究[J]. 河北工业大学学报,2020,49(3):46-54.
[33] LEE J H, KIM H G, LEE W J. Characterization and tissue incorporation of cross-linked human acellular dermal matrix. Biomaterials. 2015;44:195-205.
[34] CARLSON TL, LEE KW, PIERCE LM. Effect of cross-linked and non–cross-linked acellular dermal matrices on the expression of mediators involved in wound healing and matrix remodeling. Plast Reconstr Surg. 2013;131(4):697-705.
[35] SCHMITT CM, SCHLEGEL KA, GAMMEL L, et al. Gingiva thickening with a porcine collagen matrix in a preclinical dog model: Histological outcomes. J Clin Periodontol. 2019;46(12):1273-1281.
[36] ROTHAMEL D, BENNER M, FIENITZ T, et al. Biodegradation pattern and tissue integration of native and cross-linked porcine collagen soft tissue augmentation matrices–an experimental study in the rat. Head Face Med. 2014;10:10.
[37] ABDOLLAHI M, REZAEI M, JAFARPOUR A, et al. Sequential extraction of gel-forming proteins, collagen and collagen hydrolysate from gutted silver carp (Hypophthalmichthys molitrix), a biorefinery approach. Food Chem. 2018;242:568-578.
[38] LIU X, GOHI BFCA, ZENG H, et al. Effect of collagen peptides-carboxymethyl chitosan microspheres on ultraviolet induced damages. Mater Express. 2015;5(6):497-504.
[39] 李菲,乔静,段晋瑜,等. 引导性组织再生术对浓缩生长因子联合植骨术治疗下颌磨牙Ⅱ度根分叉病变临床效果的影响[J]. 北京大学学报(医学版),2020;52(2):346-352.
[40] MA T, SUN W Q, WANG J. Thermophysical stability and biodegradability of regenerative tissue scaffolds. J Therm Anal Calorim. 2022;147(16):8757-8764.
[41] AROCA S, KEGLEVICH T, BARBIERI B, et al. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet‐rich fibrin membrane for the treatment of adjacent multiple gingival recessions: A 6‐month study. J Periodont. 2009;80(2):244-252.